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Past Issues
Volume 21, numbers 2
April – June 2007
Special Issue on HIV and Aging
Guest Editor Steven Karpiak, Ph.D.,
AIDS Community Research Initiative of America (ACRIA)
Reality Demands Change
The challenges that require new strategies and priorities
Depression, Distress, HIV, and Aging
A mental health issue that demands closer inspection
Cardiovascular Disease and HIV
The smoking gun
Taking Care of Each Other
Caregiving for older adults with HIV will define who we are
Reality Demands Change: People Over Age 50 Living With HIV Continues to Increase
Stephen Karpiak, Ph.D.
A signal event in the history of the HIV/AIDS epidemic occurred in June 2007. The New York City Council passed a $1 million initiative to provide HIV education and prevention information to older adults. The leadership for this initiative came from council member Maria del Carmen Arroyo, chairwoman of the council's Committee on Aging. Key support for the initiative came from the prestigious and influential Council for Senior Center Services in New York City as well as many AIDS service organizations and agencies serving older adults. HIV is no longer an issue defined by HIV prevention messages that focus solely on the risky sexual behaviors of youths and young adults. GMHC's decision to devote this issue to matters of aging and HIV is in response to changed conditions and a recognition that nearly one third of all New Yorkers living with HIV are now aged 50 or older.
In New York City, the HIV/AIDS epicenter of the United States, 32% of the almost 100,000 people living with HIV are over age 50 and more than 70% over age 40. This is a result of antiretroviral drug treatment. It is probable that older adults will account for the majority of people with HIV within the next decade. Unfortunately, they face a health care system, social support networks, and communities ill-prepared to meet their needs. Quite simply—who would have thought that people with HIV would live long lives? The need to suspend the disbelief that people can age with HIV is one hurdle. The challenge requires overcoming ageism and accepting the fact that HIV must take its place amid the panoply of illnesses that are associated with aging.
Research on Older Adults with HIV (ROAH)
In 2006, key findings of ROAH (Research on Older Adults with HIV) the nation's first comprehensive study addressing the aging HIV/AIDS population, conducted by the AIDS Community Research Initiative of America (ACRIA), was released. The study examined a New York City cohort of 1,000 people living with HIV. They represent the underserved, unacknowledged, yet substantial HIV-positive population of men and women of all sexual orientations and races in New York City who are growing old with this disease. ROAH looked both at their unique health needs, i.e., complications that arise from or are exacerbated by their age, and the complex psychological and social issues that affect these older adults.
Many see the face of AIDS belonging to a white, homosexual male—the media archetype of the 1980s. Yet in New York City and other urban centers, the face of HIV/AIDS is that of a heterosexual-identified person over the age of 50 who is a person of color and increasingly likely to be female. Heterosexual sex is the fastest-growing mode of transmission, with 61% of people over 50 infected within the last five years citing this transmission mode—nearly double the figure 10 years ago.
The Great Unknown: Health Complications of Aging With HIV
The primary reason for the growing number of people over 50 with HIV is the success of anti-HIV drugs. As people with HIV grow older, they face a host of health challenges that are common in older adults but will be compounded by HIV/AIDS. They are reaching a stage in life where they are prone to such age-related conditions as adult-onset diabetes, cardiovascular disease, osteoporosis, cancer, dementia, and mental illness. These are among the comorbidities of aging. Will these age-associated conditions manifest themselves earlier and with greater severity in this aging HIV population? What are the potential unwanted interactions between antiretroviral treatments and the complex treatment regimens used to treat these age-associated comorbidities?
As we age, immune system function declines. Illnesses are generally exacerbated by the body's weakened immune response, making older persons with HIV/AIDS more susceptible to serious complications. ROAH found that older adults living with HIV are more prone to depression. The ROAH study group reported having the following comorbidity rates: depression at 52%, arthritis and hepatitis at 31% each, neuropathy at 30%, and hypertension at 27%.
Psychosocial Implications of Aging With HIV
Aging well is not only a function of taking the right pills. The role of psychosocial issues as we grow older is paramount in achieving successful aging. The reliance on families, friends, and social service entities, often referred to as informal caregiving, is a critical element for this phase of one's life. These support networks are at best fragile for the aging HIV population. Stigma and social isolation, compounded by loneliness and depression, paint a bleak picture.
