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Protective and risk factors associated with stigma in a population of older adults living with HIV in Ontario, Canada
- Authors:
- EMLET Charles A., et al
- Journal article citation:
- AIDS Care, 25(10), 2013, pp.1330-1339.
- Publisher:
- Taylor and Francis
Although the deleterious effects of HIV stigma are well documented, less is known about how various types of stigma impact older adults living with HIV disease and what factors exacerbate or lessen the effects of HIV stigma. Using cross-sectional data from the OHTN cohort study (OCS), we undertook multiple linear regression to determine the predictors of overall HIV stigma, and enacted, anticipated, and internalised stigma subscales in a sample of OCS participants age 50 and over (n=378). Being female, heterosexual, engaging in maladaptive coping, and having poor self-rated health were associated with greater overall stigma while being older, having greater mastery, increased emotional-informational social support, and a longer time since HIV diagnosis were associated with lower levels of stigma. The final model accounted for 31% of the variance in overall stigma. Differences in these findings by subscale and implications for practice are discussed. (Publisher abstract)
Knowledge and use of AIDS and aging services by older, HIV-infected adults
- Author:
- EMLET Charles A.
- Journal article citation:
- Journal of HIV/AIDS and Social Services, 3(1), 2004, pp.9-24.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This American study of 41 adults, age 50 and over with HIV/AIDS, compared the knowledge and use of services commonly available from the HIV network as well as the ageing network. The study sample had similar knowledge of HIV services and services designed for older adults. These individuals, however, used a significantly higher number of services provided through the HIV network (mean of 2.61 services) compared to the aging network (mean of .68 services). Predictors for service use varied across systems. While the primary predictor of HIV service use was awareness, Medicaid eligibility and living arrangements were predictive of use of services from the aging network.
‘I'm happy in my life now, I'm a positive person’: approaches to successful ageing in older adults living with HIV in Ontario, Canada
- Authors:
- EMLET Charles A., et al
- Journal article citation:
- Ageing and Society, 37(10), 2017, pp.2128-2151.
- Publisher:
- Cambridge University Press
Worldwide approximately 3.6 million people aged 50 and older are living and ageing with the human immunodeficiency virus (HIV). Few studies have explored successful ageing from the insider perspective of those living well and ageing with HIV. This study draws upon the lived experience and wisdom of older, HIV-positive adults living in Ontario, Canada in order to understand their views and strategies for successful ageing. This qualitative study involved semi-structured interviews with 30 individuals age 50 years and older who are HIV-positive. Purposive sampling techniques were used to recruit individuals who shared their experiences of successful ageing. Constructivist grounded theory coding techniques were used for analysis. Themes related to successful ageing included resilience strategies and challenges, social support and environmental context. Stigma and struggles to maintain health were identified as impediments to successful ageing. Models of successful ageing must take into account the potential for a subjective appraisal of success in populations suffering from chronic and life-threatening illnesses including HIV. Practitioners can draw upon organically existent strengths in this population in order to provide intervention development for older adults around the world who are struggling to manage their HIV. (Publisher abstract)
Extending the use of the 40-item HIV-stigma scale to older adults: an examination of reliability and validity
- Author:
- EMLET Charles A.
- Journal article citation:
- Journal of HIV/AIDS and Social Services, 6(3), 2007, pp.43-54.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The original testing of the 40-item stigma scale developed by Berger et al. included very few older people but the need for appropriate measurement instruments has been heightened by the survival of people with HIV/AIDS to older ages, and also by new infections in people over 50. The scale was administered to 25 older adults (mean age 56.1 years) who also completed a semi-structured questionnaire about their views on how well the scale captured their experience of stigma. The scale, and its four sub-scales, showed excellent internal consistency and good convergent validity with the CES-D depression scale. Sixty-four respondents felt that it did a good job in capturing their experiences of stigma, or offered suggestions for improvement. The author concludes that the scale appears to maintain its integrity when used with older people. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
"You're awfully old to have this disease": experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS
- Author:
- EMLET Charles A.
- Journal article citation:
- Gerontologist, 46(6), December 2006, pp.781-790.
- Publisher:
- Oxford University Press
Older adults living with HIV infection may be doubly stigmatized, as they are branded by both age as well as HIV status. Through semi structured interviews, this study sought to examine whether older adults with HIV/AIDS experience both ageism and HIV stigma and how those experiences manifest in their lives. Twenty-five in-depth interviews were completed with adults aged 50 years and older who were living with HIV or AIDS in the United States. Purposive sampling was used to recruit these individuals who shared their experiences. Open coding and axial coding of interview transcripts were completed on all interviews, resulting in the development of a framework of these experiences. The majority (68%) of the respondents experienced both ageism and HIV-associated stigma. The experiences were often separate, although some interrelated stigma did occur. Nine themes emerged from the interviews, including rejection, stereotyping, fear of contagion, violations of confidentiality, and internalized ageism. All themes fell into four categories: social discrimination, institutional discrimination, anticipatory stigma, and other. The research identified themes that may be sources of felt as well as enacted stigma and discrimination related to both aging and HIV. This concept of double jeopardy exists in the lives of the majority of people interviewed and has relevance to the creation of appropriate intervention strategies.
