Community-Based Collaboration in Support of Older Persons

This study describes the processes for community-based collaboration in support of the older person living in the world of HIV/AIDS in South Africa. Secondary data from study from 333 older persons (> 60 years) and 28 leaders of community agencies of and for health and wellbeing were thematically analyzed. Findings suggest that older persons are resources in community partnership for ameliorating the impact of HIV and AIDS. This would be the case even as the older people may be living with HIV or AIDS.     

The Impacts of the HIV/AIDS Pandemic and Socioeconomic Development on the Living Arrangements of Older Persons in Sub-Saharan Africa: A Country-Level Analysis

This study investigates whether socioeconomic development and the HIV/AIDS pandemic are associated with living arrangement patterns in older persons in 23 sub-Saharan African countries. Country-level aggregate data were taken from previous household surveys and information provided by the United Nations, the World Bank, and the World Health Organization. Results showed that 13.5% of older persons (aged 60 years or over) were living with grandchildren but not adult children (i.e., skipped generation households). Countries higher in HIV/AIDS prevalence had more skipped generation households, and also more older persons living with spouse only and fewer older persons living with other relatives. Countries with higher socioeconomic development had fewer older persons living with children younger than 25 years old and more living with spouse only or with other relatives and unrelated persons. The pandemic and socioeconomic development combine to accelerate the breakdown of the extended family structure so that older persons are less and less likely to reside with, and to receive support from, their children.     

The effects of HIV disease and older age on laboratory-based,naturalistic, and self-perceived symptoms of prospective memory: does retrieval cue type and delay interval matter?

There is a rising prevalence of older HIV+ adults who are at risk of deficits in higher order neurocognitive functions and associated problems in everyday functioning. The current study applied multiprocess theory to examine the effects of HIV and aging on measures of laboratory-based, naturalistic, and self-perceived symptoms of prospective memory (PM). Participants included 125 Younger (48 with HIV, age = 32 ± 4.6 years) and 189 Older (112 with HIV, age = 56 ± 4.9 years) adults. Controlling for global neurocognitive functioning, mood, and other demographics, older age and HIV had independent effects on long-delay time-based PM in the laboratory, whereas on a naturalistic PM task older HIV? adults performed better than older HIV+ adults and younger persons. In line with the naturalistic findings, older age, but not HIV, was associated with a relative sparing of self-perceived PM failures in daily life across longer delay self-cued intervals. Findings suggest that, even in relatively younger aging cohorts, the effects of HIV and older age on PM can vary across PM delay intervals by the strategic demands of the retrieval cue type, are expressed differently in the laboratory and in daily life, and are independent of other higher order neurocognitive functions (e.g., retrospective memory).     

HIV-related stigma among market workers in China.

HIV-related stigma was examined among 209 employees and owners of stalls in 5 markets in an eastern coastal city in China. Of the participants 53% were women and 47% were men; 100% were Han. Ages ranged from 18 to 49 years (M=35, SD=8.1). Half of the participants believed that punishment was an appropriate response toward those living with HIV (50%). Over half (56%) were unwilling to be friends with infected individuals. The majority thought that those living with HIV should be isolated (73%). They agreed that persons living with HIV should not take care of other people's children (85%). Punishing beliefs toward persons living with HIV were related to being male, older, married, less educated, and unwilling to be tested for HIV.     

the relationship between pain and coping styles among hiv-positive men and women

Abstract

Pain in HIV/AIDS patients is associated with compromised quality of life and emotional adjustment. Although previous findings support a relationship between coping styles and subjective pain for various groups of chronically-ill persons, little research has examined the associations between coping and pain in HIV-positive or AIDS patients. The purpose of this study was to explore the relationship between pain and coping styles among 105 HIV-positive participants (32 women and 73 men) in a randomized clinical trial designed to examine the effect of group psychotherapy on quality of life and health behavior. Participants completed the Brief COPE, the pain scale from the Medical Outcomes Study-HIV, and a demographic and medical questionnaire. Multiple regression analysis, with pain as the dependent variable, showed that participants who reported coping through denial reported greater pain severity (p < 0.0001). These results suggest that denial as a coping strategy appears to be signficantly associated with pain for persons with HIV/AIDS. However, further research is necessary to determine the causal relationship between pain and coping through denial. These findings also point to the possibility of psychological intervention in order to modify maladaptive coping styles and to ameliorate pain in this population.     

Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: preliminary results from a community survey.

Widespread Internet use has revolutionized health information and patient education for persons with chronic illnesses. The authors surveyed 147 HIV-positive persons to examine factors associated with Internet use and associations between Internet use and health. Information, motivation, and behavioral skills associated with using the Internet were related to Internet use. The authors found that health-related Internet use was associated with HIV disease knowledge, active coping, information seeking coping, and social support among persons who were using the Internet. These preliminary findings suggest an association between using the Internet for health-related information and health benefits among people living with HIV/AIDS, supporting the development of interventions to close the digital divide in HIV/AIDS care.     

