Stephen E. Karpiak

Loneliness and HIV-related stigma explain depression among older HIV-positive adults

Abstract Advances in the treatment of HIV have resulted in a large growing population of older adults with HIV. These aging adults face added social, psychological, and physical challenges associated with the aging process. Correlations between depression, loneliness, health, and HIV/AIDS-related stigma have been studied, but there is little evaluation of these associations among HIV-positive adults over the age of 50. Data for these analyses were taken from the Research on Older Adults with HIV study of 914 New York City-based HIV-positive men and women over the age of 50. In total, 39.1% of participants exhibited symptoms of major depression (CES-D>23). Multivariate modeling successfully explained 42% of the variance in depression which was significantly related to increased HIV-associated stigma, increased loneliness, decreased cognitive functioning, reduced levels of energy, and being younger. These data underscore the need for service providers and researchers to assert more aggressive and innovative efforts to resolve both psychosocial and physical health issues that characterize the graying of the AIDS epidemic in the USA. Data suggest that focusing efforts to reduce HIV-related stigma and loneliness may have lasting effects in reducing major depressive symptoms and improving perceived health.

Comorbidities and depression in older adults with HIV

OBJECTIVE To investigate whether the high rates of depression found in older adults living with HIV are associated with the number and types of comorbidities. METHODS The Research on Older Adults with HIV (ROAH) study collected self-reported health data on ~1000 New York City HIV-positive men and women aged 50 years and older. Participants provided data on health problems experienced in the past year and depressive symptomatology (Center for Epidemiological Studies Depression Scale (CES-D)). Data were analysed using a non-parametric test of association and multiple regression analysis. RESULTS The correlation between CES-D scores and number of comorbidities was significant (r=0.24). In multivariate analyses, depression remained a significant covariate of the number of comorbid conditions, in addition to female gender, inadequate income, history of drug and alcohol use, AIDS diagnosis and self-rated health. Correlations of depression with specific comorbidities varied. Significant correlations with sensory loss and dermatological problems were observed. Significant correlations existed with heart and respiratory conditions as well as fractures, but the directionality of these cross-sectional relationships is uncertain. CONCLUSIONS The findings suggest the need for further longitudinal research to understand how high rates of depressive symptoms are related to comorbidities. Focussed clinical care that strives to prevent the collapse of the immune system must evolve into an effective treatment strategy for multimorbidities, where HIV is but one of many other chronic illnesses. If the management of depression continues to be a low priority, the older person with HIV may experience an avoidable reduction in life expectancy.

Social Care Networks and Older LGBT Adults: Challenges for the Future

Research on service needs among older adults rarely addresses the special circumstances of lesbian, gay, bisexual, and transgender (LGBT) individuals, such as their reliance on friend-centered social networks or the experience of discrimination from service providers. Limited data suggests that older LGBT adults underutilize health and social services that are important in maintaining independence and quality of life. This study explored the social care networks of this population using a mixed-methods approach. Data were obtained from 210 LGBT older adults. The average age was 60 years, and 71% were men, 24% were women, and 5% were transgender or intersex. One-third was Black, and 62% were Caucasian. Quantitative assessments found high levels of morbidity and friend-centered support networks. Need for and use of services was frequently reported. Content analysis revealed unmet needs for basic supports, including housing, economic supports, and help with entitlements. Limited opportunities for socialization were strongly expressed, particularly among older lesbians. Implications for senior programs and policies are discussed.

Service Utilization Among Older Adults With HIV: The Joint Association of Sexual Identity and Gender

This study examines the association of sexual identity and gender among older clients with HIV at an AIDS service organization using the Andersen Model. Data confirm those aging with HIV exhibit high rates of age-associated illnesses 10 to 20 years before expected. They have fragile social networks that cannot supply the informal supports needed. This aging population will need to increasingly access community-based services. Sexual identity and gender were weak covariates of service utilization. Although heterosexual men used more services, utilization was largely predicted by service needs and the use of case management. Implications for service delivery and policy are discussed.

“I'm Created in God's Image, and God Don't Create Junk”: Religious Participation and Support Among Older GLBT Adults

There is an emerging literature on the integration of sexual and religious identities among gay, lesbian, bisexual, and transgender (GLBT) adults. However, this work has not assessed the experiences of GLBT adults 50 and older, whose life course issues and social care needs are different than younger members of this population. Using qualitative methods, we explored the religious engagement of 210 older GLBT adults, and examined the support received from their religious congregations. Results identified intrinsic and extrinsic adaptational strategies that facilitate high levels of religious engagement, as well as considerable congregational support. Implications for research and practice are discussed.

