No One Is Immune: A Community Education Partnership Addressing HIV/AIDS and Older Adults

There has been a dramatic increase in the number of new HIV diagnoses among people aged 50 to 64 in the United States, and according to the Centers for Disease Control and Prevention (CDC), in just 7 years (by 2015) 50% of those living with AIDS will be aged 50 or older. To address this public health concern, viable HIV/AIDS prevention and treatment options for individuals over the age of 50 are necessary. This article discusses the No One Is Immune initiative that planned, implemented, and coordinated evidence- based HIV/AIDS prevention and education programs specifically tailored for middle-aged and older adults. Guided by the health belief model, an educational conference entitled "Sexuality, Medication, and HIV/AIDS in Middle and Later Adulthood" was conducted along with research activities that assessed HIV/AIDS knowledge gained using both qualitative and quantitative measures. This project can be replicated by other providers within the aging network.     

Knowledge and Attitudes About HIV/AIDS Among Community-Living Older Women: Reexamining Issues of Age and Gender

ABSTRACT

Although older women face unique risks related to HIV/AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.     

中国老年艾滋病的流行状况分析

艾滋病在中国的迅速流行已是不争的事实,但是人们普遍认为“艾滋病是年轻人的病”。调查资料显示,50岁及以上的老年艾滋病病毒感染者报告人数已达到全国感染者的1/10,并呈快速增长趋势。老年感染人群的主要感染渠道以既往有偿献血感染为主。老年艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人增多无论对家庭还是对社会均产生严重的后果,在艾滋病预防和控制战役中,老年是一个不可忽略的人群,应引起高度重视。     

Community Cleavages: Gay and Bisexual Men’s Perceptions of Gay and Mainstream Community Acceptance in the Post-AIDS,Post-Rights Era

Changes in gay and bisexual men’s connectedness to the gay community are related to the declining public visibility of HIV/AIDS and greater acceptance for homosexuality and bisexuality in mainstream society. Little work, however, has focused on perceived acceptance for subgroups within the gay community or broader society. Using interviews (n = 20) and a survey (n = 202) of gay and bisexual men in a mid-sized Canadian city, we find perceived hierarchies of acceptance for the various subgroups as well as an age effect wherein middle-aged men perceive the least acceptance for all groups. These differences are linked with the uneven impact of social, political, and institutional changes relevant to gay and bisexual men in Canada.     

PrEP Awareness in the Context of HIV/AIDS Conspiracy Beliefs Among Black/African American and Hispanic/Latino MSM in Three Urban US Cities

ABSTRACT

We examined HIV conspiracy beliefs and PrEP awareness in a convenience sample of minority MSM. Participants in three cities completed a behavioral self-assessment on sociodemographics, PrEP awareness, and HIV/AIDS conspiracy beliefs. HIV/AIDS conspiracy beliefs were more common among Black than Latino MSM (58% vs. 42%, p < .05), and among younger men than older men (age 18–29 (50%), 30–39 (22%), 40+ (28%); p < .05). PrEP awareness co-occurred with conspiracy belief less (37%) than with non-belief (63%, p < .05), persisting in multivariable regression (aOR = 0.52, 95% CI = 0.38–0.71). This relationship suggests that current HIV care and prevention messaging is either inaccessible or not credible to some minority subpopulations.     

Internalized Homophobia,HIV Knowledge,and HIV/AIDS Personal Responsibility Beliefs: Correlates of HIV/AIDS Discrimination among MSM in the Context of Institutionalized Stigma

ABSTRACT

There exists a paucity of research on the psychosocial risk factors of HIV/AIDS among men who have sex with men (MSM) in settings where they are stigmatized or face prosecution. The present study investigates discrimination against people living with HIV (PLHIV), internalized homophobia, HIV/AIDS personal responsibility beliefs and HIV knowledge in a purposive sample of 106 self-identified MSM obtained through a web-based survey disseminated by two voluntary welfare organizations. Results indicate that internalized homophobia is positively associated with discrimination against PLHIV. Internalized homophobia also substantially mediates the effect of HIV/AIDS personal responsibility beliefs on discrimination against PLHIV, highlighting the confounded nature of HIV/AIDS and homosexual stigma in a setting where stigma is deep-rooted and institutionalized. Internalized homophobia may thus serve as a barrier to the effectiveness of HIV prevention efforts among MSM in Singapore.     