Studies like ROAH find that older adults living with HIV are marginalized (ageism) and neglected, creating a population of people over 50 who are living with this disease, yet who lack the social support systems they need and whose health care providers may be insensitive to their unique and changing needs. Feelings of shame lead to isolation and apprehension about seeking necessary care. These feelings also prevent individuals from revealing their condition to their families, with less than half of ROAH respondents reporting they had told their families of their diagnosis, and only 35% had told their friends.
Policy Examination Needed
It is vital that those who determine the priorities of funding streams for HIV/AIDS care and management consider the issue of aging and HIV as a significant factor and not an epiphenomenon. Limited research paints a stark picture of an aging population, living alone, lacking the social support others take for granted.
AIDS service organizations (ASOs) are not going to be able to retool themselves to address the massive demands that aging places on people. Those who provide health care to this population must increase their knowledge of age-related illnesses and be sensitive to potential complications due to HIV/AIDS and its treatment. Similarly, older adults with HIV must empower and educate themselves regarding aging issues and be prepared to engage their health providers with their needs and concerns. Older adults living with HIV must feel safe to engage the health and social support systems that every other aging person can access. Mainstreaming is needed. In that process stigma will be reduced.
The Final Challenge
Lastly, aging well is a function of the support of a person's community. How we care for each other as we age will ultimately define who we are. The need to reduce stigma is key in this process. HIV stigma, rooted in homophobia, pervades every niche in the lives of those living with HIV. This includes family, friends, health care providers, politicians, community leaders, people of faith, shopkeepers, neighbors, and more. In Africa, where HIV is devastating millions, the answer, as it does here, rests with communities of people.
Depression and Distress in Older HIV+ Adults
Judith G. Rabkin, Ph.D., MPH
Martin McElhiney, Ph.D.
Little is known about the effects of aging on mood and cognitive abilities on people with HIV/AIDS. There is some basis for concern that older HIV+ people may have elevated rates of distress and disorder. Older people in general have fewer sources of social or institutional support, fewer surviving peers, and fewer family members to provide emotional and material support. For older adults who are HIV+, additional sources of strain include illness management, often-complex medication regimens, and psychosocial challenges such as the likelihood that their non-HIV+ peers may consider HIV infection more stigmatizing than do younger people. Comorbid medical conditions are more common, which themselves may be associated with depression and cognitive problems. Cognitive disorders associated with aging also may be present. These factors must be considered in light of the repeated (and counterintuitive) epidemiological finding that, in general population surveys, older people have lower rates of lifetime and current depressive disorders, substance use disorders, and anxiety disorders than do younger respondents (Kessler et al, 2005).
In this brief review, we examine the available research evidence regarding prevalence of distress and depression in older HIV+ adults. We compare these findings where possible with prevalence rates for two comparison groups: younger HIV+ adults and older HIV- adults. These groups are intended to control for the influence of age and HIV status, although we have found no large-scale studies that include both control groups.
Effects of Study Design on Rates of Disorder
Before citing rates of distress and disorder, it is important to note the many reasons why different studies have found widely discrepant findings. Inevitably, there is a trade-off between diagnostic precision and the time, cost, and staff training required to assess disorders. Smaller studies in general use much more extensive and lengthy face-to-face diagnostic procedures while large studies tend to use diagnostic "screens," which are briefer less precise and tend to overestimate distress rates. Depressive symptoms overlap with medical symptoms such as fatigue, insomnia, and weight loss; self-rating scales that include such somatic symptoms (and most do) may show misleadingly high rates of "depressive" symptoms.
Choice of respondents also influences results. For example, rates of mood disorders are much higher in substance-using samples independent of HIV status, and in samples recruited from medical clinics compared to community respondents. HIV symptom severity also may influence depression rates. Overall, the more disorders assessed, the higher the overall prevalence rate. These can contribute to the differences in reported rates of distress and disorder. With respect to substance use disorders, inclusion of cannabis (marijuana) use
elevates the overall rates, as marijuana is used medicinally in HIV+ patients to enhance appetite and relieve neuropathic pain as well as being used recreationally. The more diagnoses included, the higher the rate.
Distress and Depressive Disorders
Formal diagnostic studies of the prevalence of psychiatric disorders in HIV+ samples have been conducted over the past 20 years. Earlier studies of gay men with and without HIV infection using psychiatric diagnostic interviews tended to find lower overall rates of current major depression, in the range of 5% to 10%, with few differences attributable to HIV status (Rabkin, 1996). Later studies, with larger and more heterogeneous samples including women and injection-drug users, have reported elevated rates of depressive symptoms, in the range of 30%–60%; many but not all relied on diagnostic "screens" or self-report symptom checklists (Treisman et al, 2001; Bing et al, 2001).
