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Bell S, Ranuschio B, Waldron JM, Barnes L, Sheik-Yosef N, Villalobos E, Wackens J, Liboro RM. Pandemic upon Pandemic: Middle-Aged and Older Men Who Have Sex with Men Living with HIV Coping and Thriving during the Peak of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5979. [PMID: 37297583 PMCID: PMC10252860 DOI: 10.3390/ijerph20115979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
When the COVID-19 pandemic emerged in early 2020, not only did it abruptly impede the progress that was being made toward achieving global targets to end the HIV pandemic, but it also created significant impacts on the physical and mental health of middle-aged and older men who have sex with men living with HIV. Utilizing a qualitative, community-based participatory research approach, we conducted semi-structured, one-on-one interviews with 16 ethnoracially diverse, middle-aged and older men who have sex with men living with HIV residing in Southern Nevada, to examine the different ways the COVID-19 pandemic directly impacted their physical and mental health, and explore how they eventually coped and thrived during the peak of the crisis. Using thematic analysis to analyze our interview data, we identified three prominent themes: (1) challenges to obtaining credible health information, (2) the physical and mental health impacts of the COVID-19-pandemic-imposed social isolation, and (3) digital technologies and online connections for medical and social purposes. In this article, we extensively discuss these themes, the current discourse on these themes in academic literature, and how the perspectives, input, and lived experiences of our participants during the peak of the COVID-19 pandemic could be critical to addressing issues they had already been experiencing prior to the emergence of the pandemic in 2020, and just as importantly, helping us best prepare in stark anticipation of the next potentially devastating pandemic.
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Affiliation(s)
- Sherry Bell
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Brandon Ranuschio
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - John M. Waldron
- LGBTQIA+ Community Center of Southern Nevada (The Center), Las Vegas, NV 89101, USA;
| | - Lianne Barnes
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Nadia Sheik-Yosef
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Esmeralda Villalobos
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Janelle Wackens
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Renato M. Liboro
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
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Zanganeh A, Khademi N, Ziapour A, Farahmandmoghadam N, Izadi N, Saeidi S, Aghayani A, Teimouri R, Moghadam S, Khodaey A, Ghasemi SR, Pourmirza Kalhori R. Lifestyle in People Living With HIV: A Study of Patients in Kermanshah, Iran. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580221150567. [PMID: 36912157 PMCID: PMC10014975 DOI: 10.1177/00469580221150567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
There is limited research on the role of lifestyle in people living with HIV (PLWH). This study investigated the health-promoting lifestyle among PLWH in Kermanshah-Iran. This cross-sectional study was conducted in 321 PLWH patients referred to the Kermanshah Behavioral Diseases counseling Center between 2017 and 2018. Patients were selected using the convenience sampling method. Data was collected using a standard health promotion lifestyle profile (HPLP-II) questionnaire. Regression and T-tests were used in SPSS 21 and Stata software to analyze the data. The mean age of patients was 41.07 ± 9.14 years. The mean HPLP score of patients in stress management had the lowest mean score (19.44 ± 4.22), and health responsibility had the highest mean score (22.22 ± 4.57). Comparisons between women and men also showed that women had a lower mean score than men in stress management. In addition, significant differences in their HPLP were observed only in the area of physical activity. The final model had significant influence on the PLWH (P < .001), in which the main predictors were housing status, family members, and feelings of happiness. These variables had a negative effect on HPLP in PLWH's. An appropriate education and training has improved the PLWH health-oriented lifestyle. Given that the housing situation affected health responsibility, nutrition, spiritual growth, interpersonal relationships, and stress management, may have caused severe anxiety and confusion in PLWH. Addiction also had a negative effect on patients' spiritual growth. Relatively simple lifestyle changes such as nutrition and stress management can significantly improve PLWH.
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Affiliation(s)
- Alireza Zanganeh
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nahid Khademi
- Department of Medical Ethics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Ziapour
- Cardiovascular Research Center, Health Institute, Imam-Ali hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Naser Farahmandmoghadam
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Neda Izadi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Saeidi
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Raziyeh Teimouri
- UniSA Creative, University of South Australia, Adelaide, Australia
| | | | - Ali Khodaey
- Geography and Urban Planning, University of Zanjan, Zanjan, Iran
| | - Seyed Ramin Ghasemi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Pourmirza Kalhori
- Department of Medical Emergencies, School of Paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Fu Z, Yan M, Meng C. The effectiveness of remote delivered intervention for loneliness reduction in older adults: A systematic review and meta-analysis. Front Psychol 2022; 13:935544. [PMID: 35967719 PMCID: PMC9372715 DOI: 10.3389/fpsyg.2022.935544] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRemotely delivered intervention is widely applied to loneliness treatment in older adults, but the effect is controversial. This study aimed to evaluate the effects of remotely delivered intervention on loneliness using a systematic review and meta-analysis.MethodsThe PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL (EBSCO), PsycINFO (EBSCO) databases were searched for studies, the search ended on 7 July 2021. Thirteen randomized controlled trials of remotely delivered intervention compared with usual care, brief contact, or no intervention for loneliness were included. A random-effects model measured estimation of loneliness reduction. Furthermore, standardized mean differences (SMDs), 95% confidence intervals (CIs), publication bias, and heterogeneity were calculated. Subgroup analysis was used to explore the factors that might affect the treatment effects.ResultsThe evidence of remotely delivered intervention on loneliness reduction was certain (SMD = −0.41 [95% CI, −0.70 to −0.13]). Media subgroup analysis supported the effectiveness of intervention delivered by video call (SMD = −0.54 [95% CI, −0.83 to −0.25]); treatment strategy subgroup analysis found evidence to support the effectiveness of increasing social support and maladaptive social cognition treatment strategy (SMD = −0.47 [95% CI, −0.77 to −0.18] and SMD = −1.04 [95% CI, −1.98 to −0.10], respectively); participants subgroup analysis shown the effectiveness of intervention for older adults living in LTC and social isolation (SMD = −1.40 [95% CI, −2.43 to −0.36] and SMD = −0.55 [95% CI, −0.74 to −0.36], respectively); group format subgroup analysis testified the effectiveness of intervention carried out in individual format (SMD = −0.39 [95% CI, −0.71 to −0.07]); measurement time points subgroup analysis found the positive effect of intervention at 3 months and 3 to 6 months stage (SMD = −0.33 [95% CI, −0.52 to −0.14] and SMD = −0.32 [95% CI, −0.57 to −0.07], respectively). Significant publication bias was detected (p < 0.05), and the heterogeneity of the studies was substantial.ConclusionThis systematic review and meta-analysis demonstrate that remotely delivered intervention can reduce loneliness in older adults, and it appears to be affected by media type, treatment strategy, participants characteristics, group format, and measurement time points.
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Affiliation(s)
- Zhengke Fu
- Department of Computational Communication, School of Media and Law, Ningbo Tech University, Ningbo, China
- *Correspondence: Zhengke Fu,
| | - Mengsi Yan
- Department of Japanese Language Study, School of Humanity, Ningbo University of Finance and Economics, Ningbo, China
| | - Chao Meng
- Department of Computational Communication, School of Media and Law, Ningbo Tech University, Ningbo, China
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Autenrieth CS, Beck EJ, Stelzle D, Mallouris C, Mahy M, Ghys P. Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000-2020. PLoS One 2018; 13:e0207005. [PMID: 30496302 PMCID: PMC6264840 DOI: 10.1371/journal.pone.0207005] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/23/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The increasing numbers of people living with HIV (PLHIV) who are receiving antiretroviral therapy (ART) have near normal life-expectancy, resulting in more people living with HIV over the age of 50 years (PLHIV50+). Estimates of the number of PLHIV50+ are needed for the development of tailored therapeutic and prevention interventions at country, regional and global level. METHODS The AIDS Impact Module of the Spectrum software was used to compute the numbers of PLHIV, new infections, and AIDS-related deaths for PLHIV50+ for the years 2000-2016. Projections until 2020 were calculated based on an assumed ART scale-up to 81% coverage by 2020, consistent with the UNAIDS 90-90-90 treatment targets. RESULTS Globally, there were 5.7 million [4.7 million- 6.6 million] PLHIV50+ in 2016. The proportion of PLHIV50+ increased substantially from 8% in 2000 to 16% in 2016 and is expected to increase to 21% by 2020. In 2016, 80% of PLHIV50+ lived in low- and middle-income countries (LMICs), with Eastern and Southern Africa containing the largest number of PLHIV50+. While the proportion of PLHIV50+ was greater in high income countries, LMICs have higher numbers of PLHIV50+ that are expected to continue to increase by 2020. CONCLUSIONS The number of PLHIV50+ has increased dramatically since 2000 and this is expected to continue by 2020, especially in LMICs. HIV prevention campaigns, testing and treatment programs should also focus on the specific needs of PLHIV50+. Integrated health and social services should be developed to cater for the changing physical, psychological and social needs of PLHIV50+, many of whom will need to use HIV and non-HIV services.
