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Zolopa C, Høj SB, Minoyan N, Bruneau J, Makarenko I, Larney S. Ageing and older people who use illicit opioids, cocaine or methamphetamine: a scoping review and literature map. Addiction 2022; 117:2168-2188. [PMID: 35072313 PMCID: PMC9544522 DOI: 10.1111/add.15813] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
AIMS To provide an overview of research literature on ageing and older people who use illicit opioids and stimulants by documenting the conceptual frameworks used and content areas that have been investigated. METHODS We conducted a scoping review of literature relating to ageing and older people who use illicit stimulants and opioids, defining 'older' as 40 years and above. Primary studies, secondary studies and editorials were included. Searches were conducted in PubMed and Embase in July 2020 and March 2021; the Cochrane library was searched in November 2021. Charted data included methodological details, any conceptual frameworks explicitly applied by authors and the content areas that were the focus of the publication. We developed a hierarchy of content areas and mapped this to provide a visual guide to the research area. RESULTS Of the 164 publications included in this review, only 16 explicitly applied a conceptual framework. Seven core content areas were identified, with most publications contributing to multiple content areas: acknowledgement of drug use among older people (n = 64), health status (n = 129), health services (n = 109), drug use practices and patterns (n = 84), social environments (n = 74), the criminal legal system (n = 28) and quality of life (n = 15). CONCLUSIONS The literature regarding older people who use illicit drugs remains under-theorized. Conceptual frameworks are rarely applied and few have been purposely adapted to this population. Health status and health services access and use are among the most frequently researched topics in this area.
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Affiliation(s)
- Camille Zolopa
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada
| | - Stine B Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Social and Preventative Medicine, School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Julie Bruneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Iuliia Makarenko
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Sarah Larney
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
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2
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Lorvick J, Browne EN, Lambdin BH, Comfort M. Polydrug use patterns, risk behavior and unmet healthcare need in a community-based sample of women who use cocaine, heroin or methamphetamine. Addict Behav 2018; 85:94-99. [PMID: 29883856 DOI: 10.1016/j.addbeh.2018.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/05/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of multiple illicit drugs (polydrug use) is associated with health-related harms and elevated risk of drug overdose. Polydrug use in common among women who use 'hard' drugs, such as cocaine, heroin or methamphetamine. METHODS Quantitative data collection was conducted with a community-recruited sample of 624 women who used heroin, methamphetamine or cocaine in Oakland, CA during 2014-2015. We conducted latent class analysis to classify polydrug use patterns. We assessed associations between classes of polydrug use and infectious disease risk behaviors, health care utilization and unmet health care need. RESULTS We identified four distinct classes of drug use: (1) predominantly crack (52% of women); (2) powder cocaine & non-heroin opioids (8%); (3) moderate polydrug use (25%); (4) heavy polydrug use (15%). Odds of sexual risk, injection drug use and unmet healthcare need were twice as high in the heavy polydrug use class as the predominantly crack class (p > 0.01 for each outcome). The rate of binge drinking (as days per month) was also significantly higher in the heavy polydrug class (p = 0.01). The moderate polydrug use class had higher odds of injection drug use and drug treatment participation, compared to the mainly crack class (p < 0.001 for each outcome). There were no differences between classes in health insurance or health care utilization. DISCUSSION Reduction of polydrug use could be an effective harm reduction strategy to address sexual and injection risk among women. The use of both opioids and stimulants in three of the four classes suggests that multi-modal substance abuse treatment approaches may be most appropriate.
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Affiliation(s)
- Jennifer Lorvick
- RTI International, Behavioral and Urban Health Program, United States.
| | - Erica N Browne
- RTI International, Women's Global Health Imperative, United States
| | - Barrot H Lambdin
- RTI International, Behavioral and Urban Health Program, United States; University of Washington, United States
| | - Megan Comfort
- RTI International, Behavioral and Urban Health Program, United States; University of California, San Francisco, United States
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3
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Sok P, Gardner S, Bekele T, Globerman J, Seeman MV, Greene S, Sobota M, Koornstra JJ, Monette L, Hambly K, Hwang SW, Watson J, Walker G, Rourke SB. Unmet basic needs negatively affect health-related quality of life in people aging with HIV: results from the Positive Spaces, Healthy Places study. BMC Public Health 2018; 18:644. [PMID: 29783965 PMCID: PMC5963101 DOI: 10.1186/s12889-018-5391-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 03/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background Basic needs (e.g., food security and stable housing) are important determinants of health and well-being, yet their impact on health-related quality of life (HRQoL) in the context of HIV and aging has not been systematically investigated. Methods Multiple linear regression models examined the relationship between unmet basic needs, and physical and mental HRQoL by age strata (20-34, 35-49 and 50+) in a cross-sectional sample of 496 people living with HIV in Ontario, Canada. Results An overwhelming majority of participants (87%) reported unmet needs related to food, clothing or housing. The prevalence of unmet basic needs in the two older groups appeared to be lower than among younger participants, but the difference did not reach statistical significance. The presence of unmet basic needs predicted substantially lower mean physical health and mental health summary scores in the two oldest groups. Notably, age moderated the influence of unmet basic needs on HRQoL. Conclusions The availability and accessibility of food security, appropriate clothing and stable housing for people living with HIV who are aging need to become a higher priority for program planners and decision makers.