In summary, rates of depressive disorders and substance use disorders among HIV+ respondents may or may not be elevated compared with those of HIV- respondents from the same community (e.g. gay men, substance-using respondents), but they are clearly elevated compared to rates for the general population. The available evidence does not show increasing rates of psychopathology with declining CD4 counts, although somatic symptoms are indeed correlated with depression. It is noteworthy that most respondents with lifetime or current depressive disorders report an onset that preceded knowledge of HIV status and most likely preceded infection. Finally, we wish to emphasize that most HIV+ adults are not depressed most of the time, and many show a resiliency surprising in the face of the daunting medical and psychosocial issues they confront.
Age, Distress, and Depression
In all major population studies, rates of both depressive disorders and substance use decrease substantially by age and birth cohort. For example, in a nationally representative population study of 9,000 respondents, 12-month and lifetime prevalence rates for the youngest cohort (ages 18–29) were about double the rates of the oldest cohort (aged 60+) (Kessler et al, 2003). In another recent face-to-face survey of 43,000 adults (Hasin, 2005), current rates of major depression were 6.4% for respondents aged 18–29 and 2.7% for those over age 65; lifetime rates similarly declined from 12% to 8% in these age groups. Overall, the decline with age is dramatic, not subtle, in community samples.
Because HIV/AIDS has until recently been a disease of youth and middle age, few of the earlier prevalence studies of psychopathology included enough older HIV+ respondents to analyze their data separately, and even today, "older" is defined as "over age 49" in most HIV studies. The limited available evidence has found that while younger and older HIV+ people do show some differences regarding psychological adjustment, "more striking is the large number of similarities between the two groups" (Heckman TG et al, 2002). In two similar studies, age was not a predictor of depressive symptoms.
A recently completed survey of 914 HIV+ community residents age 50 or older used a self-report rating scale, the CES-D, to assess depressive symptoms (Karpiak & Shippy, 2006). Over 80% of respondents were nonwhite, and 45% reported a history of incarceration. In this sample, 26% of respondents reported symptoms consistent with a diagnosis of depressive disorder.
The single largest database to address the relation between age and depression in the context of HIV infection probably is the combined Veterans Aging 3 Site Study (VACS 3), with 881 HIV+ subjects, and the HIV Cost and Service Utilization Study (HCSUS), which included 2,864 HIV+ subjects (Zigmond et al, 2003). Of these, 286 in the HCSUS sample and 370 of the VACS sample were aged 50+. Elicitation of depressive symptoms was by self-report. They found that older age was associated with a lower likelihood of reporting depressed mood.
In cohort studies conducted in the 1990s of gay men with HIV/AIDS, we used the Structured Clinical Interview for DSM-IV (SCID) to diagnose major depression in 308 men, of whom 42 were aged over 50 years, and 134 HIV- men of whom 20 were over age 50 (Rabkin et al, 2004). This is the only data set we know of that included controls for both age and serostatus, and used the gold standard method of diagnosis rather than self-report rating scales. In both groups, the mean age was 55. Current major depression rates were 6% for HIV+ men under 50 and 5% for those over 50, and 6% for HIV- men under 50 and zero for those over 50. In these comparisons, older HIV-negative men had lower rates, as expected according to general population surveys, but HIV+ men over 50 did not show this decline.
Similar findings have been reported from the Veterans Aging Cohort 5-Site Study: Depressive symptoms declined with age among HIV-negative but not HIV+ veterans (Justice et al, 2004). Perhaps the available literature can be summarized by these findings: It is not that older HIV+ people have elevated rates compared to younger HIV+ people, but their rate of depression does not decline with age as it does in the general population. Future research needs to include both younger HIV+ and older HIV-negative comparison groups, with "older" being defined as at least age 60, controlling for variables including education, medication history, and HIV stage.
References
Hasin D et al. Epidemiology of major depressive disorder: Results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry 2005; 62:1097–1106.
Heckman TG et al. Psychological symptoms among persons 50 years of age and older living with HIV disease. Aging & Mental Health 2002; 6:121–128.
Justice A et al. Psychiatric and neurocognitive disorders among HIV+ and negative veterans in care: Veterans Aging Cohort 5-Site Study. AIDS 2004; 18 (Suppl 1):S49–S59.