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Affiliation(s)
| | - Eduard J. Beck
- UNAIDS, Programme Branch, Geneva, Switzerland
- UNAIDS, Latin American and Caribbean Regional Support Team, Georgetown, Guyana
| | | | | | - Mary Mahy
- UNAIDS, Programme Branch, Geneva, Switzerland
| | - Peter Ghys
- UNAIDS, Programme Branch, Geneva, Switzerland
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Abstract
: HIV infection, in many circumstances, can now be managed as a chronic disease due to the marked increase in life expectancy since the introduction of combination antiretroviral therapy (ART). As the patients who first had access to combination ART age into their 50s and 60s, the effects of chronic HIV infection on health have become an important research focus in HIV infection. People living with HIV appear to exhibit an earlier occurrence of some aging-related conditions compared to people without HIV, in part due to higher rates of comorbidities, high-risk behaviors (e.g. smoking, substance use), chronic immune activation, inflammation, and ART-specific factors. Some studies have even suggested an earlier-than-expected appearance of the 'geriatric syndromes,' which are complex medical syndromes of older adults that are associated with morbidity and mortality. The geriatric syndromes include a wide variety of disease processes ranging from incontinence and dementia to impairments in physical function. This review will focus on one geriatric syndrome, sarcopenia, in older HIV-infected populations, and its relation to other aging syndromes, including frailty and falls. The contribution of HIV itself, ART exposure, and specific comorbidities, and the importance of early recognition and prevention of these aging syndromes will be highlighted.
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Affiliation(s)
- Kellie L Hawkins
- aUniversity of Colorado, Aurora, Colorado bJohns Hopkins School of Medicine cJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Catalan J, Tuffrey V, Ridge D, Rosenfeld D. What influences quality of life in older people living with HIV? AIDS Res Ther 2017; 14:22. [PMID: 28400851 PMCID: PMC5387225 DOI: 10.1186/s12981-017-0148-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with HIV with access to treatment are growing older and living healthier lives than in the past, and while health improvements and increased survival rates are welcome, the psychological and social consequences and quality of life of ageing are complex for this group. Understanding how ageing, HIV and quality of life intersect is key to developing effective interventions to improve QoL. METHODS One hundred people with HIV over the age of 50 (range 50-87, mean 58), were recruited through HIV community organizations, and clinics, and included men who have sex with men (MSM), and Black African and White heterosexual men and women. The WHOQOL-HIV BREF was used, as well as the Every Day Memory Questionnaire, and additional questions on anxiety and depression to supplement the WHOQOL. RESULTS While most rated their quality of life (QoL) positively, bivariate analysis showed that better QoL (total score and most domains) was strongly associated with being a man; in a relationship; in paid employment; having higher level of income; not on benefits, and to a lesser degree with being MSM, having higher level of education, and diagnosed after the age of 40. Multivariate analysis showed that not being on benefits was the variable most consistently associated with better quality of life, as was being partnered. Concerns about everyday memory difficulties, and anxiety and depression scores were strong predictors of poorer quality of life. CONCLUSION While the cross-sectional nature of the investigation could not establish that the associations were causal, the findings indicate that concerns about memory difficulties, anxiety and depression, as well as gender, ethnicity, financial factors, and relationship status, are important contributors to QoL in this group. These findings point towards the need for further research to clarify the mechanisms through which the factors identified here affect QoL, and to identify possible interventions to improve the QoL of older people living with HIV.
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George MC, Wongmek A, Kaku M, Nmashie A, Robinson-Papp J. A Mixed-Methods Pilot Study of Mindfulness-Based Stress Reduction for HIV-Associated Chronic Pain. Behav Med 2017; 43:108-119. [PMID: 26651852 PMCID: PMC6005203 DOI: 10.1080/08964289.2015.1107525] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Treatment guidelines for chronic pain recommend nonpharmacologic modalities as part of a comprehensive management plan. Chronic pain is common among people living with HIV/AIDS, but there is little data to guide the choice of nonpharmacologic therapies in this complex population. We performed a mixed-methods feasibility study of Mindfulness-Based Stress Reduction (MBSR) versus health education control with 32 inner city, HIV-infected participants. Outcome measures included: the Brief Pain Inventory, Perceived Stress Scale, HIV Symptoms Index, autonomic function testing, and audiotaped focus groups. Post-intervention, participants reported modest improvements in pain measures and perceived stress, but no effect of group assignment was observed. At 3-month follow-up, 79% of MBSR participants were still practicing, and pain intensity was improved, whereas in the control group pain intensity had worsened. Qualitative analysis revealed a strong sense of community in both groups, but only MBSR was perceived as useful for relaxation and pain relief.
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Affiliation(s)
- Mary Catherine George
- Icahn School of Medicine at Mount Sinai Department of Neurology, Research Program Manager, fax: 212-987-3301,
| | - Arada Wongmek
- Icahn School of Medicine at Mount Sinai Department of Neurology, Visiting Research Scholar, fax: 212-987-3301,
| | - Michelle Kaku
- Icahn School of Medicine at Mount Sinai Department of Neurology, Neurology Resident, fax: 212-987-3301,
| | - Alexandra Nmashie
- Icahn School of Medicine at Mount Sinai Department of Neurology, Research Coordinator, fax: 212-987-3301,
| | - Jessica Robinson-Papp
- Icahn School of Medicine at Mount Sinai Department of Neurology, Assistant Professor, fax: 212-987-3301,
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Vincent W, Fang X, Calabrese SK, Heckman TG, Sikkema KJ, Hansen NB. HIV-related shame and health-related quality of life among older, HIV-positive adults. J Behav Med 2016; 40:434-444. [PMID: 27904976 DOI: 10.1007/s10865-016-9812-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
This study investigated how HIV-related shame is associated with health-related quality of life (HRQoL) in older people living with HIV (PLHIV). Structural equation modeling tested whether HIV-related shame was associated with three dimensions of HRQoL (physical, emotional, and social well-being) and whether there were significant indirect associations of HIV-related shame with the three HRQoL dimensions via depression and loneliness in a sample of 299 PLHIV ≥50 years old. Results showed that depression and loneliness were key mechanisms, with depression at least partially accounting for the association between HIV-related shame and both emotional and physical well-being, respectively, and loneliness accounting for the association between HIV-related shame and social well-being. HIV-related shame appears to be an important correlate of HRQoL in older PLHIV and may provide a promising leveraging point by which to improve HRQoL in older PLHIV.
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Affiliation(s)
- Wilson Vincent
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA.
| | - Xindi Fang
- School of Public Health, Yale University, New Haven, CT, USA
| | - Sarah K Calabrese
- Department of Psychology, George Washington University, Washington, DC, USA
| | | | - Kathleen J Sikkema
- Department of Psychology and Neuroscience and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nathan B Hansen
- College of Public Health, University of Georgia, Athens, GA, USA
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Okonkwo NO, Larkan F, Galligan M. An assessment of the levels of perceived social support among older adults living with HIV and AIDS in Dublin. SPRINGERPLUS 2016; 5:726. [PMID: 27375995 PMCID: PMC4909667 DOI: 10.1186/s40064-016-2302-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/08/2016] [Indexed: 12/19/2022]
Abstract
Objectives
To determine the level of perceived social support among older adults living with HIV and AIDS in Dublin. Methods The study utilized a cross-sectional survey design to collect data from 46 adults aged 50 years or older who are members of open heart house (OHH) in Ireland, a peer support network for people living with HIV and AIDS. Participants completed a set of interviewer-assisted questionnaires, which included the multidimensional measure of perceived social support (PSS) to assess the level of social support. Results Levels of PSS among participants were observed as follows: 54 % had low PSS, 33 % had a moderate PSS and 13 % had high PSS. A fifth of the study participants had a history of injection drug use (IDU) and this group reported higher PSS scores in general than non-IDU’s (H = 79.500, Z = −2.678, p = 0.006). PSS scores were observed to be higher in general among participants with longer duration of infection [H(2) = 7.856, p = 0.020]. Conclusion Despite its limitations, this study provides vital information about the level of social support among older people living with HIV and AIDS at OHH Dublin. An unexpected but interesting finding was the positive relationship between IDU and PSS level. Formulation of strategies to enable older PLHA to be more proactive members of their community through a peer support network sponsored volunteer services should be encouraged.