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Affiliation(s)
- Phan Sok
- Institute of Medical-Science, University of Toronto, Toronto, Canada.
| | | | | | | | - Mary V Seeman
- Institute of Medical-Science, University of Toronto, Toronto, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, Canada.,Fife House, Toronto, Canada
| | | | | | | | | | - Stephen W Hwang
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - James Watson
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Glen Walker
- Positive Living Niagara, St. Catherine, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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4
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Grau LE, Zhan W, Heimer R. Prevention knowledge, risk behaviours and seroprevalence among nonurban injectors of southwest Connecticut. Drug Alcohol Rev 2016; 35:628-36. [PMID: 27073014 DOI: 10.1111/dar.12396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/21/2016] [Accepted: 01/31/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Little is known about injection-associated risk behaviours, knowledge and seroprevalence of viral infections among people who inject drugs (PWID) in nonurban locales in the US. Harm reduction services are more available in urban locales. The present study examined a cohort of active PWID residing in non urban areas of Connecticut to investigate how primarily injecting in urban or non urban areas was associated with injection-associated risk behaviours, knowledge and prevalence of blood-borne viruses. DESIGN AND METHODS We described the sample and performed bivariate and multivariable analyses on injection-associated risk behaviours, HIV/hepatitis/overdose knowledge and baseline serological data to identify differences between individuals who injected primarily in nonurban locales and those who did not. RESULTS Harm reduction knowledge and use of harm reduction services were poor in both groups. Those injecting most often in urban settings were 1.88 (1.19, 2.98 95% confidence interval) times more likely to engage in at least one injection-associated risk behaviour than their nonurban counterpart. Seroprevalence rates (23.6% for hepatitis B virus, 39.2% for hepatitis C virus, and 1.1% for HIV) were no different between the two groups. DISCUSSION AND CONCLUSIONS The data provided little evidence that the benefits of urban harm reduction programs, such as syringe exchange, risk reduction interventions and education programs have penetrated into this nonurban population, even among those who injected in urban locales where such programs exist. Harm reduction interventions for nonurban communities of PWID are needed to reduce HIV and hepatitis B and C transmission. [Grau LB, Zhan W, Heimer R. Prevention knowledge, risk behaviours and seroprevalence among nonurban injectors of southwest Connecticut. Drug Alcohol Rev 2016;35:628-636].
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Affiliation(s)
- Lauretta E Grau
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.
| | - Weihai Zhan
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.,Department of Children and Families, Hartford, USA
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
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5
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Hearn LE, Whitehead NE, Dunne EM, Latimer WW. Correlates of Trichomonas vaginalis Among Middle Age and Older Adults Who Use Drugs. Subst Use Misuse 2015; 50:1501-9. [PMID: 26583203 PMCID: PMC6941433 DOI: 10.3109/10826084.2015.1018546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent studies have reported high rates of Trichomonas vaginalis among middle age and older adults. Though trichomoniasis risk factors in this age cohort remain largely unknown, illicit drug use has been associated with increased incidence of sexually transmitted infections (STIs). The number of mid-older adults using illicit drugs has increased significantly in recent years suggesting the need to understand the relationship between drug use and STIs in this age cohort. OBJECTIVES This study examined the relationship between drug use, sexual-risk behaviors, and biologically confirmed T. vaginalis in a sample of mid-older and younger adults who reported recent drug use. METHODS The cross-sectional design examined the relationship between past 6-month drug use, sexual risk-behaviors, and PCR-confirmed T. vaginalis in 264 adults age 18-64 who were recruited from Baltimore, Maryland. These relationships were also explored in the age-stratified sample among those 18-44 years ("younger") and individuals 45+ years ("mid-older"). RESULTS Trichomoniasis prevalence did not differ significantly between younger (18.8%) and mid-older (19.1%) adults. Mid-older adults that tested positive for T. vaginalis were more likely to have used marijuana and crack in the past 6 months. Among younger adults, there were no associations between trichomoniasis and past 6-month drug use and sexual-risk behavior. CONCLUSIONS/IMPORTANCE Age- and drug-related immune decline is hypothesized to contribute to increase susceptibility to T. vaginalis in mid-older adults. Broad screening for trichomoniasis, particularly among older adults who are often not regarded as at risk for STIs, is needed to control this often asymptomatic infection.