Karpiak S and Shippy R. Research on Older Adults with HIV: ROAH (2006 at www.acria.org).
Kessler R et al. Prevalence, severity and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617–627.
Kessler R et al. The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289:3095–3105.
Rabkin JG et al. Mood and substance use disorders in older adults with HIV/AIDS: Methodological issues and preliminary evidence. JAIDS 2004; 18 (Suppl 1):S43–S48.
Zigmond DS et al. Differences in symptom expression in older HIV-positive patients: The Veterans Aging Cohort 3 Site Study and Cost and Service Utilization Study experience. JAIDS 2003; 33:S84–S92.
Bing E et al. Psychiatric disorders and drug use among HIV-infected adults in the United States. Arch Gen Psychiatry 2001; 58:721–728.
Treisman G et al. Psychiatric issues in the management of patients with HIV infection. JAMA 2001; 286:2857–2864.
Rabkin JG. Prevalence of psychiatric disorders in HIV illness.
Intl Rev Psychiatry 1996; 8:157–166.
Cardiovascular Disease and HIV
By Richard Havlik, MD
In the past 10 years, mortality and complication rates for HIV/AIDS have fallen because of the use of highly active antiretroviral therapy (HAART). This experience is a remarkable success story. As a result, many now consider living with HIV a chronic disease. The average age of living HIV/AIDS patients is increasing. This increasing age in HIV patients will raise the risk of cardiovascular disease, which increases with age.
Each year, heart disease kills more Americans than cancer. Diseases of the heart alone caused 30% of all deaths, with other diseases of the cardiovascular system causing substantial further death and disability, including stroke. There is increased emphasis on preventing cardiovascular disease by modifying risk factors, such as diet, exercise, and smoking.
Heart Attack and HIV
A possible increase in myocardial infarction (MI) or simply a heart attack in HIV/AIDS patients was first identified in a large study of a predominantly European population (DAD Study Group, 2003). The risk was modest, because the average age was relatively low; the actual number of cases was small. Some studies from the United States did confirm the increase (Currier et al, 2003), while others did not (Bozzette et al, 2003). A few smaller clinical studies of atherosclerosis showed increased frequency of MI with treatment, especially protease inhibitors (Currier, 2002). Other studies identified increased coronary heart disease in untreated HIV/AIDS patients (Klein et al, 2002). Last year the results of a clinical trial evaluation of intermittent HAART therapy (SMART), based on treatment when CD4 cells dropped below a target value versus continuous treatment to minimize exposure time to HAART, were reported (SMART Study Group, 2006). It was hypothesized that cardiovascular complications would be lower in the intermittently treated group. In fact, the study was stopped early because a significantly higher number of individuals developed cardiovascular disease in the intermittent subgroup. The result suggests that rather than treatment, it may be HIV itself that could be contributing to increased cardiovascular risk. However, another recent report from a large observational study, suggests that increased exposure to protease inhibitors is associated with an increase in MI's (DAD Study Group, 2007).
Although the scientific explanation for these observations still needs clarification, the immediate conclusion is that more medical attention must be paid to increased cardiovascular risk in current HIV/AIDS patients, whether HAART-treated or not. Prescribing practices by staff for cardiac risk in HIV/AIDS patients will require an array of intensive medical approaches (Stein, 2005).
HIV, Age, and Gender
Obviously, we cannot halt the aging process. We need to recognize the fact that older age and being a male increases cardiac risk. The good news is that cumulative mortality rates for HIV patients exposed to HAART are not significantly different between those older than 50 years and less than 50 years, so there is not an added burden from a treatment differential (Perez, 2003). Results from the DAD Study cohort suggest that for every five-year increment of age, cardiac risk increases about 40%. (DAD Study Group, 2003). The risk for men is about twice that for pre-menopausal women. After menopause the risk of cardiovascular disease increases substantially for older women, reaching the risk of men at approximately age 75. As treated, HIV-positive men and women live longer, their risk of HIV-related death will decrease and their cardiovascular risk will increase.
Smoking, HIV, and Coronary Heart Disease
Smoking is a major risk factor for coronary heart disease (CHD) as well as cancer and lung disease. Smokers incur about a 1.5-fold increased risk for cardiac disease (Wilson et al, 1998). In the DAD study the risk was twofold (DAD Study Group, 2003). It is significant to note that in the ACRIA ROAH study the frequency of smoking among HIV patients over 50 years of age is very high, with about 60% being current smokers. If this high level is reflected in future studies of older HIV populations, it represents a major risk factor for age-related chronic diseases. Of all the cardiovascular risk factors, smoking is the most potent and yet has the most potential to result in immediate risk reduction with cessation.
