Colette M. Vallee

Mental Health and HIV

Publisher Summary This chapter discusses the distinction between mental-health problems that existed prior to human immunodeficiency virus (HIV) infection and those with post-HIV onset. Pre-existing problems are conceptualized as producing or contributing to risk behavior and thus to HIV infection; postinfection mental-health problems may also interfere with treatment for HIV and contribute to infection of others. The mental health and HIV/AIDS literature, some studies of older adults, the West-central Florida Older Adult project findings, treatment issues, and suicide factors are reviewed. Considering the tremendous number of stressors that people living with HIV (PLWHIV) must deal with and the high prevalence of mood disorders, suicide is a reasonable concern with this population. Psychiatric morbidity, alcohol and drug abuse, and behavioral disorder have also been viewed as risk factors for suicide. There is no disagreement that mental-health problems, disorders, and psychological distress are highly prevalent among both PLWHIV and people at risk for HIV infection. Even though suicide rates among PLWHIV are not clear, this issue is a serious concern for a variety of reasons. The chapter lists recommendations and encourages increased investment of resources in the prevention programs.

The Experience of Older Adults Living with HIV

This chapter depicts graphically the diversity of older people impacted by human immunodeficiency virus (HIV) disease and the varied responses that they may have to their diagnosis. It is based on extensive and relatively unstructured narrative interviews with 15 older people living with HIV (PLWHIV), and provides a personal glimpse of the impact the HIV diagnosis has on their lives. The chapter opens with a biographical overview of the participants, followed by excerpts from their interviews, reflecting the range of their experiences pertaining to frequently mentioned aspects of living with HIV. The participants described the circumstances leading them to testing and their initial responses to the HIV diagnosis. Although at the time of their diagnosis, most of the participants had little understanding of HIV disease and what it might mean for them, they shared a sense that they had somehow become tainted or diminished because of it. The narrative research participants experienced a high degree of anxiety at the time of their HIV diagnosis. A number of specific issues were mentioned by the participants as being particularly stressful as they confront life as an older adult with HIV disease.

HIV/AIDS in Middle-Aged and Older Adults: A Research Response

The chapter presents a case study of an individual infected by human immunodeficiency virus (HIV).. It illustrates a number of issues that have been raised while working with older people living with HIV disease (PLWHIV). It states that postdiagnosis, many older people are too often found forced to live their lives in a manner that differs greatly from the way they had planned—their reality often falls far short of the dreams toward which they worked throughout their careers. People who are considered to be middle-aged are often at the greatest risk of economic hardship after an HIV diagnosis. In the ≥ 40 age groups, which capture the age range of 45 and older, AIDS cases have increased steadily from 30.9% of the total cases diagnosed between 1981 and 1987 to 41.8% of the total cases diagnosed between 1996 and 2000. The increasing incidence and prevalence of HIV/AIDS among older people are likely to continue into the future because of a number of factors. HIV disease in older adults mostly stems from sexual behavior and this aspect of their lives needs to be addressed with older adults if further transmission of the virus is to be halted.

HIV/AIDS in Middle-Aged and Older Adults

The chapter presents a case study of an individual infected by human immunodeficiency virus (HIV).. It illustrates a number of issues that have been raised while working with older people living with HIV disease (PLWHIV). It states that postdiagnosis, many older people are too often found forced to live their lives in a manner that differs greatly from the way they had planned—their reality often falls far short of the dreams toward which they worked throughout their careers. People who are considered to be middle-aged are often at the greatest risk of economic hardship after an HIV diagnosis. In the ≥ 40 age groups, which capture the age range of 45 and older, AIDS cases have increased steadily from 30.9% of the total cases diagnosed between 1981 and 1987 to 41.8% of the total cases diagnosed between 1996 and 2000. The increasing incidence and prevalence of HIV/AIDS among older people are likely to continue into the future because of a number of factors. HIV disease in older adults mostly stems from sexual behavior and this aspect of their lives needs to be addressed with older adults if further transmission of the virus is to be halted.

People of Color

The HIV epidemic in the United States has heavily impacted people of color, particularly Blacks/African-Americans and Latinos/Hispanics. This chapter focuses on the impact of HIV disease on these groups, with major emphasis on the ways in which culturally competent outreach, prevention, and treatment programs can be designed to reach them. The chapter cites examples of strategies and programs that have been effective in reaching African-Americans and Hispanics. The primary reasons for the lower socioeconomic status (SES) of older African-Americans are patterns of limited employment opportunities and periods of unemployment throughout their lives. They have been concentrated in low-paying, sporadic service jobs with few benefits and no coverage by Social Security prior to the 1950s. The African-American participants in the survey project were found to be severely socioeconomically disadvantaged. The chapter addresses the barriers to effective outreach among African-Americans and the challenges associated with providing HIV-related services for Hispanic populations.Publisher Summary The HIV epidemic in the United States has heavily impacted people of color, particularly Blacks/African-Americans and Latinos/Hispanics. This chapter focuses on the impact of HIV disease on these groups, with major emphasis on the ways in which culturally competent outreach, prevention, and treatment programs can be designed to reach them. The chapter cites examples of strategies and programs that have been effective in reaching African-Americans and Hispanics. The primary reasons for the lower socioeconomic status (SES) of older African-Americans are patterns of limited employment opportunities and periods of unemployment throughout their lives. They have been concentrated in low-paying, sporadic service jobs with few benefits and no coverage by Social Security prior to the 1950s. The African-American participants in the survey project were found to be severely socioeconomically disadvantaged. The chapter addresses the barriers to effective outreach among African-Americans and the challenges associated with providing HIV-related services for Hispanic populations.