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Affiliation(s)
- Lauren E Hearn
- a Clinical and Health Psychology , University of Florida , Gainesville , Florida , USA
| | | | - Eugene M Dunne
- a Clinical and Health Psychology , University of Florida , Gainesville , Florida , USA
| | - William W Latimer
- b School of Health Sciences , Human Services and Nursing, Lehman College , CUNY , Bronx, New York , USA
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6
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Ludwig-Barron N, Wagner KD, Syvertsen JL, Ewald IJ, Patterson TL, Semple SJ, Stockman JK. "When you get old like this … you don't run those risks anymore": influence of age on sexual risk behaviors and condom use attitudes among methamphetamine-using heterosexual women with a history of partner violence. Womens Health Issues 2014; 24:620-8. [PMID: 25128035 PMCID: PMC4254316 DOI: 10.1016/j.whi.2014.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/25/2014] [Accepted: 06/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Drug use and partner violence affect older women, yet few studies highlight age-specific HIV risks and prevention strategies. This study compares sexual risk behaviors, condom use attitudes, and HIV knowledge between midlife/older women (ages 45+) and younger women (ages 18-44) reporting methamphetamine use and partner violence in San Diego, California. METHODS Our mixed methods study used themes from a qualitative substudy (n = 18) to inform logistic regression analysis of baseline data from an HIV behavioral intervention trial (n = 154). FINDINGS Age-related qualitative themes included physiologic determinants, HIV knowledge, and "dodging the bullet," referring to a lifetime of uncertainty surrounding HIV serostatus after engaging in unsafe drug and sex practices. Midlife/older age was associated with never being married (24.2% vs. 51.2; p = .03), having less than a high school education/GED (12.1% vs. 34.7%; p = .04), lower condom use self-efficacy (2.87 vs. 3.19; p = .03), lower positive outcome expectancies (1.9 vs. 2.1; p = .04), and lower HIV knowledge (85.3% vs. 89.7%; p = .04); however, sexual risk behaviors were not associated with age group. In the multivariate analysis, midlife/older age remained independently associated with lower condom use self-efficacy (adjusted odds ratio, 0.49; 95% CI, 0.27-0.87) and lower HIV knowledge (adjusted odds ratio, 0.96; 95% CI, 0.93-0.99). CONCLUSIONS Midlife/older methamphetamine-using women with experiences of partner violence present similar sexual risk profiles, but possess different HIV-related knowledge and attitudes toward prevention methods compared with their younger counterparts. Clinicians and public health practitioners can have a positive impact on this overlooked population by assessing HIV risks during routine screenings, encouraging HIV testing, and providing age-appropriate HIV prevention education.
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Affiliation(s)
- Natasha Ludwig-Barron
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
| | | | - Ivy J Ewald
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Shirley J Semple
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Jamila K Stockman
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California.
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Abstract
RÉSUMÉIl manque de recherche spécifique qui décrit les aspects sociaux du vieillissement avec le virus de l’immunodéficience humaine/syndrome d’immunodéficience acquise (VIH/SIDA) au Canada, malgré une augmentation globale de la population viellissante et l’augmentation du nombre de ceux qui vieillissent avec le VIH/SIDA. Une revue systématique de la littérature été menée en se focalisant sélectivement sur les aspects sociaux aux personnes âgées vivant avec le VIH/SIDA. Les thèmes principaux qui se dégagent dans la littérature sont l’âgisme et la stigmatisation, le sexe, la santé mentale et les soutiens sociales. On présente des recommandations sur la recherche à l’avenir, les modèles théoriques, et le programmatisation.
