Challenges of Depression and Suicidal Ideation Associated With Aging With HIV/AIDS: Implications for Social Work

As the number of older adults with HIV/AIDS increases, new challenges are emerging that threaten their ability to age with this disease. Threats of particular concern are depression and suicidal ideation. Studies show that those aging with HIV/AIDS have a number of stressors that tax their coping mechanisms, increasing vulnerability to depression and suicidal ideation. These stressors can be categorized into three areas. First, there are psychosocial stressors that can contribute to depression. Second, there are health and biochemical stressors that can contribute to depression, as well as compromise cognitive abilities needed to adapt to such stressors. Third, cognitive stressors may create predispositions to depression. In particular, certain cognitive abilities needed to cope with depression and suicidal ideation may be compromised by aging with HIV/AIDS. A model of these stressors is provided for didactic purposes, as well as to suggest implications for social work practice and research.     

Hardiness,Successful Aging,and HIV: Implications for Social Work

ABSTRACT

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.     

HIV/AIDS fifty and older: a hidden and growing population

Contrary to common belief, HIV and AIDS are prevalent in the older adult population. Currently, between ten to fifteen percent of HIV/AIDS new cases occur in individuals fifty and older (Chiao, Ries, & Sande, 1999). With the aging of the baby boomer generation, and the introduction of erectile dysfunction medications, such statistics are guaranteed to increase at alarming rates. This population also faces hazardous risk factors that increase its possibility of contracting the disease. Stereotypes and lack of information continue to limit older adults from receiving the medical, educational, and psychological attention they need to avoid and to combat the virus. This article discusses the rising trends in the fifty and older population as well as some of the factors that increase the prevalence of HIV/AIDS among this population. Prevention, assessment, and treatment practices are also outlined; if instituted, these interventions may help promote a significant reduction in the rate of HIV/AIDS infection in the older adult population.     

Too old to test? Prevalence and correlates of HIV testing among sexually active older adults

ABSTRACT

Older adults account for 17% of new HIV diagnoses in the US and are more likely to be diagnosed with HIV later in the course of the disease compared to younger people. We calculated the prevalence and associated factors of having ever been tested for HIV among sexually active older adults. We analyzed data from the 2008–2016 General Social Survey Limited to respondents ≥65 years of age who reported more than one sex partner(s) in past 12 months (n = 757). HIV testing prevalence, prevalence ratios, and 95% confidence intervals were calculated by demographic variables and HIV-related risk behaviors. An estimated 16.3% of sexually active older adults have tested for HIV, and 15.9% were at increased risk for HIV infection (reported injection drug and/or crack–cocaine use, exchanging money for sex, more than three sex partners in the past year, or men who reported having sex with another man). In the adjusted model, adults aged 65–70, not married, self-identified as gay/bisexual, and at increased risk for HIV infection were more likely to have tested for HIV. An estimated 83.7% of sexually active older adults never tested for HIV. Strategies are needed to increase HIV awareness and testing among potentially high-risk older adults.     

AIDS,the individual,family and community: psychosocial issues

Understanding of the psychosocial factors associated with acquired immunodeficiency syndrome (AIDS) at both the individual and societal levels is essential to the design of programs aimed at treating the virus and containing its spread. In Africa, AIDS has profound implications for economic development, the general quality of life, demographic patterns, male-female relationships, child development, and family structure. Relevant psychosocial issues include fear of the unknown and the tendency to depersonalize AIDS victims, burn-out on the part of caretakers, fear of contagion, fear of being around a dying person, helplessness, and anger. Poverty undermines coping capacities and pushes many families affected by AIDS into disorganization and crisis. Moreover, the shame and guilt associated with AIDS in Africa leads many families to isolate themselves from social support. Through trends such as the loss of skilled manpower to AIDS and a need for aging parents to reassume full care of infected adult children, AIDS has disrupted Africa's social system as well. Community education is essential to reduce fears related to living amidst those who are infected, sick, and dying and minimize the erosion of societal institutions.     

Beneath the Mask: A Group Therapy Model Supporting Children Infected With and Affected by HIV/AIDS

In 2007 a study was conducted to identify the outcomes of an activity-based psychosocial intervention called Leading the Way, a program designed for children infected with and/or affected by HIV/AIDS, based in Toronto, Canada. Qualitative and quantitative data showed that children who were unaware of the HIV status of their families experienced heightened anxiety and depression when compared to children who were aware of the presence of HIV in their families. Furthermore, data indicated that though the intervention positively influenced children's senses of self and their ability to cope and problem solve, deep social stigma surrounding HIV continued to profoundly affect the lives of these children. The ethical dilemmas involved in serving populations of children who have not been disclosed to regarding their own or a family members' HIV status came to light in the development of the program and are discussed in the analysis of data.     

Older Latina Women and HIV/AIDS: An Examination of Sexuality and Culture as they Relate to Risk and Protective Factors

Older Latina women are one of the least studied American demographic groups with regard to social, health, or sexual behavior. This could leave social workers and other geriatric professionals unprepared for dealing with HIV/AIDS in this population. Currently, older Latina women are one of the fastest growing groups of new AIDS cases. Twenty percent of all women ever diagnosed with the disease are Latina and 5.5% of Latinas infected with the virus are older. The number of diagnosed infections is increasing in older women, including Latinas, in spite of recent declines in infection rates with younger populations. There are also a potentially large number of cases that go misdiagnosed or undiagnosed.

