Advertisement

Diversity, stigma, and social integration among older adults with HIV

  • Mark Brennan-Ing
Review
  • 6 Downloads

Abstract

The population of people with HIV is aging globally as access to anti-retroviral therapy becomes more widely available. The diversity of older population with HIV has an impact on their experiences of stigma. HIV stigma may be enacted or felt. Enacted stigma is the prejudice, discrimination, and mistreatment that individuals and societies use to sanction people with HIV. Felt stigma refers to the internalized feelings of shame, guilt, and fear that arise from enacted stigma. Nondisclosure is rooted in the fear of negative consequences of revealing one’s HIV status, such as losing a job, or being rejected by one’s social network. Stigma may also affect social integration through self-protective withdrawal to avoid anticipated stigma. In addition to facing HIV stigma, people with HIV may possess multiple discredited identities due to their race, ethnicity, gender identity, etc., which is described as intersectionality. Older age represents an additional intersectional identity that affects people with HIV through the experience of ageism. Stigma and discrimination from HIV or any discredited identity are linked to poorer physical and mental health outcomes. Given the pervasiveness of stigma, it is not surprising that many older adults with HIV are socially isolated and report greater self-perceived stigma compared to those who are more socially integrated. While there is evidence that HIV stigma has declined compared to previous eras, more research is needed on HIV stigma among older adults in low- and middle-income countries to design policies and programs to combat HIV stigma globally.

Keywords

Intersectionality Ageism Social isolation Physical health Mental health 

Notes

Acknowledgements

Thanks to Austin Gerhard Oswald, MA, and Erica Thomas, RN for their assistance with the literature review for this article. Thanks also to Jamie Frankenberg, LMSW for reviewing an earlier version of this article.