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8
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Abstract
RÉSUMÉIl manque de recherche spécifique qui décrit les aspects sociaux du vieillissement avec le virus de l’immunodéficience humaine/syndrome d’immunodéficience acquise (VIH/SIDA) au Canada, malgré une augmentation globale de la population viellissante et l’augmentation du nombre de ceux qui vieillissent avec le VIH/SIDA. Une revue systématique de la littérature été menée en se focalisant sélectivement sur les aspects sociaux aux personnes âgées vivant avec le VIH/SIDA. Les thèmes principaux qui se dégagent dans la littérature sont l’âgisme et la stigmatisation, le sexe, la santé mentale et les soutiens sociales. On présente des recommandations sur la recherche à l’avenir, les modèles théoriques, et le programmatisation.
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9
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Abstract
IMPORTANCE Human immunodeficiency virus (HIV)-positive patients treated with antiretroviral therapy now have increased life expectancy and develop chronic illnesses that are often seen in older HIV-negative patients. OBJECTIVE To address emerging issues related to aging with HIV. Screening older adults for HIV, diagnosis of concomitant diseases, management of multiple comorbid medical illnesses, social isolation, polypharmacy, and factors associated with end-of-life care are reviewed. EVIDENCE ACQUISITION Published guidelines and consensus statements were reviewed. PubMed and PsycINFO were searched between January 2000 and February 2013. Articles not appearing in the search that were referenced by reviewed articles were also evaluated. FINDINGS The population of older HIV-positive patients is rapidly expanding. It is estimated that by 2015 one-half of the individuals in the United States with HIV will be older than age 50. Older HIV-infected patients are prone to having similar chronic diseases as their HIV-negative counterparts, as well as illnesses associated with co-infections. Medical treatments associated with these conditions, when added to an antiretroviral regimen, increase risk for polypharmacy. Care of aging HIV-infected patients involves a need to balance a number of concurrent comorbid medical conditions. CONCLUSIONS AND RELEVANCE HIV is no longer a fatal disease. Management of multiple comorbid diseases is a common feature associated with longer life expectancy in HIV-positive patients. There is a need to better understand how to optimize the care of these patients.
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Affiliation(s)
- Meredith Greene
- Division of Geriatric Medicine, Department of Medicine, University of California, San Francisco, CA, USA
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10
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van der Knaap N, Grady BPX, Schim van der Loeff MF, Heijman T, Speksnijder A, Geskus R, Prins M. Drug users in Amsterdam: are they still at risk for HIV? PLoS One 2013; 8:e59125. [PMID: 23527107 PMCID: PMC3601054 DOI: 10.1371/journal.pone.0059125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 02/11/2013] [Indexed: 11/19/2022] Open
Abstract
Background and Aims To examine whether drug users (DU) in the Amsterdam Cohort Study (ACS) are still at risk for HIV, we studied trends in HIV incidence and injecting and sexual risk behaviour from 1986 to 2011. Methods The ACS is an open, prospective cohort study on HIV. Calendar time trends in HIV incidence were modelled using Poisson regression. Trends in risk behaviour were modelled via generalized estimating equations. In 2010, a screening for STI (chlamydia, gonorrhoea and syphilis) was performed. Determinants of unprotected sex were studied using logistic regression analysis. Results The HIV incidence among 1298 participants of the ACS with a total follow-up of 12,921 person-years (PY) declined from 6.0/100 PY (95% confidence interval [CI] 3.2–11.1) in 1986 to less than 1/100 PY from 1997 onwards. Both injection and sexual risk behaviour declined significantly over time. Out of 197 participants screened for STI in 2010–2011, median age 49 years (IQR 43–59), only 5 (2.5%) were diagnosed with an STI. In multivariable analysis, having a steady partner (aOR 4.1, 95% CI 1.6–10.5) was associated with unprotected sex. HIV-infected participants were less likely to report unprotected sex (aOR 0.07, 95% CI 0.02–0.37). Conclusions HIV incidence and injection risk behaviour declined from 1986 onwards. STI prevalence is low; unprotected sex is associated with steady partners and is less common among HIV-infected participants. These findings indicate a low transmission risk of HIV and STI, which suggests that DU do not play a significant role in the current spread of HIV in Amsterdam.