This article also addresses risk and protective factors related to gender roles, traditional Latino family values, religion, socioeconomic factors, health, and health care, with special attention to the triple jeopardy faced by this population by virtue of being female, seniors, and minorities. The article concludes with recommendations for the development of culturally competent practices with older Latinas and the development of a research agenda to better understand their risk-related and health-seeking behavior.     

Resilience among older caregivers in rural Namibia: The role of financial status,social support and health

Background: Namibia has one of the highest human immunodeficiency virus (HIV) prevalence rates and one of the highest rates of orphanhood in the world, and older caregivers provide much of the care to Namibians living with HIV and acquired immune deficiency syndrome (AIDS) (UNAIDS, 2014). In this study, the authors explore how financial status, social support, and health were related to the resilience of caregivers caring for people affected by HIV and AIDS in rural northern Namibia, Africa. Method: Data were collected through a structured interview from (N = 147) caregivers from the Zambezi region. Results: Findings from this study show that employment and physical health were significantly associated with increased resilience in older caregivers. Discussion: Our findings point to the need for employment assistance and health services to improve the resilience of caregivers caring for people living with HIV and AIDS. We conclude that there is a need for more vigorous concerted efforts from public and private sector practitioners and policy makers to create more sustained formal employment opportunities and intervention programs aimed at improving the overall health of older HIV caregivers, especially those residing in rural HIV endemic communities in developing countries.     

Making sense of HIV/AIDS: Pascal de Duve and the sensitive historian of education1

ABSTRACT

Since the 1990s historians, in general, have increasingly engaged in critical analyses of the emergence and development of what has come to be known as ‘the HIV/AIDS pandemic’. Historians of education have also become interested in the role-played by education in the history of HIV/AIDS. Although the existing educational histories have successfully examined the multiple and far-reaching power structures that helped shape the educational responses to the disease, I will argue that their focus on ideological and geopolitical power structures runs the risk of losing sight of the crucial and often sensorial responses of individuals who have played a part in the educational history of HIV/AIDS. One such individual is the Flemish philosopher Pascal de Duve, who was diagnosed with HIV in 1989. De Duve’s particular approach to the disease clearly illustrate the importance of the senses in how people attributed particular meanings to HIV/AIDS. Knowing that this approach would prove surprising to both his readership and to his wider television audience, de Duve employed sensory experiences and modes of communication (for instance, gesture) to educative ends. I conclude that an intersensorial approach to the past will render historians of education more sensitive to unexpected personal responses towards HIV/AIDS to unexpected personal responses towards HIV/AIDS.     

Addressing risk factors of cognitive impairment in adults aging with HIV: a social work model

With advances in life-extending medications and later- life infections, the number of older adults with HIV is increasing. Unfortunately, the synergistic effects of aging with HIV may place many people at risk of developing cognitive impairments which can disrupt everyday functioning. Fortunately, cognitive reserve may be maintained, or in some cases improved, by taking action to prevent or mitigate such loss. Preventative and treatment strategies that support biopsychosocial aspects of cognition include reducing alcohol and substance use; improving nutrition; diminishing the effects of comorbidities; increasing social contact; reducing depression and stress levels; engaging in cognitively stimulating activities; applying cognitive remediation therapies; and incorporating psychopharmacological interventions. Such strategies can improve the physiological integrity and health of the brain, thus supporting neuroplasticity and increasing cognitive reserve. Social workers are in a favorable position to recognize cognitive decline in clients and recommend or administer solutions to address such problems. A model for social workers advocating for older clients with HIV who have cognitive problems is provided.     

Ageism: A Review of Research and Policy Implications

The current literature on aging and ageism is summarized in support of a theoretical perspective that includes both the biological and the psychosocial components of these processes. Conceptual and methodological problems are identified in models that rely on a deficit approach to aging. We suggest that the biased responses of others foster older adults' stress-related emotional and hormonal responses—responses that may effectively reduce their social and cognitive competence. This negative feedback process ultimately acts in a stereotype-maintaining fashion. Implications are drawn for possible changes in social policy and institutional practices that may reduce or prevent the harmful effects of ageism. Examples are given of existing policies and practices that limit the lives of older adults (in the guise of protection), along with newly instituted policies and practices (including those at an international level) that place the welfare of older adults in the context of life course issues shared by all.     

The Economic and Gender Consequences of South Africa's Home‐based Care Policy

South Africa's approach to care provision in the era of HIV/AIDS is home‐ and community‐based care, but in reality care for ill people in the home is provided on an unpaid basis, predominantly by women. But how much do they spend on this care work, in time and money? And what economic consequences does this policy have, particularly for poorer women? This article is based on findings from a study that focuses on unpaid care provision within the home for those in late‐stage HIV/AIDS in KwaZulu‐Natal, South Africa, and specifically on the costs of such provision. The findings show that female caregivers are bearing the bulk of the costs of care provision for ill people within the home on an unpaid basis. Home‐based care is cost‐effective for the provincial government but not for unpaid caregivers who are subsidizing the provincial economy. While hospital care for people with HIV/AIDS has been capped, home‐based care services have not been increased to a commensurate level. Unpaid caregivers and ill people within the home are largely disconnected from the health system. The analysis clearly shows that the home‐based care policy is not resulting in appropriate or sufficient support for these individuals in need and needs to be revised.     