People of Color: HIV Prevention and Treatment Issues

The HIV epidemic in the United States has heavily impacted people of color, particularly Blacks/African-Americans and Latinos/Hispanics. This chapter focuses on the impact of HIV disease on these groups, with major emphasis on the ways in which culturally competent outreach, prevention, and treatment programs can be designed to reach them. The chapter cites examples of strategies and programs that have been effective in reaching African-Americans and Hispanics. The primary reasons for the lower socioeconomic status (SES) of older African-Americans are patterns of limited employment opportunities and periods of unemployment throughout their lives. They have been concentrated in low-paying, sporadic service jobs with few benefits and no coverage by Social Security prior to the 1950s. The African-American participants in the survey project were found to be severely socioeconomically disadvantaged. The chapter addresses the barriers to effective outreach among African-Americans and the challenges associated with providing HIV-related services for Hispanic populations.Publisher Summary The HIV epidemic in the United States has heavily impacted people of color, particularly Blacks/African-Americans and Latinos/Hispanics. This chapter focuses on the impact of HIV disease on these groups, with major emphasis on the ways in which culturally competent outreach, prevention, and treatment programs can be designed to reach them. The chapter cites examples of strategies and programs that have been effective in reaching African-Americans and Hispanics. The primary reasons for the lower socioeconomic status (SES) of older African-Americans are patterns of limited employment opportunities and periods of unemployment throughout their lives. They have been concentrated in low-paying, sporadic service jobs with few benefits and no coverage by Social Security prior to the 1950s. The African-American participants in the survey project were found to be severely socioeconomically disadvantaged. The chapter addresses the barriers to effective outreach among African-Americans and the challenges associated with providing HIV-related services for Hispanic populations.

Chapter 10 – Older Adult Sexuality and HIV

This chapter reviews sexual changes that take place during the aging process, cultural issues related to older-adult sexuality, and psychosocial matters that impact sexuality and vulnerability to infection. A survey conducted by Starr and Weiner (1981) concerning feelings about the sexual activities of older adults revealed that older people defined and expressed their sexuality in more diffuse and varied ways than did younger cohorts. Older people who lack knowledge about normal age-related changes in sexual functioning may adopt societal attitudes about sexual activity in later life, thus experiencing anxiety regarding sexual expression. The constraints that society imposes on the sexual freedom of older people are particularly evident in elder-care institutions. Older residents who display any form of sexual expression should not be regarded as having a behavioral problem, but as expressing a normal function of their sexuality. The institution has become their home and they should be afforded the privacy to engage in sexual practices. The chapter reviews the effects of the aging process on sexuality, along with some of the associations between older-adult sexuality and HIV disease.

Overview of the Biomedical Aspects of HIV and Its Impact on Older Adults

This chapter presents a review of the basics of human immunodeficiency virus (HIV) infection, beginning with the natural history of the infection and including HIV disease classifications. It includes a brief look at some of the common opportunistic infections (OIs) and conditions that may result from HIV infection. HIV testing and counseling procedures are described, along with key features in disease monitoring, followed by an overview of the changes in HIV disease and its treatment over time. The chapter concludes with a discussion on the biomedical impact and challenges of HIV as it affects older adults. The assumption that older adults are not at risk for HIV may result in either misdiagnosis or delayed diagnosis of illness and subsequently, in delayed treatment. Late diagnosis of HIV and age-related decreases in immune function, as well as the presence of other health conditions (comorbidities), appear to negatively affect survival among older adults. In spite of the obvious need for a fuller understanding of HIV as it affects older adults, older PLWHIV have been largely ignored in clinical research studies on HIV disease and its treatment.

Findings from the West Central Florida Survey of Middle-Aged and Older Adults with HIV Disease

This chapter offers information on face-to-face survey interviews with 172 people living with HIV (PLWHIV), 45 years of age and older. The important findings include high levels of education in the cohort of older PLWHIV in combination with dramatically low current-income levels and high rates of poverty; high rates of historical risk events and behavior; high HIV-related stressor rates; marked ethnic differences in income and stressors; high rates of mental-health symptoms; and strong relationships between stress factors and mental-health symptoms. A number of socioeconomic status (SES) indicators were analyzed, including education levels, sources and levels of income, and household characteristics. A higher proportion of African-American PLWHIV than Whites indicated that their closest friends did not know of their HIV infection, which is a socially distancing phenomenon. The PLWHIV reported rates of depression, anxiety, hostility, and stress symptoms 7–15 times greater than people in the general population. Nearly half of the cohort reported severe emotional symptoms of one kind or another.

HIV-Related Stressors, Coping, and Social Support

This chapter focuses on a detailed discussion of stress, coping, and social-support issues. It reports findings from the HIV/AIDS research literature on stress, coping, and social support. It mentions that particularly during the past five years, stress and coping have been increasingly of interest to researchers in the HIV/AIDS field. Some research has indicated that older adults are less inclined than others to utilize effective coping strategies. A limited number of studies of middle-aged and older people living with HIV (PLWHIV) are reviewed. Findings from the West-central Florida HIV/AIDS survey project on stressors, coping strategies, and social support are discussed, which is stated to be typically consistent with general research literature and the HIV/AIDS research literature on stress, coping, and social support.. The chapter reflects on the issues related to the quality of life with which the PLWHIV struggle, mentioning that the middle and older PLWHIV had experienced significant decreases in annual income, had relatively low incomes, and a high proportion was living in poverty. The chapter concludes with suggested strategies for improving services and outcomes for older adults facing HIV disease.