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Affiliation(s)
- Nelson Obiora Okonkwo
- Centre for Global Health, University of Dublin Trinity College, 7-9 Leinster Street, Dublin 2, Ireland
| | - Fiona Larkan
- Centre for Global Health, University of Dublin Trinity College, 7-9 Leinster Street, Dublin 2, Ireland
| | - Marie Galligan
- Biostatistician, University College Dublin, Belfield, Dublin, Ireland
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Nideröst S, Imhof C. Aging With HIV in the Era of Antiretroviral Treatment: Living Conditions and the Quality of Life of People Aged Above 50 Living With HIV/AIDS in Switzerland. Gerontol Geriatr Med 2016; 2:2333721416636300. [PMID: 28138489 PMCID: PMC5119792 DOI: 10.1177/2333721416636300] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/27/2016] [Accepted: 02/02/2016] [Indexed: 11/16/2022] Open
Abstract
The aim of this cross-sectional study was to identify the living conditions and the quality of life of people aged more than 50 who were living with HIV in Switzerland. Participants were consecutively sampled through different HIV-specific sites. Seventy-two HIV-positive persons filled in an anonymous standardized questionnaire, either paper-pencil or online. Descriptive and inferential statistics were calculated. Quality of life was rated quite high (M = 14.9, SD = 4.14). The multivariate regression analyses showed that mental and physical health problems, long-term living with HIV, having a high degree of needed support, and financial problems decreased quality of life, and perceived available social support was an important predictor in maintaining quality of life. In addition to current offers to support mental health and social networks, efforts to integrate people of working age into the labor market and efforts to reduce stigma and the social marginalization of older HIV-positive people should be fostered.
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Affiliation(s)
- Sibylle Nideröst
- University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Christoph Imhof
- University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Abstract
The aim of this study was to explore the social networks of older adults living with HIV. Interviews were conducted with nine individuals aged 50 or older living with HIV in Helsinki, Finland. Analysis of transcripts was analysed by inductive qualitative content analysis. Results indicated that these participants' networks tended to be large, including those both aware and unaware of the participants' health status. Analysis identified three main themes: large multifaceted social networks, importance of a support group, and downsizing of social networks. Support received appeared to be of great importance in coping with their health condition, especially since the time of diagnosis. Friends and family were the primary source of informal support. The majority of participants relied mostly on friends, some of whom were HIV-positive. Formal support came primarily from the HIV organisation's support group. In this study group, non-disclosure did not impact participants' well-being. In years to come, social networks of older adults living with HIV may shrink due to personal reasons other than HIV-disclosure. What is of primary importance is that healthcare professionals become knowledgeable about psychosocial issues of older adults living with HIV, identifying latent problems and developing adequate interventions in the early stages of the disease; this would help prevent social isolation and foster successful ageing with HIV.
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Affiliation(s)
- Nuno Ribeiro Nobre
- a Haartman Hospital's Emergency Department , Helsinki , Finland.,b School of Health Sciences, Public Health , University of Tampere , Tampere , Finland
| | - Jari Kylmä
- b School of Health Sciences, Public Health , University of Tampere , Tampere , Finland
| | - Tapio Kirsi
- b School of Health Sciences, Public Health , University of Tampere , Tampere , Finland
| | - Marco Pereira
- c Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
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Masten J. "A Shrinking Kind of Life": Gay Men's Experience of Aging With HIV. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2015; 58:319-337. [PMID: 25590461 DOI: 10.1080/01634372.2015.1005786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
More people are living with HIV into midlife and older age. Although increased longevity brings new hope, it also raises unanticipated challenges--especially for gay men who never thought they would live into middle and older age. Middle-aged and older people are more likely to face multiple comorbidities, yet many lack the necessary supports to help them adapt to the challenges of aging with HIV. This article presents the findings of a qualitative study developed to explore gay men's experience of aging with HIV. Multiple in-depth exploratory interviews were conducted with 15 gay-identified men living with HIV/AIDS over an 18-month period. A systematic strategy data analysis consistent with grounded theory revealed a pattern of subtle adjustments to living with HIV that resulted in diminishing circles of social support and social involvement. This dynamic is referred to as "a shrinking kind of life," an in-vivo code built from the participant's own words. Four themes from the research (physical challenges, a magnitude of loss, internal changes, & stigma) are discussed. Conclusions include recommendations for future research and implications for practice in the field. Practitioners knowledgeable of the factors that impact their social involvement can empower gay men through individual and group interventions to confront a shrinking kind of life and define for themselves what it means to optimally age with HIV.
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Affiliation(s)
- James Masten
- a Action for HIV and Aging (AHA Project) , New York , New York , USA
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Discrepancies between HIV prevention communication attitudes and actual conversations about HIV testing within social and sexual networks of African American men who have sex with men. Sex Transm Dis 2014; 41:221-6. [PMID: 24622631 DOI: 10.1097/olq.0000000000000112] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Promoting communication among African American men who have sex with men (AA MSM) and their social networks about HIV testing is an avenue for altering HIV prevention social norms. This study examined the attitudes of AA MSM on talking with peers about HIV testing and characteristics of their network members with whom they have these conversations. METHODS Data came from a cross-sectional survey of 226 AA MSM who were 18 years or older and self-reported sex with another male in the prior 90 days. Participants completed an inventory to characterize network members with whom they had conversations about HIV testing and HIV status. RESULTS Most of the sample reported that it was important/very important to talk to male friends about HIV (85%) and that they were comfortable/very comfortable talking with their friends about sexual behaviors (84%). However, a small proportion of the social network had been talked to by the participant about HIV testing (14%). Among sexual networks, 58% had been talked to about their HIV status, and this was positively associated with main and casual partner type compared with partners with whom money or drugs were exchanged. CONCLUSIONS Findings suggest that positive attitudes about communication may be necessary but not sufficient for actual conversations to occur. Designing interventions that increase communication with social networks is warranted.
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Ramirez-Valles J, Dirkes J, Barrett HA. GayBy Boomers' social support: exploring the connection between health and emotional and instrumental support in older gay men. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:218-234. [PMID: 24798546 DOI: 10.1080/01634372.2013.843225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 09/08/2013] [Indexed: 06/03/2023]
Abstract
We evaluate the association between emotional and instrumental support and perceived health and depression symptoms in a sample of 182 gay/bisexual men age ≥ 55. Perceived health was positively correlated with number of sources of emotional support and depression was negatively associated with instrumental support and health care providers' knowledge of patients' sexual orientation. Depression mediates the connection between providers' knowledge of patients' sexual orientation and perceived health. Number of sources of emotional support varied negatively with age and ethnic minority status, and positively with living with a partner. Instrumental support seemed to be dependent on living with a partner.
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Affiliation(s)
- Jesus Ramirez-Valles
- a School of Public Health , University of Illinois-Chicago , Chicago , Illinois , USA
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15
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Moreno M, de Matos MG, Cabral AJ. Where Does Fear Lead Us: Antiretroviral Treatment Adherence in Maputo. Health (London) 2014. [DOI: 10.4236/health.2014.67083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Zhang Y, Fuller-Thomson E, Anne Mitchell C, Zhang X. Older Adults with HIV/AIDS in Rural China. Open AIDS J 2013; 7:51-7. [PMID: 24454590 PMCID: PMC3893720 DOI: 10.2174/1874613601307010051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 12/02/2022] Open
Abstract
Although the number of older people living with HIV/AIDS (PLWHA) has increased substantially, few studies have focused on older PLWHA in developing countries. Based on a sample of 866 rural PLWHA in Henan, Anhui and Yunnan provinces in China, this study compares the characteristics of PLWHA aged 50 or older (n=185) with younger PLWHA (n=681). Most of the older PLWHA were female (n=112), illiterate, married and at the clinical stage of HIV. Over 90% of older people with HIV/AIDS lived in Henan and Anhui provinces. The severe epidemic in Henan and Anhui provinces was caused by commercial blood and plasma donation. Older PLWHA were less educated, received less social support and were more likely to live alone than younger PLWHA. The results underline the importance of developing programs and policy initiatives targeted at older people infected with HIV/AIDS. The policy and program recommendations include using a gender sensitive strategy, designing specific AIDS education and prevention programs suitable for low-literacy older adults and social support interventions for older PLWHA.