Gay Theatre,AIDS, and Taboo: Reconsidering Robert Chesley

Theatre was among the first popular culture forms to address HIV/AIDS and did so memorably in such works as The Normal Heart, As Is, Love! Valor! Compassion!, and March of the Falsettos. As a response to criticisms of stage dramas focusing on HIV/AIDS in the main as undifferentiated and melodramatic, the author suggests critical consideration of two works by playwright Robert Chesley. In her analysis of Night Sweats and Jerker, the author argues Chesley offers an alternative perspective that is both liberatory and sex-positive.     

Theory-Based Policy Development for HIV Prevention in Racial/Ethnic Minority Midlife and Older Women

ABSTRACT

In 2008, there were more than a million persons with HIV/AIDS in the United States. The CDC (2007) estimates that 15% of persons with HIV/AIDS are over age 50. At greater risk are women of color. Most intervention efforts have focused on intrapersonal aspects of an individual and his or her sexual-risk behaviors, with little or no attention directed toward interpersonal and socioenvironmental considerations of risk and prevention. This paper considers the limitations of current national policies relating to HIV prevention in minority populations, especially among midlife and older women of color. In particular, this paper examines risk and prevention policies in light of ecological perspectives, social capital, and dialogical theories.     

SHORT REVIEWS

Book reviewed in this article: Richard L. Harris (ED.) Globalization and Development in Latin America. David Henley Fertility, Food and Fever: Population, Economy and Environment in North and Central Sulawesi, 1600–1930. Nie Jing ‐Bao Behind the Silence: Chinese Voices on Abortion. Dudley L. Poston and Michael Micklin (EDS.) Handbook of Population. United Nations Department of Economic and Social Affairs , Population Division World Mortality Report 2005. UN Millennium Project Task Force ON HIV/AIDS, Malaria , TB, and Access to Essential Medicines , Working Group on HIV/AIDS Combating AIDS in the Developing World.     

Knowledge and attitudes about HIV/AIDS among community-living older women: reexamining issues of age and gender

Although older women face unique risks related to HIV/ AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.     

The United Nations on the Demographic Impact of the AIDS Epidemic

A report prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and released in Geneva on 27 June 2000 (just prior to the XIIIth International AIDS Conference held in Durban, South Africa) updates estimates of the demographic impact of the epidemic. It characterizes AIDS in the new millennium as presenting “a grim picture with glimmers of hope”—the latter based on the expectation that national responses aimed at preventing and fighting the disease are in some places becoming more effective. According to the report, which emphasizes the considerable statistical weaknesses of its global estimates, the number of people living with HIV/AIDS in 1999 was 34.3 million (of which 33.0 million were adults and 1.3 million were children under age 15; slightly less than half of the adults affected, 15.7 million, were women). Deaths attributed to AIDS in 1999 amounted to 2.8 million, bringing the total since the beginning of the epidemic to 18.8 million. These figures represent moderate upward revisions of earlier UN estimates shown in the Documents section of PDR 25, no. 4. The revised estimate of the number of persons newly infected with HIV in 1999 is, in contrast, slightly lower: 5.4 million, of which 4.7 million were adults and 2.3 million were women. An excerpt from the 135‐page Report on the Global HIV/AIDS Epidemic, focusing on countries in the worst‐affected area, sub‐Saharan Africa, is reproduced below. (Figures shown have been renumbered.)     

Sexuality and HIV/AIDS: An Exploration of Older Heterosexual Women's Knowledge Levels

Sexuality research tends to ignore older populations, and little is known about older women's sexual health knowledge. To fill this research gap, 186 Canadian heterosexual women 50 years and older were surveyed about their knowledge regarding sexuality and HIV/AIDS. Respondents had moderate levels of overall knowledge of sexual health and aging, correctly answering, on average, 60% of the 35 questions. They had lower levels of HIV/AIDS knowledge, correctly answering just over 50% of the 25 questions. Results indicate the need for social awareness and education in this group regarding both general sexual health later in life and HIV/AIDS.     