Quality of life and affect in older persons: Hope, time frames, and training effects

This is a preliminary report of a project designed to increase hope and quality of life (QOL) in older persons through a series of five training sessions. The training sessions for the experimental groups are based on research on happiness, goal imagery, and time management. Data indicates that the training is effective in increasing expected QOL. Several measures of affect and stress are examined as a function of three time frames of self-reported QOL. Daily uplifts are significantly related to present and future QOL while measures of stress and major life changes are not. Correlations of affective measures with QOL tend to increase from time frames of the past five years through the present to the next five years, indicating the relevance of hope for older persons. Training for increased hope works with older persons. Data obtained in the process is used to address theoretical models of QOL in older persons. This project was supported by a grant from the American Association of Retired Persons Andrus Foundation.     

Application of a modified health belief model to hiv preventive behavioral intentions among gay and bisexual men

Abstract

The utility of a modified health belief model (Janz and Becker, 1984) for predicting the intention to use condoms was tested in a study among gay and bisexual men. The model explained a reasonable amount of variance. It was found that younger men's decision to have safe sex was guided by factors other than those that influenced older men. Among younger men, the intention to use a condom was positively related to the relative number of persons with AIDS in their social environment (cues to action) and to the perceived benefits of HIV preventive behavior. Among older men, this behavioral intention was much more determined by their perception of the prevalence of HIV and by their perception of their vulnerability to HIV infection. These findings are important because they may partly explain the recent increase in AIDS-risk behavior among young gay and bisexual men. The discussion focuses on these findings and on the implications for interventions aimed at promoting safe sex.     

An Investigation of Quality of Life of the Elderly in South Africa, with Specific Reference to Mpumalanga Province

This paper is based on a research study that investigated the quality of life of elderly persons (aged 60 years and over) in South Africa in the wake of population aging, HIV/AIDS, the process of modernization which ushered in new challenges and the legacy of apartheid. A combination of all these factors among others has played a major role in lowering the quality of life of senior citizens in South Africa. For effective measurement purposes, a conceptual framework of broad categories of quality of life indicators for this proportion of the population are identified as: household structure, social inclusion, care of older persons and care burden on the elderly. Under these broad categories we investigate such specific indicators as: general health; satisfaction with basic needs of food, clothing and housing; emotional well-being; and their environmental harmony regarding access to amenities of transport, sanitation, safe water and security. The influence of socio-demographic factors on the above indicators is also examined. The long term goal of the study is to provide guidance for more creative policies including strategies of poverty reduction, housing older people in a dignified way and providing a wide range of options that facilitate healthy aging, in so doing, catering for the best interests and needs of senior citizens in South Africa. A representative sample of size 900 randomly selected elderly persons in Mpumalanga Province, South Africa is used. Structured interviews and direct observation are used to collect data, and bivariate statistical analyses performed.     

Perceived importance of services for persons with AIDS: recipient, family, caregiver, and public differences

596 adults from a moderately sized community in central California were divided into four groups (person with HIV or AIDS, friend or relative, caregiver or service provider for such a person, or member of the general public) and completed a schedule assessing their perceptions of the importance of 36 items related to potential services for persons with HIV or AIDS. Factor analysis of these items yielded in six constructs (Counseling, Medical, Assistance, Homecare, Adjunct/Auxiliary, and Nontraditional), accounting for 65.0% of the variance. Over-all, regardless of group membership, Medical Services were perceived as of highest importance, but differences were found across all groups regarding Assistance Services and Nontraditional Services for persons with AIDS. Implications and suggestions for research are discussed.     

Are Transgender Persons at Higher Risk for HIV Than Other Sexual Minorities? A Comparison of HIV Prevalence and Risks

SUMMARY

Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and nontransgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either nontransgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts.     

The Neuropsychology of HIV/AIDS in Older Adults

Highly active antiretroviral therapy is allowing increasing numbers of adults to age with HIV. The neuropsychological effects of aging with HIV are reviewed through three types of studies. First, the separate effects of HIV and aging on cognition are examined in studies that compare younger adults with HIV with neurologically normal older adults. Second, studies examine the impact of aging within samples of adults with HIV only. Third, providing the most critical evidence, are studies that assess cognition in younger and older adults with HIV relative to younger and older adults without HIV. In general research findings are inconclusive. Large individual differences among older adults with HIV as well as co-factors (APOE4 and detectable viral load) may account for inconsistent findings in the literature. A subgroup of older adults with HIV may be at greater risk for cognitive impairment, especially in attention functioning.     

Effects of Gender, Age, and Education on Assertiveness in a Nigerian Sample

Two hundred fourteen (214) married persons, 101 men and 113 women aged 20–60, with at least high school education, participated in the study which investigated the effects of gender, age, and educational attainment on assertiveness among married persons in Nigeria. The Assertive Behavior Assessment scale (ABAS; Onyeizugbo, 1998 ) was used to measure assertiveness. It was hypothesized that persons with higher educational attainment will report more assertiveness than persons with lower educational attainment. Results supported the hypothesis. In addition, interactions between gender and age, and gender and educational attainment were found. Younger men reported more assertiveness than younger women whereas older women reported more assertiveness than older men. Also, women participants of lower educational attainment reported more assertiveness than their men counterparts whereas men of higher educational attainment reported more assertiveness than their women counterparts. Results of this study suggest that women in Nigeria may become more assertive with age.     