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Affiliation(s)
- Yurong Zhang
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Xiulan Zhang
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
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17
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Greysen SR, Horwitz LI, Covinsky KE, Gordon K, Ohl ME, Justice AC. Does social isolation predict hospitalization and mortality among HIV+ and uninfected older veterans? J Am Geriatr Soc 2013; 61:1456-63. [PMID: 23927911 DOI: 10.1111/jgs.12410] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare levels of social isolation in aging veterans with and without the human immunodeficiency virus (HIV) and determine associations with hospital admission and mortality. DESIGN Longitudinal data analysis. SETTING The Veterans Aging Cohort Study (VACS), at eight VA Medical Centers nationally. PARTICIPANTS Veterans aged 55 and older enrolled in VACS from 2002 to 2008 (N = 1,836). MEASUREMENTS A Social Isolation Score (SIS) was created using baseline survey responses about relationship status; number of friends and family and frequency of visits; and involvement in volunteer work, religious or self-help groups, and other community activities. Scores were compared according to age and HIV status, and multivariable regression was used to assess effects of SIS on hospital admission and all-cause mortality. RESULTS Mean SIS was higher for HIV-positive (HIV+) individuals, with increasing difference according to age (P = .01 for trend). Social isolation was also more prevalent for HIV+ (59%) than uninfected participants (51%, P < .001). In multivariable regression analysis of HIV+ and uninfected groups combined, adjusted for demographic and clinical features, isolation was independently associated with greater risk of incident hospitalization (hazard rate (HR) = 1.25, 95% confidence interval (CI) = 1.09-1.42) and risk of all-cause mortality (HR=1.28, 95% CI = 1.06-1.54). Risk estimates calculated for HIV+ and uninfected groups separately were not significantly different. CONCLUSION Social isolation is associated with greater risk of hospitalization and death in HIV+ and uninfected older veterans. Despite similar effects in both groups, the population-level effect of social isolation may be greater in those who are HIV+ because of the higher prevalence of social isolation, particularly in the oldest individuals.
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Affiliation(s)
- S Ryan Greysen
- Divisions of Hospital Medicine, University of California at San Francisco, San Francisco, California
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18
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Jeffries WL, Marks G, Lauby J, Murrill CS, Millett GA. Homophobia is associated with sexual behavior that increases risk of acquiring and transmitting HIV infection among black men who have sex with men. AIDS Behav 2013; 17:1442-53. [PMID: 22569942 DOI: 10.1007/s10461-012-0189-y] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigated whether the experience of homophobic events increases the odds of engaging in unprotected anal intercourse (UAI) among black men who have sex with men (MSM) and whether social integration level buffered the association. Participants (N = 1,154) reported homophobic events experienced in the past 12 months. Social integration measures included social support, closeness with family members and friends, attachment to the black gay community, openness about sexuality within religious communities, and MSM social network size. Logistic regression analyses indicated that experiencing homophobia was associated with (1) UAI among men not previously diagnosed with HIV and (2) sexual HIV transmission risk behavior among men who knew they were HIV-infected. None of the social integration measures buffered these associations. Homophobia may promote acquisition and transmission of HIV infection among black MSM. Interventions are needed to reduce homophobia experienced by black MSM.
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Affiliation(s)
- William L Jeffries
- Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-37, Atlanta, GA 30333, USA.
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19
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Symptom manageability in Swiss HIV-infected patients. Appl Nurs Res 2013; 26:110-5. [PMID: 23481487 DOI: 10.1016/j.apnr.2013.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 01/27/2013] [Accepted: 01/28/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Managing symptoms in daily life is a challenging problem for people living with HIV. As traditional parameters used to identify symptoms needing management do not integrate aspects of daily living with symptoms, we introduced 'perceived symptom manageability' to fill this gap. AIM The aim of this study was to quantitatively explore 'perceived symptom manageability' in a sample of 268 persons living with HIV. METHODS Secondary analysis of existing cross-sectional data. Social support, gender, age, depressive and anxiety symptoms were bivariately and multivariately analyzed and related to symptom experience and manageability as measured by the HIV Symptom Assessment Scale and the HIV Symptom Manageability Scale. RESULTS Least manageable symptoms were hair loss, vomiting and insomnia. Multivariately, age (beta=-.11; p=.024), symptom distress (beta=-.62; p<.001) and total anxiety and depressive symptoms (beta=-.18; p=.003) were statistically significant correlates of symptom manageability. CONCLUSIONS Although a promising concept to identify symptoms needing management, further research employing primary data is recommended.
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20
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Skalski LM, Sikkema KJ, Heckman TG, Meade CS. Coping styles and illicit drug use in older adults with HIV/AIDS. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:1050-1058. [PMID: 23438250 DOI: 10.1037/a0031044] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prevalence of HIV infection in older adults is increasing; by 2015, over half of adults living with HIV/AIDS in the United States will be over 50. This study describes the prevalence of drug use and examines psychosocial predictors of drug use in a sample of HIV-infected adults aged 50 and older. Participants were 301 HIV-positive older adults enrolled in a clinical trial of a coping intervention aimed to reduce their depressive symptoms. One-quarter used illicit drugs in the past 60 days (48% any cocaine, 48% weekly marijuana, 44% any other drugs) with an average of 36 days for marijuana and 15 days for cocaine. After controlling for demographics, self-destructive avoidance was positively associated and spiritual coping was negatively associated with drug use. These findings suggest that assessment of drug abuse should be a routine part of care for older patients in HIV clinics. Furthermore, interventions designed to increase spiritual coping and decrease self-destructive avoidance may be particularly efficacious for HIV-infected older adults.
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Affiliation(s)
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, and Global Health Institute, Duke University
| | - Timothy G Heckman
- Department of Geriatric Medicine/Gerontology, Ohio University College of Osteopathic Medicine
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21
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Van Wagenen A, Driskell J, Bradford J. "I'm still raring to go": successful aging among lesbian, gay, bisexual, and transgender older adults. J Aging Stud 2013; 27:1-14. [PMID: 23273552 PMCID: PMC3534855 DOI: 10.1016/j.jaging.2012.09.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 08/20/2012] [Accepted: 09/06/2012] [Indexed: 11/21/2022]
Abstract
While we know that minority status differentiates the experience of aging, little research has been done to examine the ways in which patterns of successful aging may differ in diverse subgroups of older adults. In this exploratory study, we investigated and described experiences of successful aging in a sample of lesbian, gay, bisexual and transgender (LGBT) older adults. Directed by a community-based participatory research process, we conducted semi-structured in-depth interviews with 22 LGBT adults, age 60 and older. We took an inductive, grounded theory approach to analyze the taped and transcribed interviews. We coded respondent experiences in four domains: physical health, mental health, emotional state and social engagement. Four gradations of successful aging emerged. Very few in our sample met the bar for "traditional success" characterized by the absence of problems in all four domains of health. Most of the sample was coping to a degree with problems and was categorized in one of two gradations on a continuum of successful aging: "surviving and thriving" and "working at it." A small number was "ailing": not coping well with problems. Some of the experiences that respondents described were related to LGBT status; others were related to more general processes of aging. The research suggests that a successful aging framework that is modified to include coping can better describe the experiences of LGBT older adults. The modified conceptual model outlined here may be useful in future research on this population, as well as more broadly for diverse populations of adults, and may be adapted for use in practice to assess and improve health and well-being.