HIV-Related Stigma as a Mediator of the Relation Between Multiple-Minority Status and Mental Health Burden in an Aging HIV-Positive Population

Cross-sectional analyses of 904 diverse men and women aged 50 years and older living with HIV in New York City were conducted to examine the unique experiences and needs of aging HIV-positive individuals. Using Minority Stress Theory and Syndemic Theory as guiding paradigms, the authors documented the mental health burdens of the sample with regard to depression, loneliness, and diminished psychological well-being and examined how multiple-minority status and HIV-related stigma explained these burdens. Mediation modeling demonstrated that the effects of minority stressors on mental health burden were mediated by HIV-related stigma. The mediation was significant for the overall sample and for the male subsample. Results suggest that to fully address the mental health burdens experienced by aging HIV-positive individuals, we must continue to address mental health burdens directly, and at the same time, look beyond the psychiatric symptoms to address the structural inequities faced by individuals based on their multiple-minority status.

Religious Congregations and the Growing Needs of Older Adults with HIV

By 2015, half of those with HIV will be over age 50. This group has a high level of needs, lacks social supports, and will need to access community services such as those provided by religious congregations. We examined whether disclosure to a congregation would pose a barrier to accessing congregational services among adults 50 and older with HIV (n = 819). Fifty-three percent had disclosed, but those who did not disclose generally remained engaged with their congregations. Findings suggest that congregations can be a feasible source of support for older adults with HIV.

Stigma and Psychological Well-being Among Older Adults With HIV: The Impact of Spirituality and Integrative Health Approaches

Purpose of the Study The National Institutes of Health calls for research that explores what it means to age optimally with HIV/AIDS as half of the U.S. people with HIV are aged 50 or older. This study applied the stress process model to examine the association between HIV stigma and psychological well-being and mediating resources (i.e., spirituality and complementary and integrative health [CIH]) approaches) in older adults with HIV. Design and Methods Using data from the Research on Older Adults with HIV (ROAH) study, structural equation modeling was used to estimate these relationships within a latent variable model. Namely, a direct negative association between HIV stigma and psychological well-being was hypothesized that would be mediated by spirituality and/or CIH use. Results The analyses showed that the model fits the data well [χ2 (137, N = 914) = 561.44, p = .000; comparative fit index = .964; root mean square error of approximation = .058, 95% confidence interval = .053 to .063]. All observed variables significantly loaded on their latent factor, and all paths were significant. Results indicated that spirituality and CIH use significantly mediated the negative association between HIV stigma and psychological well-being. Implications Findings highlight the importance of spiritual and CIH interventions for older adults with HIV/AIDS. Practice recommendations are provided at the micro- and mesolevel.

Psychosocial and Demographic Correlates of Drug Use in a Sample of HIV-Positive Adults Ages 50 and Older

The prevalence of HIV among adults 50 and older in the USA is increasing as a result of improvements in treatment and detection of HIV infection. Substance use by this population has implications for physical and mental health outcomes. We examined patterns of demographics, mental health, and recent substance use in a diverse sample of heterosexual, bisexual, and gay adults 50 and older living with HIV/AIDS (PLWHA) in New York City. The most commonly used substances were cigarettes or alcohol; however, the majority of the sample did not report recent use of marijuana, poppers, or hard drugs (crystal methamphetamine, cocaine, crack, heroin, ecstasy, GHB, ketamine, and LSD or PCP). Statistically significant associations between substance use and psychological states (well-being and loneliness) were generally weak, and depression scores were not significantly related to use; instead, drug use was associated with gender/sexual orientation. The study observations support addressing substance use specific to subpopulations within PLWHA.

Training senior service providers about HIV and aging: Evaluation of a multiyear, multicity initiative.

ABSTRACT The Centers for Disease Control and Prevention estimate that in 2015, one half of all people living with HIV in the United States will be older than age 50. Older adults remain sexually active, and 16% of all new HIV diagnoses occur in adults age 50 and older. However, older adults rarely see themselves at risk for HIV/AIDS, and physicians are frequently reluctant to discuss sex. To address the issue of aging and HIV, ACRIA created its National Older Adults with HIV (NOAH) technical assistance and capacity-building program. NOAH targets aging and HIV providers that serve older adults at risk for or living with HIV. Program goals include increasing knowledge, reducing stigma, and creating partnerships between senior service providers (SSPs) and HIV service providers. In its first 4 years, NOAH training was provided to 150 organizations in eight cities across the United States, reaching 332 agency staff. Outcome evaluation found significant increases in knowledge about HIV and aging, and programmatic impact with regard to integration of older adults and HIV information in participating agencies’ activities. Ongoing issues included recruiting SSPs and difficulties in reaching agencies that participated for short- and long-term follow-up. Implications for workforce development are discussed.