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Affiliation(s)
- Nienke van der Knaap
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
- University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Bart P. X. Grady
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
- Center of Infectious diseases and Immunology Amsterdam (CINIMA), Department of Internal Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands
- * E-mail:
| | - Maarten F. Schim van der Loeff
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
- Center of Infectious diseases and Immunology Amsterdam (CINIMA), Department of Internal Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Titia Heijman
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
- Center of Infectious diseases and Immunology Amsterdam (CINIMA), Department of Internal Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Arjen Speksnijder
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
- Laboratory of Public Health, Public Health Service, Amsterdam, The Netherlands
| | - Ronald Geskus
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Maria Prins
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
- Center of Infectious diseases and Immunology Amsterdam (CINIMA), Department of Internal Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands
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Linley L, Prejean J, An Q, Chen M, Hall HI. Racial/ethnic disparities in HIV diagnoses among persons aged 50 years and older in 37 US States, 2005-2008. Am J Public Health 2012; 102:1527-34. [PMID: 22698035 PMCID: PMC3464816 DOI: 10.2105/ajph.2011.300431] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined racial/ethnic disparities in HIV diagnosis rates for persons aged 50 years and older. METHODS We analyzed surveillance data from the Centers for Disease Control and Prevention regarding HIV diagnoses during 2005 through 2008 in 37 states. Average annual rates of diagnoses were calculated for persons aged 50 years and older and compared with rates for persons aged 13 to 49 years. RESULTS The average annual rate of diagnosis (per 100,000 persons) for older persons was 9.8. Rates among older Blacks (49.2) and Hispanics/Latinos (19.5) were 12.6 and 5.0 times, respectively, the rate among older Whites (3.9); rates among younger Blacks (102.5) and Hispanics/Latinos (39.0) were 7.7 and 2.9 times, respectively, the rate among younger Whites (13.3). Older persons were more likely than younger persons to receive a late HIV diagnosis (prevalence ratio=1.5, P<.001). CONCLUSIONS Racial/ethnic disparities in HIV diagnosis rates are greater among persons aged 50 years and older than among younger persons. The greater HIV diagnosis rates in Blacks and later diagnosis among older persons of all races/ethnicities indicate a need to increase their awareness of risk factors for HIV infection.
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Affiliation(s)
- Laurie Linley
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
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Boeri MW, Tyndall BD. A Contextual Comparison of Risk Behaviors Among Older Adult Drug Users and Harm Reduction in Suburban Versus Inner-City Social Environments. THE JOURNAL OF APPLIED SOCIAL SCIENCES 2012; 6:72-91. [PMID: 23162176 PMCID: PMC3496929 DOI: 10.1177/1936724411431035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent epidemiological data show that older adults comprise a growing age group of drug users and new AIDS cases in the United States. Prevention and intervention studies show that risk behaviors leading to HIV infection are increasing among older users, particularly among the socially vulnerable. Yet older adults remain an under-researched population of drug users and little is known about their risk behaviors. Our aim is to address this gap in knowledge on older users by comparing contextual factors that influence risk behaviors and harm reduction strategies practiced by older drug users living in different communities. This study is based on ethnographic fieldwork in suburban and inner-city neighborhoods in a large metropolitan area in the southeastern USA. Interviewers conducted face-to-face, in-depth, life-history interviews with 69 older adults (age 45 and older) who used heroin, cocaine, and/or methamphetamine. Findings show that while risk behaviors were similar among older adult drug users living in suburban and inner-city environments, the provision of harm reduction education and paraphernalia varied widely. The results show the need for the expansion of harm reduction services focused on older adult drug users who are homeless, uninsured, or socially isolated. This application-oriented research will inform healthcare and treatment providers and generate new directions for future collaborative harm reduction services aimed to decrease the spread of HIV and other infectious diseases associated with drug use.
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13
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Slinkard MS, Kazer MW. Older Adults and HIV and STI Screening: The Patient Perspective. Geriatr Nurs 2011; 32:341-9. [DOI: 10.1016/j.gerinurse.2011.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 05/21/2011] [Accepted: 05/31/2011] [Indexed: 11/15/2022]
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15
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Abstract
This study examines the relationship between age and HIV sexual risk behaviors among a random sample of 372 women in methadone treatment in New York City. Logistic regression results indicate that women of all ages are at risk for HIV through inconsistent condom use. Exposure to intimate partner violence (IPV), alcohol use, and HIV-negative status are associated with inconsistent condom use during vaginal sex. Age (35-44), having a main sexual partner with an HIV risk factor, IPV, and alcohol use are associated with using crack or cocaine during sex. Similarly, age (35-44), having a main sexual partner with an HIV risk factor, IPV, and drug use are associated with consuming four or more drinks prior to sex. The findings highlight the importance of age-appropriate HIV prevention and intervention strategies, as well as the need to address intimate partner violence, mental health, polysubstance use, and relational factors associated with HIV sexual risk behaviors among women in methadone treatment.
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Affiliation(s)
- Malitta Engstrom
- School of Social Service Administration, The University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA.