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Affiliation(s)
- Aimee Van Wagenen
- The Fenway Institute, Center for Population Research in LGBT Health, 1340 Boylston Street, Boston, Massachusetts 02215, United States of America, Phone: 617-927-6348, Fax: 617-267-0764
| | - Jeff Driskell
- Salem State University, Department of Social Work, 353 Lafayette St, Salem, MA 01970, United States of America, Phone: 978-542-7453, Fax: 978-542-6936
| | - Judith Bradford
- The Fenway Institute, Center for Population Research in LGBT Health, 1340 Boylston Street, Boston, Massachusetts 02215, United States of America, Phone: 617-927-6015, Fax: 617-267-0764
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Slomka J, Lim JW, Gripshover B, Daly B. How have long-term survivors coped with living with HIV? J Assoc Nurses AIDS Care 2012; 24:449-59. [PMID: 23253776 DOI: 10.1016/j.jana.2012.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
Abstract
With advances in HIV treatment, more individuals have grown older with the disease. Little is known about factors that have helped these survivors manage everyday life with HIV. In this exploratory, qualitative study, we asked, "What has helped survivors cope with challenges of living long term with HIV?" Participants were recruited from a convenience sample of persons living with HIV who obtained treatment at a specialty HIV clinic; 16 long-term survivors of HIV were interviewed. Mean age was 50.13 (SD = 8.30) years; mean time from diagnosis was 16.75 (SD = 5.98) years. Results were broadly dichotomized as coping mechanisms and social supports. Three themes characterized coping mechanisms: disease coping, practical coping, and emotional coping. Social supports included themes of family, friends, professionals, peer groups, and pets. In particular, the power of patient-professional relationships and meanings derived from religion/spirituality were considered by a majority of participants to be influential factors.
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Affiliation(s)
- Jacquelyn Slomka
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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23
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Thanh DC, Moland KM, Fylkesnes K. Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam. BMC Health Serv Res 2012; 12:428. [PMID: 23176584 PMCID: PMC3549738 DOI: 10.1186/1472-6963-12-428] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 11/22/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Seeking and utilisation of HIV prevention, treatment, care, and support services for people living with HIV is often hampered by HIV-related stigma. The study aimed to explore the perceptions and experiences regarding treatment, care, and support amongst people living with HIV in Viet Nam, where the HIV epidemic is concentrated among injecting drug users, sex workers, and men who have sex with men. METHODS In-depth interviews and focus group discussions were conducted during September 2007 in 6 districts in Hai Phong with a very high HIV prevalence among injecting drug users. The information obtained was analysed and merged within topic areas. Illustrative quotes were selected. RESULTS Stigma and discrimination against people living with HIV in the community and healthcare settings was commonly reported, and substantially hampered the seeking and the utilisation of HIV-related services. The informants related the high level of stigma to the way the national HIV preventive campaigns played on fear, by employing a "scare tactic" mainly focusing on drug users and sex workers, who were defined as "social evils" in the anti-drug and anti-prostitution policy. There was a strong exclusion effect caused by the stigma, with serious implications, such as loss of job opportunities and isolation. The support and care provided by family members was experienced as vital for the spirit and hope for the future among people living with HIV. CONCLUSIONS A comprehensive care and support programme is needed. The very high levels of stigma experienced seem largely to have been created by an HIV preventive scare tactic closely linked to the "social evil" approach in the national policy on drug and prostitution. In order to reduce the stigma and create more effective interventions, this tactic will have to be replaced with approaches that create better legal and policy environments for drug users and sex workers.
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Affiliation(s)
- Duong Cong Thanh
- National Institute of Hygiene and Epidemiology, Ha noi, Viet Nam
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Karen Marie Moland
- Centre for International Health, University of Bergen, Bergen, Norway
- Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
| | - Knut Fylkesnes
- Centre for International Health, University of Bergen, Bergen, Norway
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24
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Doyle K, Weber E, Atkinson JH, Grant I, Woods SP. Aging, prospective memory, and health-related quality of life in HIV infection. AIDS Behav 2012; 16:2309-18. [PMID: 22246512 DOI: 10.1007/s10461-011-0121-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
HIV infection and older age are each independently associated with lower health-related quality of life (HRQoL) and deficits in prospective memory (PM), which is a distinct aspect of cognition involving the ability to "remember to remember" to do something at a future occasion. The present study investigated associations between PM and HRQoL in 72 older (≥ 50 years) and 41 younger (≤ 40 years) HIV-infected adults. Self-reported PM complaints predicted HRQoL across the entire sample, but there was a significant interaction between performance-based PM and age group on HRQoL, such that lower time-based PM was associated with lower HRQoL only in the younger cohort. Within the younger group, time-based and self-reported PM significantly predicted mental HRQoL independent of other risk factors (e.g. depression). These findings suggest that PM plays a unique role in HRQoL outcomes among younger persons living with HIV infection and support the examination of other age-related factors (e.g. effective use of compensatory strategies) that may regulate the adverse impact of PM on everyday functioning.
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Affiliation(s)
- Katie Doyle
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, San Diego, CA, 92093, USA.
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25
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Abstract
To identify factors associated with antiretroviral therapy (ART) adherence and virologic control among HIV-positive men on ART in primary relationships, data were collected from 210 male couples (420 men). Dyadic actor-partner analyses investigated associations with three levels of adherence-related dependent variables: self-efficacy (ASE), self-reported adherence, and virologic control. Results indicated that higher patient ASE was related to his own positive beliefs about medications, higher relationship autonomy and intimacy, and fewer depressive symptoms. Fewer depressive symptoms and less relationship satisfaction in the partner were linked to higher ASE in the patient. Better self-reported adherence was related to the patient's positive appraisal of the relationship and the partner's positive treatment efficacy beliefs. Greater medication concerns of both patient and partner were associated with less adherence. The partner's higher relationship commitment was associated with lower viral load in the patient. Findings suggest that depressive symptoms, treatment beliefs, and relationship quality factors of both partners may influence adherence-related outcomes.
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26
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Owen G, Catalan J. 'We never expected this to happen': narratives of ageing with HIV among gay men living in London, UK. CULTURE, HEALTH & SEXUALITY 2011; 14:59-72. [PMID: 22077645 DOI: 10.1080/13691058.2011.621449] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The proportion of HIV-positive people over the age of 50 is rapidly increasing in the UK. This reflects the use of antiretroviral therapies and the transformation of HIV from life-threatening disease to chronic treatable illness. In this study a biographical narrative approach was used to explore the lived experience of ageing in 10 HIV-positive gay men aged between 50 and 78. While some participants regarded ageing as an opportunity to continue progressing towards valued life goals, others were more ambivalent about their future prospects. The findings suggest that these differences were particularly influenced by an individual's biographic relationship to the history of the HIV epidemic rather than chronological age. Those with long histories of involvement with HIV were more likely to be disadvantaged by careers interrupted by illness, to be dependent on state benefits and to have social networks damaged by multiple AIDS-related bereavements. The research identifies a cohort of older gay men likely to require additional support in adapting to the challenge of growing older with HIV. The article also explores the construction of moral identities in relation to discourses of 'successful ageing' and the possibility of building supportive communities that are sensitive to the needs of older gay men.
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Affiliation(s)
- Gareth Owen
- Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK.
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27
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28
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Leung V, Luong ML, Libman M. Leptospirosis: pulmonary hemorrhage in a returned traveller. CMAJ 2011; 183:E423-7. [PMID: 21262944 DOI: 10.1503/cmaj.092203] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Victor Leung
- Division of Infectious Diseases, Department of Medicine, McGill University Health Center, Montréal, Que.
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29
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Hasanah CI, Zaliha AR, Mahiran M. Factors influencing the quality of life in patients with HIV in Malaysia. Qual Life Res 2010; 20:91-100. [DOI: 10.1007/s11136-010-9729-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2010] [Indexed: 11/29/2022]
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30
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Perceived social support, hope, and quality of life of persons living with HIV/AIDS: a case study from Nepal. Qual Life Res 2010; 19:157-66. [PMID: 20047029 DOI: 10.1007/s11136-009-9574-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE This study investigates the relationship among perceived satisfaction from social support, hope, and QOL of PLWHA. METHOD A cross-sectional in design was applied, among a sample of 160 HIV-infected persons receiving treatment, care, and support from eight community-based NGOs. QOL was assessed using the WHO (QOL)-26 tool, and social support was assessed by use of a modified Sarason's Social Support Questionnaire. A Hope Assessment Scale was also developed. RESULTS The non-family support network was greater than family support network. Overall satisfaction from social support and hope was significantly correlated with QOL; the greatest effect of social support was on environmental functioning, and the lowest was on social relationships, emotional support was less a predictor of social relationship than other types of supports. CONCLUSION The effect of perceived satisfaction from social support was through the mediation variable hope. As it has widely been recognized that community-based support is vital for issues of quality of life, strategies to improve social support and hope intervention programs are strongly encouraged. The results of the study have implications for providing care, treatment, and psycho-social support to maintain or enhance quality of life of PLWHA.