Compliance with ethical standards

Conflict of interest

The author has no conflict of interest to report regarding this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Samji H et al (2013) Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One 8(12):e81355CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    High KP et al (2012) HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. J Acquir Immune Defic Syndr (1999) 60(Suppl 1):1–18Google Scholar
  3. 3.
    Mahy M et al (2014) Increasing trends in HIV prevalence among people aged 50 years and older: evidence from estimates and survey data. AIDS (Lond Engl) 28(4):S453CrossRefGoogle Scholar
  4. 4.
    Brookmeyer R (1991) Reconstruction and future trends of the AIDS epidemic in the United States. Science 253(5015):37–42CrossRefPubMedGoogle Scholar
  5. 5.
    Piot P et al (2001) The global impact of HIV/AIDS. Nature 410(6831):968CrossRefPubMedGoogle Scholar
  6. 6.
    Dragon CN et al (2017) Transgender medicare beneficiaries and chronic conditions: exploring fee-for-service claims data. LGBT Health 4(6):404–411CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Operario D, Soma T, Underhill K (2008) Sex work and HIV status among transgender women: systematic review and meta-analysis. JAIDS J Acquir Immune Defic Syndr 48(1):97–103CrossRefPubMedGoogle Scholar
  8. 8.
    Brennan-Ing M, DeMarco RF (eds) (2017) HIV and aging. Interdisciplinary topics in gerontology, vol 42. Karger, Basel, SwitzerlandGoogle Scholar
  9. 9.
    Emlet CA (2007) Extending the use of the 40-item HIV-stigma scale to older adults: an examination of reliability and validity. J HIV/AIDS Soc Serv 6(3):43–54CrossRefGoogle Scholar
  10. 10.
    Goffman E (2009) Stigma: Notes on the management of spoiled identity. Simon and Schuster, New YorkGoogle Scholar
  11. 11.
    Barasch M (2013) Blindness: The history of a mental image in western thought. Routledge, LondonCrossRefGoogle Scholar
  12. 12.
    Emlet CA (2006) “You’re awfully old to have this disease”: experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. Gerontologist 46(6):781–790CrossRefPubMedGoogle Scholar
  13. 13.
    Emlet CA (2006) A comparison of HIV stigma and disclosure patterns between older and younger adults living with HIV/AIDS. AIDS Patient Care STDs 20(5):350–358CrossRefPubMedGoogle Scholar
  14. 14.
    Steward WT et al (2008) HIV-related stigma: adapting a theoretical framework for use in India. Soc Sci Med 67(8):1225–1235CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Poindexter CC, Shippy RA (2010) HIV diagnosis disclosure: stigma management and stigma resistance. J Gerontol Soc Work 53(4):366–381CrossRefPubMedGoogle Scholar
  16. 16.
    Brennan M, Strauss SM, Karpiak SE (2010) Religious congregations and the growing needs of older adults with HIV. J Religion Spiritual Aging 22(4):307–328CrossRefGoogle Scholar
  17. 17.
    Brennan M, Karpiak SE (2009) HIV stigma and disclosure of serostatus. In: Brennan M et al (eds) Older adults with HIV: an in-depth examination of an emerging population. Nova Science Publishers, New York, pp 51–60Google Scholar
  18. 18.
    Maeri I, El Ayadi A, Getahun M, Charlebois E, Akatukwasa C, Tumwebaze D, Itiakorit H, Owino L, Kwarisiima D, Ssemmondo E, Sang N, Kabami J, Clark TD, Petersen M, Cohen CR, Bukusi EA, Kamya M, Havlir D, Camlin CS, The SEARCH Collaboration (2016) “How can I tell?” Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV “test-and-treat” trial. AIDS Care 28(S3):59–66CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Geter A, Herron AR, Sutton MY (2018) HIV-related stigma by healthcare providers in the United States: a systematic review. AIDS Patient Care STDs 32(10):418–424CrossRefPubMedGoogle Scholar
  20. 20.
    Li L et al (2007) HIV-related stigma in health care settings: a survey of service providers in China. AIDS patient care and STDs 21(10):753–762CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Nyblade L et al (2009) Combating HIV stigma in health care settings: what works? J Int AIDS Soc 12(1):15CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Emlet CA (2017) Stigma in an aging context. HIV and aging. Karger Publishers, Basel, pp 144–158CrossRefGoogle Scholar
  23. 23.
    Valdiserri RO (2002) HIV/AIDS stigma: an impediment to public health. American Public Health Association, Washington, DCGoogle Scholar
  24. 24.
    Kingori C et al (2012) Impact of internalized stigma on HIV prevention behaviors among HIV-infected individuals seeking HIV care in Kenya. AIDS Patient Care STDs 26(12):761–768CrossRefPubMedGoogle Scholar
  25. 25.
    UNAIDS (2017) Confronting discrimination: Overcoming HIV-related stigma and discrimination in healthcare settings and beyond. Joint United Nations Programme on HIV/AIDS, Geneva, UNAIDSGoogle Scholar
  26. 26.
    Reece M et al (2007) The impact of HIV-related stigma on HIV care and prevention providers. J HIV/AIDS Soc Serv 6(3):55–73CrossRefGoogle Scholar
  27. 27.
    Jue S, Lewis SY (2001) Cultural considerations in HIV ethical decision making: a guide for mental health practitioners. In: Anderson JR, Barret RL (eds) Ethics in HIV-related psychotherapy: clinical decision making in complex cases. American Psychological Association, Washington, DC, US.  https://doi.org/10.1037/10399-004 CrossRefGoogle Scholar
  28. 28.
    Lichtenstein B, Laska MK, Clair JM (2002) Chronic sorrow in the HIV-positive patient: issues of race, gender, and social support. AIDS Patient Care STDs 16(1):27–38CrossRefPubMedGoogle Scholar
  29. 29.
    Turan B, Hatcher AM, Weiser SD, Johnson MO, Rice WS, Turan JM (2017) Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. AJPH 107(6):863–869CrossRefGoogle Scholar
  30. 30.
    Meyer IH (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 129(5):674CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Meyer IH (1995) Minority stress and mental health in gay men. J Health Soc Behav 36(1):38–56CrossRefPubMedGoogle Scholar
  32. 32.
    Porter KE, Brennan-Ing M (2019) The intersection of transgender identities, HIV, and aging. In: Hardacker C, Ducheny K, Houlberg M (eds) Transgender and gender nonconfirming health and aging. SpringerGoogle Scholar
  33. 33.
    Johnson Shen M, Freeman R, Karpiak S, Brennan-Ing M, Seidel L, Siegler EL (2018) The intersectionality of stigmas among key populations of older adults affected by HIV: a thematic analysis. Clin Gerontol.  https://doi.org/10.1080/07317115.2018.1456500 CrossRefPubMedGoogle Scholar