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16
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Brooks A, Meade CS, Potter JS, Lokhnygina Y, Calsyn DA, Greenfield SF. Gender differences in the rates and correlates of HIV risk behaviors among drug abusers. Subst Use Misuse 2010; 45:2444-69. [PMID: 20536356 PMCID: PMC3169437 DOI: 10.3109/10826084.2010.490928] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined gender differences in the rates and correlates of HIV risk behaviors among 1,429 clients participating in multi-site trials throughout the United States between 2001 and 2005 as part of the National Institute on Drug Abuse-funded Clinical Trials Network. Women engaged in higher risk sexual behaviors. Greater alcohol use and psychiatric severity were associated with higher risk behaviors for women, while impaired social relations were associated with decreased risk for men. Specific risk factors were differentially predictive of HIV risk behaviors for women and men, highlighting the need for gender-specific risk-reduction interventions. Limitations of the study are discussed.
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Affiliation(s)
- Audrey Brooks
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA.
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17
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Prevalence and Correlates of Sexual Behavior and Risk Management Among HIV-Positive Adults Over 50. Sex Transm Dis 2010. [DOI: 10.1097/olq.0b013e3181e15f20] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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High-risk drug use and sexual behaviors among out-of-treatment drug users: an aging and life course perspective. Addict Behav 2010; 35:432-7. [PMID: 20071098 DOI: 10.1016/j.addbeh.2009.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2009] [Revised: 11/01/2009] [Accepted: 12/10/2009] [Indexed: 11/20/2022]
Abstract
High-risk injection drug use and its accompanying sexual behaviors have large social and financial costs. However, little is known about how age and age at first drug use are related to high-risk injection or sex behaviors. The current study draws on life course perspectives and data from the NIDA Cooperative Agreement to examine the relationship between eight high-risk behavior variables and age and age at first drug use. Random effects negative binomial regression models reveal that the frequency of high-risk sexual behaviors in the past month decreases up to 28% with each decade of age, although the frequency of high-risk injection behaviors in the past month increases by up to 62% with each decade of age. Both high-risk injection and high-risk sex behaviors are lower among those who initiated first drug use at later ages. Previous research has indicated the importance of interventions to reduce the high-risk sexual behaviors of older drug users. The current study suggests a refocusing of public health efforts on their high-risk injection habits.
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Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A, Suhr JA, Garske JP, Johnson CJ. Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS Behav 2008; 12:943-56. [PMID: 18389361 DOI: 10.1007/s10461-008-9384-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
Abstract
This study characterized rates of sexual activity and identified psychosocial and behavioral correlates of sexual activity and condom use in a metropolitan sample of 290 HIV-infected adults 50-plus years of age. Thirty-eight percent of participants were sexually active in the past three months, 33% of whom had at least one occasion of anal or vaginal intercourse that was not condom protected. Rates and correlates of sexual activity and condom use differed between gay/bisexual men, heterosexual men, and heterosexual women. In the past three months, 72% of heterosexual men were sexually active compared to only 36% of gay/bisexual men and 21% of heterosexual women. However, among sexually active persons, only 27% of heterosexual men reported inconsistent condom use compared to 37% of gay/bisexual men and 35% of heterosexual women. As the number of older adults living with HIV/AIDS in the U.S. continues to increase, age-appropriate secondary risk-reduction interventions are urgently needed.
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Boeri MW, Sterk CE, Elifson KW. Reconceptualizing early and late onset: a life course analysis of older heroin users. THE GERONTOLOGIST 2008; 48:637-45. [PMID: 18981280 PMCID: PMC3717518 DOI: 10.1093/geront/48.5.637] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Researchers' knowledge regarding older users of illicit drugs is limited despite the increasing numbers of users. In this article, we apply a life course perspective to gain a further understanding of older adult drug use, specifically contrasting early- and late-onset heroin users. DESIGN AND METHODS We collected qualitative data from 29 older heroin users. Life course analysis focused on the users' experiences across the life span. RESULTS The findings suggest that those aging into heroin use (late onset) are disadvantaged compared to those who are maturing in (early onset) except in areas of health. IMPLICATIONS We propose that conceptualizing the use of heroin and other illicit drugs among older adults based on the user's life course trajectory will provide insights for social and health services, including drug treatment.