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31
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Zablotska I, Frankland A, Imrie J, Adam P, Westacott R, Canavan P, Prestage G. Current issues in care and support for HIV-positive gay men in Sydney. Int J STD AIDS 2009; 20:628-33. [DOI: 10.1258/ijsa.2008.008432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We explored current access to care among HIV-positive people in Australia. In 2006, 270 HIV-positive gay men from a community-based Positive Health cohort in Sydney were asked about their health (including medical and social) service needs and, subsequently, about difficulty in accessing services. We report the prevalence of specific needs, barriers and associated factors. Participants most commonly used general practitioners (64%) for HIV management and needed at least one HIV-related medical service (usually several: doctors experienced in HIV management, dentists and hospital pharmacies). Most participants were able to access them. Barriers in accessing services were related to their convenience rather than lack or quality. Cost emerged as a substantial barrier to dental care and psychological counselling (91% and 48% respectively of those in need). Need for an HIV-related social service was reported by 46% of respondents. Difficulties in accessing these related to poor services and staff attitudes. Income was associated with limited access to multiple services. In Australia, HIV-related medical service needs outweigh those for social services. Complex health services remain essential to HIV-positive people, but some services are currently not meeting their needs. To remain adequate, services need to understand and constantly adapt to the changing needs of HIV-positive people.
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Affiliation(s)
- I Zablotska
- National Centre in HIV Social Research, University of New South Wales, Sydney 2052
| | - A Frankland
- National Centre in HIV Social Research, University of New South Wales, Sydney 2052
| | - J Imrie
- National Centre in HIV Social Research, University of New South Wales, Sydney 2052
| | - P Adam
- National Centre in HIV Social Research, University of New South Wales, Sydney 2052
| | | | - P Canavan
- National Association of People Living with HIV/AIDS
| | - G Prestage
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
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32
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Sherr L, Harding R, Lampe F, Johnson M, Anderson J, Zetler S, Fisher M, Arthur G, Norwood S, Leake-Date H, Edwards S. Clinical and behavioural aspects of aging with HIV infection. PSYCHOL HEALTH MED 2009; 14:273-9. [PMID: 19444705 DOI: 10.1080/13548500902865964] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Scant attention has been paid to the effects of ageing and HIV. This study examined age distribution and explored the impact of age on the experience of illness. One thousand and seven consecutive attenders at five UK HIV clinics were approached, 904 met inclusion criteria and 778 agreed to participate (86% response rate). They provided detailed information on demographics, experience of illness, physical and psychological symptoms, quality of life, treatment experience and doctor-patient communications. Twelve percent were aged over 50. There were significantly more males in the over 50s (86% vs. 75%), more gay males x(2) = 7, p = 0.04 and fewer females (14% vs. 25%) x(2) = 5; p = 0.03. No significant differences were found on measures of education, employment or migration status or physical symptom experience. The older group had significantly lower psychological and global burden scores and were more likely to take antiretrovirals (88% vs. 79%; p = 0.04). Triggers for treatment switching showed older participants significantly less burdened by food restrictions, pill burden, taste, nausea, diarrhoea, sleep disturbance, concentration problems, anxiety depression, skin rashes, liver complaints or a need for a simpler regimen. The older group were similar in employment, education and disclosure, but complained less and reported much higher tolerance.
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Affiliation(s)
- Lorraine Sherr
- Department of Thoracic Medicine, Royal Free and University College Medical School, London, UK.
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33
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Psychological well-being among individuals aging with HIV: the value of social relationships. J Acquir Immune Defic Syndr 2009; 51:91-8. [PMID: 19282781 DOI: 10.1097/qai.0b013e318199069b] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Utilizing a heterogenous sample of adults diagnosed with HIV infection, the current study sought to explore associations among age, various dimensions of social support, and psychological and functional well-being. METHODS Cross-sectional data capturing subjective and instrumental support, social interaction, behavioral health service utilization, and psychological well-being (ie, positive affect and depressive symptomatology), and physical functioning, were collected from 109 men and women living with HIV. To explore age group differences, participants were stratified by age (<54 vs. 55+ years). RESULTS Despite endorsing greater medical comorbidity, older adults reported significantly lower depressive symptomatology and greater positive affect and were less likely to report seeing a behavioral health specialist than their younger counterparts. No age group differences emerged for instrumental support or amount of social interaction. However, older adults reported higher subjective support, which in turn was associated with lower depressive symptomatology, greater positive affect, and nonutilization of behavioral health services. CONCLUSIONS More attention should be paid to the social environment of individuals diagnosed with HIV as the quality of social relationships may be particularly important for successful psychological adaptation to HIV.
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34
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Wouters E, van Loon F, van Rensburg D, Meulemans H. Community support and disclosure of HIV serostatus to family members by public-sector antiretroviral treatment patients in the Free State Province of South Africa. AIDS Patient Care STDS 2009; 23:357-64. [PMID: 19327099 DOI: 10.1089/apc.2008.0201] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent studies have indicated that the support of close relatives is fundamental in coping with HIV/AIDS and in accessing the emotional and material support necessary for sustained adherence to treatment. Because disclosure to family members is imperative to ensure their support, identifying tools or resources that can minimize the possible risks and maximize the potential benefits of disclosure should be useful in improving the lives of people living with HIV/AIDS. Where health systems require strengthening, engaging the community in HIV/AIDS care could potentially create an environment that encourages disclosure to family members. This study investigated the impact of community support initiatives (community health workers and treatment support groups), patient characteristics (age, gender, and education), and time since first diagnosis on the disclosure of serostatus to family members by a sample of 268 public-sector antiretroviral treatment patients in a province of South Africa between August 2004 and July 2007. Whereas gender, age, and education only weakly influenced disclosure, there was a strong and stable positive association between community support and disclosure to family members. The immediate and long-term impact of community support on the disclosure by seropositive patients to family members indicates that initiatives such as community health workers and HIV support groups run by people living with HIV/AIDS should be strengthened, especially for those patients who cannot disclose their status to immediate family and close friends.
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Affiliation(s)
- Edwin Wouters
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium
| | - Francis van Loon
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium
| | - Dingie van Rensburg
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Herman Meulemans
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium
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Martin CP, Fain MJ, Klotz SA. The older HIV-positive adult: a critical review of the medical literature. Am J Med 2008; 121:1032-7. [PMID: 19028193 DOI: 10.1016/j.amjmed.2008.08.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 06/03/2008] [Accepted: 08/01/2008] [Indexed: 11/15/2022]
Abstract
Older adults make up an ever-growing proportion of human immunodeficiency virus (HIV) cases in the United States, with approximately 25% of infections occurring in adults over the age of 50 years. Although there is a preliminary body of literature addressing the socioeconomic and prognostic issues of HIV infection in older adults, very little rigorous scientific research has looked at the significant clinical issues relevant to this growing population. Treatment of older adults is complicated by an increased prevalence of medical comorbidities, but little is known about the effects of complicated medication regimens in this group, as they are routinely excluded from clinical trials of newer HIV medications. The delay in diagnosis and treatment of HIV in older adults has led to poorer outcomes, including lower baseline CD4 counts, decreased time to acquired immune deficiency syndrome diagnosis, and increased mortality. Despite these facts, there is mounting evidence that timely diagnosis and treatment of HIV in older adults leads to improved outcomes, similar to younger patients. This review evaluates the literature focusing on HIV and older adults.
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Affiliation(s)
- Clifford P Martin
- Section of Infectious Diseases, University of Arizona Health Sciences Center, Tucson, AZ 85724, USA
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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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Poindexter C, Shippy RA. Networks of older New Yorkers with HIV: fragility, resilience, and transformation. AIDS Patient Care STDS 2008; 22:723-33. [PMID: 18754703 DOI: 10.1089/apc.2007.0260] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To better understand how HIV-infected older persons receive and perceive social support, the perceptions and experiences of 34 older HIV-positive persons in New York City were explored in July and August 2005 through five focus groups. The participants' network members tended to be HIV positive and the presence of so many people with HIV in their networks tended to be serendipitous. The advantages of having a HIV-positive network include being members of a caring community that provides safety, support, mentors, and inspiration, while the disadvantage is shrinkage of the network due to illness and death. These participants demonstrated that living with HIV changes one's network because people die of HIV; new friends are made when one seeks services; and HIV-positive networks replace those lost through stigma and rejection. Social service providers and policy makers in the HIV and aging networks should expand their view of "family" and not make assumptions about the networks for older persons living with HIV. Networks expand and shrink at different times and are resilient and fragile at the same time.