SOURCES OF INFORMATION ABOUT HIV/AIDS,TRUST OF SOURCES AND PERCEIVED RISK OF INFECTION

The relationship between sources of information about AIDS/HIV, trust of the sources, how informed about AIDS people thought they were, and perceived risk to self and others were examined using three samples. One included young heterosexual students (113 females and 91 males), while the others included slightly older heterosexuals (74 females and 73 males) and homosexuals (82 males) from the general community. Homosexual men were the only group who trusted the same sources from which they received the most information (eg gay publications and AIDS organisations). Heterosexuals trusted expert sources the most, but the students received most information from magazines aimed at their peer groups and the heterosexuals in the community sample received most information from the print media. For the students, perceived personal risk was influenced most by perceived risk to male friends and people with the same sexual practices, whereas for the community samples it was influenced most by perceived risk to people with the same practices. The results suggest a strong peer influence on perceptions of personal risk of HIV infection.     

Experiences of Stigma and Spirituality of Older Black Men Living with HIV

Abstract

Previous research on HIV stigma and the use of spirituality by people living with HIV/AIDS is scarce. Moreover, the research with older Black men who have sex with men is scant. This study aimed to investigate experiences of HIV stigma and the use of spirituality among older HIV positive Black men who sleep with men. In-depth interviews were conducted with a sample of ten men. Data were analyzed utilizing to the modified van Kaam data analysis method. Three major themes were identified that explores the participants lived experiences with HIV stigma and use of spirituality: experiences of stigma reinforcing the use of spirituality; defining spirituality as a functional concept; and self-empowerment through the use of spirituality. The findings could guide social workers and other helping professionals in developing informed assessments and interventions regarding HIV stigma and the use of spirituality. Future qualitative and quantitative research is needed to achieve generalizable knowledge about the relationship between stigma on the use of spirituality.     

Impacts of HIV/AIDS on poor and socially marginalised former commercial plasma donors in rural central China: social work implications

Little is known about the impact of HIV/AIDS on people who acquired the virus through former commercial plasma donations in the mid-1990s in rural Central China. The objective of this study was to examine socioeconomic impacts associated with HIV/AIDS on poor farm workers and their families, with a particular focus on economic hardships and social exclusion. The findings from 30 interviews reveal the profound effects of deteriorating health on labour power loss. The well-being of people living with HIV/AIDS was immensely affected by the loss of income, debts due to health-related expenses and a lack of alternate sources of income. Social exclusion and HIV/AIDS-related stigma remain significant issues in a workplace, funerals, and weddings. This article highlights the economic impacts of HIV/AIDS on China’s rural population and provides recommendations for social workers to mitigate the impacts of social exclusion on vulnerable rural households in China.     

Evidence-based interventions with older adults: concluding thoughts

Taken collectively, the articles in this volume provide a method to assess psychosocial outcome research in aging. Although the outcome literature on effective interventions with older adults is uneven across condition and treatment approaches, there are some particular intervention methods that have received consistent research support. This article condenses the rich analyses presented by the volume authors and summarizes the interventions for which some evidence base exists by life issue/condition (health, mental health/cognitive and social rules) and outcomes achieved.     

Awareness of Resources for Visually Impaired Older Adults Among the Aging Network

Approximately 13% of the older adult population have severe near, intermediate and/or distance vision impairment. However, there is little recognition within the aging network that vision impairment among older adults can lead to isolation and excess disability. This article reports on a survey conducted by the Lighthouse National Center for Vision and Aging of the State Units on Aging (SUA) and Area Agencies on Aging (AAA) to assess their awareness of the vision rehabilitation network of services, their perceived need for more information on age-related vision loss and to identify specific projects known to or within the aging network addressing the needs of visually impaired older adults. Among the 298 respondent AAAs, 74% could identify at least one resource for visually impaired people, usually a segregated service offered exclusively to blind/visually impaired older adults. Eighty-three percent of the AAA respondents felt they needed to have more information on age-related vision impairment. The sparsity of programs within the aging network to address needs of visually impaired older persons is documented and discussed.     

Research with Older Adult Methadone Clients: The Importance of Monitoring Suicide Ideation

ABSTRACT

This study reports on the importance of monitoring suicide ideation among older adult research participants. A recently completed randomized controlled trial of older adults who are current clients in methadone maintenance treatment (MMT) served as a case study to elucidate a suicide protocol that was designed to account for the potential instances of suicide ideation within the research project structure. As the numbers of older adult heroin users increases, this study’s findings seek to influence research protocols that involve older adults with addictions who may be particularly vulnerable to suicide risk due to comorbid psychiatric conditions and psychosocial adversities.