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Affiliation(s)
- Miriam Williams Boeri
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, Georgia 30322, PH: 404-727-9124
- Kennesaw State University, Department of Sociology and Criminal Justice, 1000 Chastain Road, Kennesaw, Georgia 30144, PH 678-797-2069
| | - Claire E. Sterk
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, Georgia 30322, PH: 404-727-9124
| | - Kirk W. Elifson
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, Georgia 30322, PH: 404-727-9124
- Georgia State University, Department of Sociology, Atlanta, Georgia, PH: 404-651-1858
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Primary medical care and reductions in HIV risk behaviors in adults with addictions. J Addict Dis 2008; 26:17-25. [PMID: 18018805 DOI: 10.1300/j069v26n03_03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Human immunodeficiency virus (HIV) risk behaviors are prevalent in persons with addictions. OBJECTIVES To assess whether exposure to primary medical care is associated with decreases in HIV risk behaviors. DESIGN Prospective 2-year cohort of 298 adults with addictions. OUTCOMES Sex and drug-related HIV risk behaviors, measured by the Risk Assessment Battery. PREDICTORS Cumulative number of primary care visits (0, 1, > or = 2). Associations were tested using regression models for correlated data. RESULTS In women, receipt of primary care was associated with less sex risk behavior (mean decrease 2.1, p < or = 0.1). Among women and men, > or = 2 primary care visits was associated with lower odds of any drug risk behavior (OR = 0.37, p = 0.03). CONCLUSIONS Exposure to primary care can impact HIV risk behavior favorably among adults with addictions.
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Davey-Rothwell MA, Latkin CA. HIV-related communication and perceived norms: an analysis of the connection among injection drug users. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2007; 19:298-309. [PMID: 17685843 DOI: 10.1521/aeap.2007.19.4.298] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Although research has consistently shown a link between perceived norms and HIV risk behaviors, research examining interpersonal variables that may contribute to perceived norms is sparse. Verbal communication is an important mechanism for establishing, altering, and maintaining norms. In this study we assess the association between HIV-related communication and perceived norms. Baseline data from 684 drug injectors enrolled in the STEP into Action (STEP) study were analyzed. Multivariate results revealed that injection drug users (IDUs) who talked to their drug partners about HIV were less likely to perceive that they engaged in risky injection behavior (beta = -1.53, SE = 0.29, p < .001). Also, exchanging sex for money or drugs (beta = 15.83, SE = 7.02, p = .024), going to a shooting gallery (beta = 17.03, SE = 6.79, p = .013), and having an IDU sex partner (beta = 15.34, SE = 6.58, p = .020) were associated with belief that peers' practiced risky drug behaviors. These findings may be used to develop peer education HIV prevention interventions for drug users.
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Affiliation(s)
- Melissa A Davey-Rothwell
- Department of Health, Behavior and Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Cooperman NA, Arnsten JH, Klein RS. Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2007; 19:321-33. [PMID: 17685845 PMCID: PMC2505189 DOI: 10.1521/aeap.2007.19.4.321] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In a cross-sectional analysis, we investigated frequency of sexual activity and factors associated with risky sexual behavior among 624 oldermen, aged 49-80, with or at risk for HIV infection. During the prior 6 months, 75% reported sexual activity with at least one partner, and one quarter of both the HIV-negative and HIV-positive men had more than one sexual partner. Only 18% of the HIV-negative men and 58% of the HIV-positive men always used condoms with their sexual partners. Factors independently and positively associated with risky sexual behavior included lack of HIV infection, any drug use in the past 6 months, greater importance of sex in one's life, weekly or more frequent sexual activity in the past 6 months, and ever taking sildenafil. These results suggest that older men with or at risk for HIV infection are sexually active, participate in risky sexual behavior, and need safer sex interventions.
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Affiliation(s)
- Nina A Cooperman
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA.
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Neundorfer MM, Harris PB, Britton PJ, Lynch DA. HIV-risk factors for midlife and older women. THE GERONTOLOGIST 2006; 45:617-25. [PMID: 16199396 DOI: 10.1093/geront/45.5.617] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The number of women aged 45 years and older infected with the HIV virus continues to increase. This study sought to identify, from the voices of midlife and older women living with HIV, the factors in their lives that put them at risk for HIV, so as to improve HIV-prevention efforts for women of this age group. DESIGN AND METHODS In this qualitative study, we conducted in-depth interviews with 24 HIV-positive women, aged 45 to 71 years, regarding their exposure to HIV. RESULTS From these narratives, we identified five individual factors or themes that put women at risk for HIV: drug and alcohol abuse; not knowing the HIV-risk histories of male sexual partners; mental health issues, including physical or sexual abuse and life crises; taking risks for the sake of relationships; and lack of HIV-prevention information. These individual factors and sociocultural factors related to gender, age, and race and ethnicity were organized into a model of HIV-risk factors for midlife and older women. IMPLICATIONS This model identifies themes to be addressed in HIV-prevention policy, practice, and research in order to reduce the number of new cases of HIV infection among midlife and older women.