Hypertension and HIV
The adverse effects of elevated blood pressure are well known in general populations but less well appreciated in HIV patients. Hypertension is usually defined as a diastolic BP of 90 mm Hg or higher or an SBP of 140 mm Hg or higher. The frequency of hypertension is much more common in African-Americans and persons at older ages. HIV/AIDS and its treatment are probably not directly related to elevated BP (Friis-Moller et al, 2003), but elevated BP has been seen in some HIV patients with lipodystrophy when compared to other HIV patients. This finding might be related to a possible association with the dyslipidemic syndrome in HIV patients (Sattler et al, 2001). Although important risk factors, lipids are not discussed further. Treatment studies show that the avoidance of calcium channel blocker drugs in HIV patients is recommended (Bartlett, 2005). The detection and control of elevated SBP in HIV patients is well justified and cost effective.
Diabetes and HIV
Another important cardiovascular risk factor is diabetes mellitus, usually described as Type 2 (Type 1 occurs early in life and has a different cause). For the aging HIV patient there is the added problem that treatment with protease inhibitors is associated with increased glucose intolerance. This treatment effect increases the likelihood of developing diabetes. If possible, a switch in HIV regimen can be considered. With a successful HAART regimen, however, it may be more appropriate to continue the regimen and use other means to control the elevated blood sugar, such as dietary changes, weight reduction, and exercise. Even small amounts of physical activity can have beneficial effects. Fortunately, there are oral medications or insulin that can be taken safely with HIV drugs to achieve maximal lowering of blood sugar levels and presumably reduced cardiovascular risk.
Treatment regimens must be consistent with the dual goal of maintaining optimal treatment of the HIV infection. Good adherence to the HAART regimen cannot be sacrificed because of the additional pills or other treatments being prescribed for lowering cardiac risk. Fortunately, the combination of the two approaches can be achieved with moderate effort and has the potential to provide a longer and healthier life for the HIV patient.
References
Bartlett JG. The Johns Hopkins Hospital 2005–2006 Guide
to Medical Care of patients with HIV Infection. Lippincott, Philadelphia, 12th edition, 2005, p. 96.
Bozzette et al. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection.
N Engl J Med 2003; 348: 702–710.
Currier JS. Cardiovascular risk associated with HIV therapy. JAIDS 2002; 31:S16–S23.
Currier JS et al. Coronary heart disease in HIV-infected individuals. JAIDS 2003; 33:506–512.
The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group: Combination therapy and the risk of myocardial infarction. N Engl J Med 2003; 349:1993–2003.
The DAD Study Group. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med 2007; 356:1723–1735.
Friis-Moller N et al. Cardiovascular disease risk factors in HIV patients—association with antiretroviral therapy. AIDS 2003; 17:1179–1193.
Klein D et al. Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection? JAIDS 2002; 30:471–477.
Perez JL, Moore RD. Greater effect of highly active antiretroviral therapy on survival in people aged >50 years compared with younger people in an urban observational cohort. Clinical Infectious Disease 2003; 36:212–218.
Sattler FR et al. Elevatated blood pressure in subjects with lipodystrophy. AIDS 2001; 15:2001–2010.
Stein JH. Managing cardiovascular risk in patients with HIV infection. J Acquir Immune Defic Syndr 2005; 38: 115–123.
Wilson PWF et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97:1837–1847.
Taking Care of Each Other
R. Andrew Shippy, MA
The first decade of AIDS was defined by death and activism, the second by medicines and hope. How can we rally again to make the third decade one of successful aging?
Social Support Is Health Care
One of the most important findings in every study of older adults with HIV is that social support is critical to successful adaptation to life with HIV. Social support is the functional content of relationships, such as emotional and practical assistance. When family and friends are not able to provide needed assistance, people must rely on community-based services, government agencies, and the health care industry. Social support is particularly important for people as they age. Older adults living with HIV may be particularly challenged because they experience a great deal of distress because of the physical effects of their illness as well as the stigmatization of HIV.
Considerable research shows that social support can boost psychological well-being, reduce the number and intensity of physical symptoms, and improve adherence to anti-HIV medications. The benefits of social support in both reducing psychological distress and improving well-being are more important for older HIV+ adults than their younger counterparts (Chesney et al, 2003). However, the positive effects of such social support are difficult to obtain when people experience isolation caused by reduced social interactions and HIV-related stigma.