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Affiliation(s)
| | - R. Andrew Shippy
- Department of Research, AIDS Community Research Initiative of America, New York, New York
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Abstract
Since the advent of highly active antiretroviral therapy, life expectancies for persons with HIV infection are similar to those for uninfected people. A growing proportion of HIV-infected individuals are now over the age of 50. We are also seeing an increase in the incidence of HIV infection in older adults. To meet the challenges of the ongoing HIV epidemic, prevention efforts should include a focus on older adults. Also, HIV care providers must address the many comorbidities that are common in the aging population. Additional research will clarify how the processes of aging and HIV infection overlap and interact. This review addresses many of these important considerations.
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Healthy lifestyles and health-related quality of life among men living with HIV infection. J Assoc Nurses AIDS Care 2008; 18:54-66. [PMID: 17991599 DOI: 10.1016/j.jana.2007.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 03/04/2007] [Indexed: 11/23/2022]
Abstract
Although healthy lifestyles are related to improved quality of life in the general population, little is known about the role of healthy lifestyles during HIV infection. The authors examined the relationships between health-promoting behaviors, risk behaviors, stress, and health-related quality of life (HRQOL) among 226 men with HIV infection who were attending three infectious disease clinics. As hypothesized, health-promoting behaviors were positively related and stress was negatively related with most of the HRQOL dimensions. Contrary to the hypothesis, tobacco use, recreational drug use, and unsafe sexual behaviors were not related to the HRQOL dimensions. Hazardous alcohol use was negatively associated with one HRQOL dimension--social functioning. The association of modifiable factors, such as health-promoting behaviors and stress, with HQROL offers opportunities for improving HIV-related health care. Relatively simple, straightforward changes in lifestyles such as eating well, remaining active, and avoiding stressful life events may result in improvements in HRQOL.
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Vance DE, Struzick TC, Masten J. Hardiness, Successful Aging, and HIV: Implications for Social Work. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2008; 51:260-283. [PMID: 19042651 DOI: 10.1080/01634370802039544] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
<p>With dramatic developments in the treatment of HIV/AIDS, life expectancy is increasing, resulting in more middle-aged and older adults living with this disease. Little is known about the problems, and especially the strengths, of those living and aging with HIV. Hardiness is used in the gerontological literature to describe and explain how people age successfully, despite traumatic life events and chronic diseases. Similarly, the concept of hardiness may be used to guide clinicians, researchers, and clients on how to age successfully with HIV. This article provides a review of hardiness in aging and HIV, and emphasizes its importance in facilitating successful aging with this disease. Conceptual and methodological concerns in studying hardiness and successful aging are addressed. Potential interventions and clinical implications for social work are posited for augmenting qualities of hardiness in people aging with HIV.</p>
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Orlando G, Meraviglia P, Cordier L, Meroni L, Landonio S, Giorgi R, Fasolo M, Faggion I, Riva A, Zambelli A, Beretta R, Gubertini G, Dedivitiis G, Jacchetti G, Cargnel A. Antiretroviral treatment and age-related comorbidities in a cohort of older HIV-infected patients. HIV Med 2007; 7:549-57. [PMID: 17105515 DOI: 10.1111/j.1468-1293.2006.00420.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The availability of several therapeutic regimens has transformed HIV infection from a life-threatening disease into a chronic condition. Older patients (>50 years old) with HIV infection constitute a new treatment challenge in terms of the cumulative effects of ageing and antiretroviral therapy (ART). METHODS The immunovirological effects and metabolic interactions of 48 weeks of ART in older patients followed up in three Infectious Diseases Units in Milan, Italy since 1994 were compared with those in younger controls aged 25-35 years. RESULTS The 159 older patients and 118 controls enrolled in the study were comparable for HIV stage, baseline CD4 cell count and viral load but differed for mode of HIV transmission, comorbid conditions and related chronic treatments. Mean viral load decreased after 48 weeks of treatment by 2.6 log(10) HIV RNA copies/mL and CD4 count increased by 137.5 cells/microL in older patients, and similar values for immunovirological effects were obtained in the young controls. The relative risk (RR) of an abnormal test in older patients was 7.33 [95% confidence interval (CI) 4.36-12.36] for glucose, 1.73 (95% CI 1.45-2.07) for total cholesterol, 1.56 (95% CI 1.22-2.0) for high-density lipoprotein cholesterol, 1.26 (95% CI 1.02-1.56) for triglycerides, 6.48 (95% CI 4.36-9.66) for serum creatinine, and 0.45 (95% CI 0.35-0.58) for ALT. Moderate/severe liver and renal toxicities were recorded in the older patients but not in the controls. The tolerability of ART did not differ between the older patients and the controls. Thirty-nine new cardiovascular, endocrine-metabolic and neuralgic disorders (24.52 per 100 person-years) were diagnosed in the older patients and four (3.39 per 100 person-years) in the controls (P<0.0001). CONCLUSIONS Diseases induced by, or related to, the toxic effects of antiretrovirals interact with age-specific health profiles, raising new questions and challenges. Comparative epidemiological studies, research studies addressing specific questions and surveillance are needed to answer the questions that arise in clinical monitoring.
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Affiliation(s)
- G Orlando
- II Department of Infectious Diseases, L Sacco Hospital, AN-Polo Universitario L Sacco, Via GB Grassi 74, 20157 Milan, Italy.
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Chesney MA, Neilands TB, Chambers DB, Taylor JM, Folkman S. A validity and reliability study of the coping self-efficacy scale. Br J Health Psychol 2006; 11:421-37. [PMID: 16870053 PMCID: PMC1602207 DOI: 10.1348/135910705x53155] [Citation(s) in RCA: 409] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Investigate the psychometric characteristics of the coping self-efficacy (CSE) scale, a 26-item measure of one's confidence in performing coping behaviors when faced with life challenges. DESIGN Data came from two randomized clinical trials (N1=149, N2=199) evaluating a theory-based Coping Effectiveness Training (CET) intervention in reducing psychological distress and increasing positive mood in persons coping with chronic illness. METHODS The 348 participants were HIV-seropositive men with depressed mood who have sex with men. Participants were randomly assigned to intervention and comparison conditions and assessed pre- and post-intervention. Outcome variables included the CSE scale, ways of coping, and measures of social support and psychological distress and well-being. RESULTS Exploratory (EFA) and confirmatory factor analyses (CFA) revealed a 13-item reduced form of the CSE scale with three factors: Use problem-focused coping (6 items, alpha=.91), stop unpleasant emotions and thoughts (4 items, alpha=.91), and get support from friends and family (3 items, alpha=.80). Internal consistency and test-retest reliability are strong for all three factors. Concurrent validity analyses showed these factors assess self-efficacy for different types of coping. Predictive validity analyses showed that residualized change scores in using problem- and emotion-focused coping skills were predictive of reduced psychological distress and increased psychological well-being over time. CONCLUSIONS The CSE scale provides a measure of a person's perceived ability to cope effectively with life challenges, as well as a way to assess changes in CSE over time in intervention research.
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Affiliation(s)
- Margaret A Chesney
- National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, MD 20892-2182, USA.
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43
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Heckman TG, Barcikowski R, Ogles B, Suhr J, Carlson B, Holroyd K, Garske J. A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Ann Behav Med 2006; 32:27-38. [PMID: 16827627 DOI: 10.1207/s15324796abm3201_4] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND By 2015, the Centers for Disease Control and Prevention predicts that 50% of all cases of HIV/AIDS in the United States will be in persons 50 years of age or older. PURPOSE This pilot research tested whether a 12-session, coping improvement group intervention delivered via teleconference technology could improve life quality in 90 middle-age and older adults living with HIV/AIDS. METHOD This research used a lagged-treatment control group design. Forty-four HIV-infected persons 50-plus years of age participated in a coping improvement group intervention immediately after study enrollment, whereas 46 individuals received the intervention after their time-matched immediate treatment participants completed the intervention. Participants completed self-administered surveys that assessed depressive and psychological symptoms, life-stressor burden, ways of coping, coping self-efficacy, and loneliness. RESULTS Outcome analyses indicated that, compared to their delayed treatment counterparts, immediate treatment participants reported fewer psychological symptoms, lower levels of life-stressor burden, increased coping self-efficacy, and less frequent use of avoidance coping. After receiving the intervention, delayed treatment participants reported greater coping self-efficacy and less psychological symptomatology, life-stressor burden, and loneliness. However, the intervention demonstrated little ability to reduce depressive symptoms in this sample of HIV-infected older adults diagnosed with depression. CONCLUSIONS Although findings from this research suggest that telephone-delivered, coping improvement group interventions have potential to facilitate the adjustment efforts of HIV-infected older adults, more rigorous evaluations of this intervention modality for this group are needed.