Life Satisfaction of Middle-Aged and Older Chinese: The Role of Health and Health Insurance

The Chinese government has launched a series of health reforms to establish universal health insurance coverage, particularly for vulnerable groups, including middle-aged and older adults. However, the current public health insurance system is highly fragmented, consisting of different programs with different levels of premiums and benefits. We analyse whether the universal health insurance system increases the life satisfaction of middle-aged and older Chinese people and to what extent the type of health insurance affects the life satisfaction of this group. Our study is based on data from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal survey of Chinese aged 45 and above, in 2011, 2013, and 2015. We find that the life satisfaction of middle-aged and older adults does not depend on having any health insurance coverage but varies with the type of health insurance coverage, controlling for potential confounding variables such as health status, occupation, hukou status, and other demographic variables. Individuals covered by the most generous program, the Government Medical Insurance, reported a higher life satisfaction. In comparison, individuals covered by the Urban Employee Medical Insurance, the Urban Resident Medical Insurance, and the New Rural Cooperative Scheme reported a lower life satisfaction by 0.155, 0.106, and 0.112 standard deviations, respectively. Our results suggest that establishing a more equitable health insurance system should be the next step in health reforms in China.

     

Attitudes and Stereotypes Regarding Older Women and HIV Risk

Persons aged 50 years and over will soon disproportionately represent the future of the HIV/AIDS epidemic. It is estimated that by 2015 older adults will represent 50% of persons living with HIV in the United States. Despite the HIV/AIDS growing population among older adults, attitudes, beliefs, and stereotypes toward older adults that exist in general society have affected HIV prevention, education, and care. Specifically, ageist attitudes about the sexuality of older adults in general and older women in particular, low clinical HIV suspicion among healthcare providers, lack of knowledge about risk among older women, and differentials in power related to negotiating sexual practices all lead to heightened concerns for the prevention, identification, and treatment of HIV disease in mature women. This article examines common attitudes, beliefs, and stereotypes that exist within general society as well as health and social service providers that place older women at a disadvantage when it comes to HIV prevention, education, and treatment.     

Socioeconomic status, sexual behavior, and differential AIDS mortality: evidence from Côte d’Ivoire

Lack of knowledge about differential AIDS mortality seriously hampers the study of the economic impact of AIDS in developing countries. We derive HIV infection risk differentials by age, education, and other microeconomic characteristics using the Ivorian Demographic and Health Survey. Our model is based on econometrically estimated equations using commonly available variables, therefore it can be used whenever such a survey is available but there is no representative information about HIV infection by socioeconomic group. For instance, we found that educated people have a higher risk of HIV infection, because they are more likely to have several sexual partners. However, this effect is partly offset by a higher probability of condom use relative to less educated people. The identification of the socioeconomic characteristics of low and high risk groups seems indispensable to set up adequate AIDS prevention and therapy policies in developing countries.

流动人口行为特征及其空间过程与HIV/AIDS扩散

流动人口的行为特征及其空间过程是HIV/AIDS扩散的重要因素之一,其行为特征的高危性和流动性使流动人口成为HIV/AIDS的易感人群,在其流动的空间过程中与不同类型人口的相互接触,当发生与HIV/AIDS人群的高危行为时,一方面容易使自己感染HIV;另一方面,流动人口成为HIV携带者后与其他人发生高危行为则会成为HIV的传染源之一,其结果是导致了HIV/AIDS在感染者数量和感染空间上的扩散。因而,针对流动人口高危行为特征及其空间过程提出防控HIV/AIDS扩散的对策是可行的。     

How to Be a Healthy Homosexual: HIV Health Promotion and the Social Regulation of Gay Men in the United Kingdom

ABSTRACT

Primary Objective: Health promotion has arisen as the main response to the problem of HIV prevention among gay men. Using the linked concepts of governmentality and health promotion as a neoliberal disciplinary technology, this article argues that health promotion in the time of AIDS has contributed to new forms of social regulation and governance for gay men. Methods and Procedures: This article presents an analysis of data from a study of U.K. HIV health promotion for gay men (interviews with health promoters and analyses of health promotion materials). Conclusions: This analysis of health promotion is helpful in describing an emerging form of governance dependent on incentive rather than censure (censure, pathology and “cure” are how we traditionally describe the use of medical knowledge in the regulation of homosexuality).     

Defying,producing, and overlooking stereotypes? The complexities of mobilizing “grandmotherhood” as political strategy

ABSTRACT

This article explores the Canadian Grandmothers to Grandmothers Campaign, a mobilization of older women responding to the effects of HIV/AIDS in sub-Saharan Africa. Based on interviews, participant observation, and archival work, this article looks at how and to what effect “grandmotherhood,” as discourse, was mobilized and deployed, in fluid and fractured ways, in order to increase members’ credibility as global social justice actors and build their solidarity with African women. These mobilizations functioned to uphold essentialist notions of what being a grandmother means, while also challenging stereotypes of older women as frail and disengaged.