Personality Dysfunction, Coping Styles, and Clinical Symptoms in Younger and Older Adults

This study examined age-related differences in personality disorders, dispositional coping strategies, and clinical symptoms between younger (n = 79; age range = 18–29; M age = 21.2 years) and older (n = 79; age range = 55–89; M age = 65.5 years) persons (matched on gender and ethnicity). Participants completed the Coolidge Axis II Inventory (CATI), Coping Orientations to Problems Experienced Scale (COPE), and Brief Symptom Inventory (BSI). Personality results (t tests) based on the CATI revealed that older persons were significantly more obsessive–compulsive and schizoid than younger adults but significantly lower on 7 scales, including antisocial, borderline, histrionic, and sadistic. As assessed by the COPE, older adults reported lower levels of dysfunctional coping strategies than younger adults. Specifically, older persons were less likely to use mental disengagement, venting of emotions, and alcohol/drugs to cope with problems. BSI results for clinical symptoms revealed that younger adults were significantly higher on 5 of 9 scales, including anxiety, depression, and hostility. Results suggest that younger adults experience higher levels of personality and clinical symptoms and use more dysfunctional coping strategies than older adults, dispelling the myth that old age is associated with inevitable psychological impairment. Theoretical considerations, clinical implications, and future research ideas are discussed.     

Religion,sexuality, and (in)equality in the lives of older lesbian,gay, and bisexual people in the United Kingdom

This article explores how older lesbian, gay, and bisexual (LGB) people in the United Kingdom engage with religion in later life. Drawing on research with older persons who are LGB and with activists, it explores religious spaces as sites of both inclusion and exclusion, historically and in the present day. Particular consideration is given to the equality implications, in the form of parity of participation, including in the context of religious-based social care provision for older people. Future research implications are addressed.     

The Role of Male Sexual Partners in HIV Infection Among Male-to-Female Transgendered Individuals

SUMMARY

Male-to-female transgendered persons (MtF) in San Francisco have very high HIV prevalence and incidence. To explore possible sources for these high rates of HIV infection, a rapid needs assessment was conducted using two methods: (1) an interviewer-administered, mostly closed-ended survey with the male partners of MtF persons, and (2) focus groups with MtF persons. Five main themes were evident from the findings: (1) male partners of MtF persons are of all ages, races, sexual orientations, and socioeconomic backgrounds; (2) high-risk sex occurs between MtF persons and their male sexual partners, despite a high level of concern about HIV among both the male and MtF study participants; (3) drug use appears to play a role in unsafe sex between MtF and their male partners; (4) male partners of MtF persons may represent a possible bridge for HIV transmission among different populations, given that they reported sex with male and female partners, as well as transgendered partners; and (5) men engaging in receptive anal sex with MtF partners probably occurs more frequently than reported by the male participants, given the comments of MtF study participants. The results indicate a need for creative, community-based HIV prevention strategies that target the male partners of MtF transgendered persons.     

The effects of stressful life events,coping, and cortisol on HIV infection

What is the role of stress and coping in changes in immunologic and clinical indicators of human immunodeficiency virus disease progression? There is substantial evidence that stressful life events and passive coping strategies, such as denial, may have a detrimental effect on HIV disease progression. Given the harmful effects of stress and passive coping, the author reviews the limited research testing the efficacy of interventions, such as cognitive-behavioral therapies for HIV-infected persons. Finally, in trying to understand psychoimmune relationships in HIV, the evidence is examined for the mediating and direct effects of cortisol, a hormone associated with stress, on HIV disease progression. Delineating the role of psychosocial factors and cortisol on HIV disease progression may aid in the development of new interventions for this devastating disease.     

Emotional distress in nonmetropolitan persons living with HIV disease enrolled in a telephone-delivered, coping improvement group intervention.

The study delineated depressive symptoms and modeled emotional distress in persons living with HIV disease in nonmetropolitan areas of 13 U.S. states. Participants (N=329) were enrolled in a randomized clinical trial of a telephone-delivered, coping improvement group intervention, and 60% reported moderate or severe levels of depressive symptomatology on the Beck Depression Inventory. Structural equation modeling indicated that participants who experienced more severe HIV symptomatology, received less social support, and engaged in more avoidant coping also experienced more emotional distress (a latent construct comprising depressive symptoms and emotional well-being). Greater HIV-related stigma and rejection by family led to more emotional distress, with social support and avoidant coping mediating almost entirely the effects of the former 2 variables. The model accounted for 72% of the variance in emotional distress in nonmetropolitan persons living with HIV disease.