Recent studies of older adults with HIV report they may be at risk because they do not get the support they need from family and friends. Studies find that these older adults do not receive adequate emotional support or enough help with daily chores. In three studies, when they were asked if they received enough emotional and practical support, 42%–57% said they did not receive enough emotional support and 27%–79% did not receive enough practical assistance with daily chores (Karpiak et al, 2006; Schrimshaw & Siegel, 2003; Shippy & Karpiak, 2005). These older HIV+ adults may feel more isolated and stigmatized and have difficulty managing their illness (Heckman et al, 2002). Anxiety, depression, and thoughts of suicide are higher among people who lack social support resources (Heckman et al, 1999). This can be a real problem for the majority of HIV+ older adults who live alone (Karpiak et al, 2006; Shippy & Karpiak, 2005) and are isolated from family and friends.
Informal support networks are a critical component for management of any illness and one of the pillars of medical care in the United States. Family and friends are often the only resources that allow an individual to age in place. Based on 2004 estimates, nearly 29 million Americans are active caregivers, providing the equivalent of $306 billion in paid care annually (NFCA & FCA, 2006). Where are all the caregivers for older adults living with HIV? On the surface, it appears that older HIV+ adults have large, diverse social networks. Yet the majority of study participants reported inadequate social support resources. How can individuals with considerable social networks not have someone to rely on in times of need?
A disconcerting picture of these support networks emerges. We find these adults either rely on themselves or do not know to whom they can turn for assistance. A closer examination of the social networks of older HIV+ adults revealed sharply truncated networks (Shippy & Karpiak, 2005). One reason is that many people chose not to disclose their serostatus because of stigma. Failure to disclose creates barriers and can contribute to the lack of social support. Older adults are unwilling to ask for help with instrumental tasks of daily living because they do not want to disclose why they need assistance. Feelings of isolation and withdrawal from the support network contribute to the high level of unmet emotional need they experience. Most of these older adults rely on friends who are also HIV+.
Where Have the Caregivers Gone?
HIV/AIDS is often considered the rallying point for the gay rights movement in the 1980s. The gay community was being devastated by the disease, and there were no effective treatments. Groups like ACT UP demanded action by the government and the medical community. Gay men and their allies also formed organizations like GMHC, God's Love We Deliver, and others to provide services for their dying brothers. Although sometimes sick themselves, these men and women became caregivers, often providing intensive assistance to make their friends and family members comfortable as they faced the ravages of AIDS and death. With HAART people began living instead of dying, and short-term caregiving, often heroic, was no longer required. As the HIV population ages, long-term caregiving will be needed. But who will provide this support? When informal support resources are exhausted, formal support systems must intervene to meet the needs of the older individual with chronic illness(es). AIDS service organizations and related community-based organizations may be able to address the gap between the needs of older adults living with HIV and the ability of their networks to care for them. But existing service agencies will need to evolve to meet the needs of their older clients. Or older adults with HIV must seek the support they need from mainstream social service entities. Many older HIV+ adults are in relatively good health, and the isolation of the HIV ASO culture inhibits them from relating with their peers, especially those without HIV. The comment from these older adults can be summarized as "Talk to me about anything but HIV."
The challenge is clear. The answer involves reducing stigma and developing strategies to mainstream older adults with HIV so they can engage the supportive health and social services they need in order to age successfully.
References
Chesney et al. Social support, distress, and well-being in
older men living with HIV infection. Journal of Acquired Immune Deficiency Syndromes 2003; 33:S185–S193.
Heckman et al. Depressive symptomatology, daily stressors, and ways of coping among middle-age and older adults living
with HIV disease. Journal of Mental Health and Aging 1999; 5:311–322.
Heckman et al. Depressive symptoms in older adults
living with HIV disease: Application of the chronic illness quality of life model. Journal of Mental Health & Aging 2002; 8:267–279.
Karpiak SE et al. Research on older adults with HIV. New York: AIDS Community Research Initiative of America, 2006.
Schrimshaw EW & Siegel K. Perceived barriers to social support from family and friends among older adults with HIV/AIDS. Journal of Health Psychology 2003; 8:738–752.
Shippy RA & Karpiak SE. The aging HIV/AIDS
population: Fragile social networks. Aging & Mental Health 2005; 9(3), 246–254.
© 2007 Gay Men's Health Crisis
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