Case managing older people with AIDS: bridging systems - recognizing diversity
- Author:
- EMLET Charles A.
- Journal article citation:
- Journal of Gerontological Social Work, 27(1/2), 1996, pp.55-71.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Discusses the issues facing older people with AIDS in the USA and explores whether older adults use AIDS/HIV services differently to the younger population. Findings revealed that individuals of 50 years of age and older were less likely to use emotional support services and mental health services that the population over 50. Caregivers with ageing related problems, ageing related diseases, difficulty with social support and disclosure of sexual orientation were consistent themes found among a sample of cases of persons over 50 with AIDS.
Bouncing back: resilience and mastery among HIV-positive older gay and bisexual men
- Authors:
- EMLET Charles A., et al
- Journal article citation:
- Gerontologist, 57(Suppl 1), 2017, pp.S40-S49.
- Publisher:
- Oxford University Press
Purpose of the Study: Adults with HIV infection are living into old age. This study examines HIV-related factors, adverse conditions, and psychosocial characteristics that are associated with resilience (the ability to bounce back) and mastery (sense of self-efficacy) to determine factors associated with psychological well-being. Design and Methods: 2014 data from the longitudinal study Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) were analyzed, focusing on a subsample of 335 gay and bisexual older men. Multivariate linear regression was used to identify factors that contributed or detracted from resilience and mastery in the sample recruited from 17 sites from across the United States. Results: Resilience and mastery were independently associated with psychological health-related quality of life. In multivariate analysis, adjusting for demographic characteristics, previous diagnosis of depression was negatively associated with resilience. Time since HIV diagnosis was positively associated with mastery whereas victimization was negatively associated with mastery. Social support and community engagement were positively associated with both resilience and mastery. Implications: Individual and structural-environmental characteristics contributed to resilience and mastery. These findings can be used to develop interventions incorporating an increased understanding of factors that are associated with both resilience and mastery. (Edited publisher abstract)
"I'm not going to die from the AIDS": resilience in aging with HIV disease
- Authors:
- EMLET Charles A., TOZAY Shakima, RAVEIS Victoria H.
- Journal article citation:
- Gerontologist, 51(1), February 2011, pp.101-111.
- Publisher:
- Oxford University Press
This paper on the resilience and strengths of 25 men and women (aged 50-72) living with HIV AIDS in the USA advocates the use of resilience theory and the strengths perspective in research and practice with regard to ageing with HIV AIDS. Despite the potential deleterious effects of HIV AIDS, some participants described positive, lived experiences which they directly accredited to the disease. Semi-structured interviews and data analysis revealed seven themes including: self- acceptance and management; optimism and will to live; generativity; relational living; and independence. Overcoming fears of stereotyped attitudes to HIV AIDS had helped participants to be optimistic about living with the disease and increased their will to live. Some hoped to give back to community and society through advocacy and education for younger generations. The benefits of relational living and previous and ongoing family and peer support for participants were cited as important. However, self-management and independence were also highlighted as key. The authors stress the importance of resilience and strengths to the lives of older people with HIV AIDS. They call for research on larger cohorts and the development of more robust assessment methodology to enable routine evaluation of resilience in the field by practitioners attending HIV AIDS patients.
An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS
- Author:
- EMLET Charles A.
- Journal article citation:
- Health and Social Work, 31(4), November 2006, pp.299-308.
- Publisher:
- Oxford University Press
This study examined social networks and social isolation in older (50 years or more) and younger (ages 20 to 39) adults with HIV/AIDS. The author conducted interviews with 88 individuals living with HIV/AIDS in the Pacific Northwest, USA. Both groups' social networks had similar patterns; however, older adults were more likely to live alone. More than 38 percent of older adults and 54 percent of older adults of color were at risk of social isolation compared with 25 percent of those 20 to 39 years of age. Older men and older adults of color had significantly lower scores on the social network scale than others. Having a confidant and receiving instrumental support were significantly correlated with reduced HIV stigma. Implications for social work practitioners are discussed.
Risk and protective factors associated with health-related quality of life among older gay and bisexual men living with HIV disease
- Authors:
- EMLET Charles A., FREDRIKSEN-GOLDSEN Karen I., KIM Hyun-Jun
- Journal article citation:
- Gerontologist, 53(6), 2013, pp.963-972.
- Publisher:
- Oxford University Press
Purpose: To identify risk and protective factors associated with mental and physical health-related quality of life, after controlling for key background characteristics, in a population of older gay and bisexual men living with HIV disease. Previous research examining quality of life among persons living with HIV rarely includes older adults. Design and Methods: Survey responses from 226 gay and bisexual men aged 50 and older, and living with HIV disease, which were part of the Caring and Aging with Pride study, were analysed using multivariate linear regression models. Results: Findings reveal that comorbidity, limitations in activities, and victimisation are significant risk factors for decreased physical and mental health-related quality of life. Stigma and HIV progression did not contribute to the overall outcome variables in multivariate models. Social support and self-efficacy serve as protective factors although social support was only significant with mental health-related quality of life. Implications: Comorbidity, functional limitations, and lifetime victimisation are risks to quality of life among older gay and bisexual men with HIV disease. Self-efficacy and social support represent intrapersonal and interpersonal resources that can be enhanced through interventions to improve health-related quality of life. (Publisher abstract)