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Affiliation(s)
- Marcia M Neundorfer
- Myers Research Institute, Menorah Park Center for Senior Living, Beachwood, OH, 44122, USA.
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Hartel DM, Schoenbaum EE, Lo Y, Klein RS. Gender differences in illicit substance use among middle-aged drug users with or at risk for HIV infection. Clin Infect Dis 2006; 43:525-31. [PMID: 16838244 PMCID: PMC2435189 DOI: 10.1086/505978] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2006] [Accepted: 05/10/2006] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of the present study was to examine gender differences and other factors associated with current heroin and cocaine use among middle-aged drug users. METHODS Baseline data were merged from 2 studies of men and of women with or at risk for HIV infection. Analysis was restricted to study participants who had ever used heroin or cocaine and who were 49-60 years of age at the time that they were interviewed. HIV-antibody status, drug-use history, and psychosocial and sociodemographic data were examined. Logistic regression models were used to assess factors independently associated with current heroin and cocaine use. RESULTS Of 627 persons who ever used heroin and/or cocaine, 250 (39.9%) reported using these drugs within 6 months of the study interview conducted at baseline. Men were more likely to be using drugs currently, compared with women (42.3% vs. 28.2%; P = .007). In multivariate analysis, men, unemployed persons, and HIV-seronegative persons were more likely to be using heroin or cocaine at the time of the interview. In addition, current marijuana users, persons drinking alcohol on a daily basis, and persons who had been homeless in the 6 months before the interview were also more likely to be using these drugs. CONCLUSION A relatively high proportion of middle-aged substance users with or at risk for HIV infection, especially men, may continue to use illicit drugs into the sixth decade of life. The differences noted between men and women who have used heroin and/or cocaine at some point in their lives suggest that special attention be given to aging and gender issues in framing HIV-prevention and drug-treatment programs.
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Affiliation(s)
- Diana M Hartel
- Department of Epidemiology and Population Health, AIDS Research Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
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Abstract
With the advent of highly active antiretroviral therapy (HAART) in mid-1995, the prognosis for HIV-infected individuals has brightened dramatically. However, the conjunction of potent antiviral therapy and longer life expectancy may engender a variety of health risks that, heretofore, HIV specialists have not had to confront. The long-term effects of HIV infection itself and exposure to antiretroviral agents is unknown. Several aspects of aging, including psychiatric disease, neurocognitive impairment, and metabolic and hormonal disorders, may be influenced by chronic exposure to HIV and/or HIV therapeutics. In this paper, we discuss the health issues confronting HIV-infected older adults and areas for future research.
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Affiliation(s)
- Rakhi Kohli
- Division of Geographic Medicine and Infectious Disease, Department of Medicine, Tufts-New England Medical Center, 750 Washington Street #41, Boston, MA 02111, USA.
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Levy JA, Ory MG, Crystal S. HIV/AIDS interventions for midlife and older adults: current status and challenges. J Acquir Immune Defic Syndr 2003; 33 Suppl 2:S59-67. [PMID: 12853854 DOI: 10.1097/00126334-200306012-00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Drawing on both domestic and global international perspectives, this special issue is devoted to articles that confront the challenges of understanding, preventing, and intervening, with HIV/AIDS as an epidemic that carries increasingly serious consequences for a growing number of adults who are 50 years of age or older. This issue builds on papers first presented at an HIV/AIDS and aging conference sponsored in the fall of 2000 by the National Institute on Aging of the National Institutes of Health. The editors have selected articles that focus dually on what is currently known and what needs to be known to successfully address the needs of persons 50 years of age or older who are vulnerable to the virus's effects. This special issue is organized around a series of subsections representing key issues and research findings related to HIV/AIDS and aging issues, including the epidemiology of HIV/AIDS and aging, HIV/AIDS risk and risk behavior, settings and situations as social contexts of risk, clinical challenges with older populations, living with and managing HIV/AIDS, interventions and research methods, new frontiers and challenges, and strategies for action. Some articles are data driven, whereas others are reflective pieces that recount personal experiences in living with the virus or point to new directions for research and practice. In this introduction, the editors highlight findings and approaches from each article and further add to our knowledge by setting these articles within the context of major themes relevant to the study of HIV/AIDS in an aging population.
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Affiliation(s)
- Judith A Levy
- University of Illinois School of Public Health, Chicago 60612, USA.
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