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Testing Mindful Awareness as a Moderator in the Association Between HIV-Related Stress and Drug and Alcohol Use Problems Among People Living with HIV



People living with HIV (PLWH) are disproportionately affected by stressful life events. HIV-related stress adds to general life stressors to increase health risks among this population. Stress has not only been associated with HIV progression but it is also linked to HIV transmission risk behavior (e.g., substance use). Older adults living with HIV (OALWH) experience additional age-related stress and are at increased risk for substance use. Mindfulness buffers against stress for PLWH; however, research has yet to examine mindfulness as a buffer between HIV-related stress and substance use for OALWH.


Participants were 130 OALWH (Mage = 54.65, SD = 4.20) and 74.6% were Black. The majority were male (69.2%), and nearly half identified as heterosexual (48.5%). A hierarchical linear regression examined the main and interactive effects of mindful awareness and two types of HIV-related stress (e.g., stigma and rumination) on alcohol and drug use problems.


In step one of the model, we examined HIV stigma (β = .231, p = .015) and found no significant interaction with mindful awareness. In step two, HIV rumination (β = .288, p = .001) was added. We found a significant interaction (β = .196, p = .020), indicating those with low mindful awareness and high rumination reported the greatest substance use problems. Exploratory analyses revealed an indirect effect of HIV stigma on substance use through HIV rumination as well as a significant effect for second-stage moderated mediation.


These findings support mindful awareness as a buffer against HIV rumination for OALWH. Further, our results have important implications for the utility of mindfulness-based interventions (MBIs) with OALWH and comorbid substance use disorders.

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Data collection for these secondary analyses was supported by a research grant from the National Institute of Drug Abuse (NIDA; R01-DA029567, PI: Parsons). The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health. The researchers have complied with APA ethical standards in the treatment of the sample.

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Authors and Affiliations



KMS: led in conceptualizing and designing the current study, executed the secondary data analyses, and wrote the methods, results, and discussion. SS and SG: collaborated with the writing of the introduction. DM: collaborated in the review and editing of the final manuscript. HJR: collaborated in the conceptualization of study design and assisted with analyses, as well as the review and editing of the final manuscript.

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Correspondence to H. Jonathon Rendina.

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The authors declare that they have no conflict of interest.

Ethics Statement

All study protocols were approved by the City University of New York (CUNY) Institutional Review Board.

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All participants provided their consent to take part in the study.

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Sizemore, K.M., Samrock, S., Gray, S. et al. Testing Mindful Awareness as a Moderator in the Association Between HIV-Related Stress and Drug and Alcohol Use Problems Among People Living with HIV. Mindfulness 11, 1159–1169 (2020).

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  • Moderated mediation
  • Mindfulness
  • Stigma
  • HIV
  • Substance use
  • Older adults