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Remien RH, Stirratt MJ, Dognin J, Day E, El-Bassel N, Warne P. Moving From Theory to Research to Practice. J Acquir Immune Defic Syndr 2006; 43 Suppl 1:S69-78. [PMID: 17133206 DOI: 10.1097/01.qai.0000248340.20685.7d] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a dearth of evidence on the relative efficacy of intervention modalities to improve and maintain patient adherence to antiretroviral medications. Although empiric findings from research on HIV/AIDS, other diseases, and chronic medical conditions consistently demonstrate that social support plays an important role in facilitating adherence, few HIV/AIDS interventions have directly targeted this factor. Ewart's social action theory emphasizes the role of social relationships in behavior change and provides a comprehensive and useful guide to the development of interventions for adherence. We describe the development, content, and testing of SMART Couples, an effective antiretroviral adherence intervention that is grounded in social action theory and designed to enhance social support for ART adherence. Finally, we discuss some of the challenges of translating findings from the randomized clinical trial of this intervention into clinical practice and offer recommendations for integration of lessons learned into ongoing clinical care.
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Affiliation(s)
- Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University New York, NY 10032, USA.
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Stirratt MJ, Remien RH, Smith A, Copeland OQ, Dolezal C, Krieger D. The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS Behav 2006; 10:483-93. [PMID: 16721505 DOI: 10.1007/s10461-006-9106-6] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined the relationship between HIV serostatus disclosure and adherence to antiretroviral therapy (ART). The study was conducted with 215 HIV-seropositive patients who demonstrated poor adherence (<80%) and who were in serodiscordant relationships. Participants completed self-report measures regarding HIV serostatus disclosure and reasons for missing ART doses, as well as electronic monitoring of ART adherence (MEMS caps). Overall, 19% of the sample reported missing medication doses in the last two months due to concerns regarding serostatus disclosure. Participants who reported greater serostatus disclosure to others demonstrated higher rates of adherence, and this relationship remained after controlling for other explanatory variables. The relationship between disclosure and adherence was not mediated by practical support for adherence from others. Interventions to improve ART adherence should address the role of serostatus disclosure by providing patients with skills to maintain adherence in contexts of non-disclosure and to make informed choices regarding selective disclosure.
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Affiliation(s)
- Michael J Stirratt
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York 10032, USA.
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Ko CH, Yen CF, Yen JY, Yang MJ. Psychosocial impact among the public of the severe acute respiratory syndrome epidemic in Taiwan. Psychiatry Clin Neurosci 2006; 60:397-403. [PMID: 16884438 DOI: 10.1111/j.1440-1819.2006.01522.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
During the 2003 outbreak, severe acute respiratory syndrome (SARS) spread to more than 30 countries. Not only did it cause severe health problems but it also imposed a great psychological impact on the public. SARS emerged in Taiwan during April 2003. This study investigates the psychosocial impact and the associated factors of depression of the SARS epidemic in Taiwan when the epidemic had just been controlled. A total of 1552 respondents were recruited in the study by random selection from the telephone book. Demographic data, SARS experience, self-perceived health state, neighborhood relationships, and depression were surveyed by telephone interviewing. Respondents were grouped as 'impacted group' and 'non-impacted group' according to whether they or their friends and family had been quarantined, or suspected of being infected. The psychosocial impact and associated factors were compared between the two groups. The 'impacted group' had higher depressive levels, poorer neighborhood relationships, poorer self-perceived health, and a higher economic impact than the 'non-impacted group'. The poorer self-perceived health and economic impact factors were associated with depression. The neighborhood relationship factor was negatively associated with depression for the 'impacted group', but not for the 'non-impacted group'. The 'impacted group' had experienced greater psychosocial impact possibly due to the SARS impact, the economic downturn, poor self-perceived health conditions, and decreased social support systems. An appropriate mental health intervention to improve the self-perceived health condition, to provide instrumental and psychological support for the 'impacted group', and to decrease the stigmatization and discrimination from the public could have buffered the psychological impact from this epidemic disaster.
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Affiliation(s)
- Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
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Bucciardini R, Murri R, Guarinieri M, Starace F, Martini M, Vatrella A, Cafaro L, Fantoni M, Grisetti R, Monforte AD, Fragola V, Arcieri R, Del Borgo C, Tramarin A, Massella M, Lorenzetti D, Vella S. ISSQoL: A New Questionnaire for Evaluating the Quality of Life of People Living with HIV in the HAART Era*. Qual Life Res 2006; 15:377-90. [PMID: 16547775 DOI: 10.1007/s11136-005-3212-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people in the era of highly active antiretroviral therapy (HAART). METHODS The self-administered questionnaire was developed by an Italian network including researchers, physicians, people living with HIV, national institutions and community-based organizations (CBO) through several steps: (1) review of existing HRQoL literature and questionnaires for HIV-infected people; (2) selection of relevant domains measuring HRQoL in HIV-infected people, and identification of new domains related to new aspects of HRQoL concerning HAART-treated individuals; (3) conduction of two pre-test analyses in independent groups of Italian HIV-positive people (n approximately =100) distributed throughout the country. The objectives of the first pre-test were to verify the usefulness of the questionnaire, to construct a form easily understandable by everyone, to define the domains and their significance; the second pre-test aimed at evaluating and reshaping the questionnaire based on a statistical analysis of the outcomes of first pre-test; (4) validation analysis. A large cohort of people with HIV infection was recruited for the last step. RESULTS The internal consistence reliability (Cronbach's alpha) was >or=0.70 for all domains. Most domains had Cronbach's coefficient >0.80. All domains demonstrated convergent and discriminant validity. The final version of ISSQoL includes two sections: HRQoL Core Evaluation Form (9 domains) and Additional Important Areas for HRQoL (6 domains). The ISSQoL was administered together with two additional forms: a Daily Impact of Symptoms Form and a Demographic Information Form. The Additional Important Areas for HRQoL include social support, interaction with medical staff, treatment impact, body changes, life planning, and motherhood/fatherhood. CONCLUSION The data reported in the present paper provide preliminary evidence of the reliability and validity of the ISSQoL questionnaire for the measurement of HRQoL in HIV-infected people. The direct involvement of HIV-positive people in all the phases of the project was a key aspect of our work.
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Affiliation(s)
- R Bucciardini
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy.
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Parsons JT, Rosof E, Punzalan JC, Di Maria L. Integration of motivational interviewing and cognitive behavioral therapy to improve HIV medication adherence and reduce substance use among HIV-positive men and women: results of a pilot project. AIDS Patient Care STDS 2005; 19:31-9. [PMID: 15665633 DOI: 10.1089/apc.2005.19.31] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Directly addressing HIV medication adherence and substance use together is ideal in light of the research on the complex connections between these two behaviors. This paper describes the development of a pilot program in which a combined motivational interviewing and cognitive behavioral therapy intervention was used to increase adherence to highly active antiretroviral therapy (HAART) and reduce substance use in HIV-infected adults. The main goals of the pilot study were (1) to confirm the ability to recruit HIV-positive substance users taking HAART; (2) to demonstrate the ability to retain participants over the course of an eight-session intervention; and (3) to examine changes in substance use and HAART adherence from pretreatment to posttreatment. Twelve HIV-positive adults with a substance use disorder participated in an 8-week intervention, which consisted of weekly individual sessions with a trained therapist. Results showed that despite the small sample size, there was a significant reduction in substance use from pretreatment to posttreatment. No statistically significant differences were found for changes in HIV medication adherence, but the trends suggest the potential for positive results with a larger sample. Retention for all eight sessions of the treatment was 73.3%. Eighty percent completed the 3-month follow-up assessment. Participants reported high therapeutic alliance reflecting comfort with their therapists and in the treatment. Overall, the pilot demonstrated feasibility and acceptability of the treatment. Furthermore, results suggest that this may, in fact, be an effective intervention to reduce substance use and improve HIV medication adherence.
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Affiliation(s)
- Jeffrey T Parsons
- Hunter College of the City University of New York, New York, New York 10021, USA.
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49
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2003; 18:1149-56. [PMID: 14870737 DOI: 10.1002/gps.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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50
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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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