  34. 34.
    Storholm ED et al (2013) HIV-related stigma as a mediator of the relation between multiple-minority status and mental health burden in an aging HIV-positive population. J HIV/AIDS Soc Serv 12(1):9–25CrossRefGoogle Scholar
  35. 35.
    Thoreson RR (2014) Troubling the waters of a ‘wave of homophobia’: political economies of anti-queer animus in sub-Saharan Africa. Sexualities 17(1–2):23–42CrossRefGoogle Scholar
  36. 36.
    Levy SR, Macdonald JL (2016) Progress on understanding ageism. J Soc Issues 72(1):5–25CrossRefGoogle Scholar
  37. 37.
    Jönson H (2012) We will be different! Ageism and the temporal construction of old age. Gerontologist 53(2):198–204CrossRefPubMedGoogle Scholar
  38. 38.
    Wight RG et al (2015) Internalized gay ageism, mattering, and depressive symptoms among midlife and older gay-identified men. Soc Sci Med 147:200–208CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Slater LZ et al (2015) The multiple stigma experience and quality of life in older gay men with HIV. J Assoc Nurses AIDS Care 26(1):24–35CrossRefPubMedGoogle Scholar
  40. 40.
    Levy BR, Slade MD, Kasl SV (2002) Longitudinal benefit of positive self-perceptions of aging on functional health. J Gerontol Ser B Psychol Sci Soc Sci 57(5):P409–P417CrossRefGoogle Scholar
  41. 41.
    Levy B (2009) Stereotype embodiment: a psychosocial approach to aging. Curr Directions Psychol Sci 18(6):332–336CrossRefGoogle Scholar
  42. 42.
    Levy BR et al (2002) Longevity increased by positive self-perceptions of aging. J Pers Soc Psychol 83(2):261CrossRefPubMedGoogle Scholar
  43. 43.
    DeMarco RF et al (2017) Ageism, aging and HIV: community responses to prevention, treatment, care and support. HIV and Aging. Karger Publishers, Basel, pp 234–239CrossRefGoogle Scholar
  44. 44.
    Grov C et al (2010) Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care 22(5):630–639CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Vanable PA, Carey MP, Blair DC, Littlewood RA (2006) Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav 10(5):473–482CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Rueda S et al (2016) Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open 6(7):e011453CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Slater LZ et al (2013) Support, stigma, health, coping, and quality of life in older gay men with HIV. J Assoc Nurses AIDS Care 24(1):38–49CrossRefPubMedGoogle Scholar
  48. 48.
    Porter KE et al (2015) Stigma and psychological well-being among older adults with HIV: the impact of spirituality and integrative health approaches. Gerontologist 57(2):219–228Google Scholar
  49. 49.
    Emlet CA (2007) Experiences of stigma in older adults living with HIV/AIDS: a mixed-methods analysis. AIDS Patient Care STDs 21(10):740–752CrossRefPubMedGoogle Scholar
  50. 50.
    Foster PP, Gaskins SW (2009) Older African Americans’ management of HIV/AIDS stigma. AIDS Care 21(10):1306–1312CrossRefPubMedGoogle Scholar
  51. 51.
    Stanley LD (1999) Transforming AIDS: the moral management of stigmatized identity. Anthropol Med 6(1):103–120CrossRefGoogle Scholar
  52. 52.
    Emlet CA et al (2013) Protective and risk factors associated with stigma in a population of older adults living with HIV in Ontario, Canada. AIDS Care 25(10):1330–1339CrossRefPubMedGoogle Scholar
  53. 53.
    Emlet CA et al (2015) The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter? AIDS Care 27(4):520–528CrossRefPubMedGoogle Scholar
  54. 54.
    Porter KE, Brennan-Ing M, Burr JA, Dugan E, Karpiak SE (2017) HIV stigma and older men’s psychological well-being: do coping resources differ for gay/bisexual and straight men? J Gerontol Ser B.  https://doi.org/10.1093/geronb/gbx101 CrossRefGoogle Scholar
  55. 55.
    Emlet CA (2006) An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health Soc Work 31(4):299–308CrossRefPubMedGoogle Scholar
  56. 56.
    Holt-Lunstad J, Smith TB, Layton JB (2010) Social relationships and mortality risk: a meta-analytic review. PLoS Med 7(7):e1000316CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Cornwell EY, Waite LJ (2009) Social disconnectedness, perceived isolation, and health among older adults. J Health Soc Behav 50(1):31–48CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Stewart KE, Cianfrini L, Walker J (2005) Stress, social support and housing are related to health status among HIV-positive persons in the Deep South of the United States. AIDS Care 17(3):350–358CrossRefPubMedGoogle Scholar
  59. 59.
    Greysen SR et al (2013) Does social isolation predict hospitalization and mortality among HIV + and uninfected older veterans? J Am Geriatr Soc 61(9):1456–1463CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Edwards LV (2006) Perceived social support and HIV/AIDS medication adherence among African American women. Qual Health Res 16(5):679–691CrossRefPubMedGoogle Scholar
  61. 61.
    Haile R, Padilla MB, Parker EA (2011) ‘Stuck in the quagmire of an HIV ghetto’: the meaning of stigma in the lives of older black gay and bisexual men living with HIV in New York City. Cult Health Sex 13(04):429–442CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Brennan-Ing M, Seidel L, Karpiak SE (2017) Social support systems and social network characteristics of older adults with HIV. HIV and aging. Karger Publishers, Basel, pp 159–172CrossRefGoogle Scholar
  63. 63.
    Dewaele A et al (2011) Families of choice? Exploring the supportive networks of lesbians, gay men, and bisexuals 1. J Appl Soc Psychol 41(2):312–331CrossRefGoogle Scholar
  64. 64.
    Nobre NR et al (2016) Social networks of older adults living with HIV in Finland. AIDS Care 28(2):186–190CrossRefPubMedGoogle Scholar
  65. 65.
    Karpiak SE, Brennan M (2009) The emerging population of older adults with HIV and introduction to the ROAH research study. In: Brennan M et al (eds) Older adults with HIV: an in-depth examination of an emerging population. Nova Science Publishers, New York, pp 1–12Google Scholar
  66. 66.
    Carstensen LL, Fung HH, Charles ST (2003) Socioemotional selectivity theory and the regulation of emotion in the second half of life. Mot Emot 27(2):103–123CrossRefGoogle Scholar
  67. 67.
    Golub SA et al (2010) Prevalence and correlates of sexual behavior and risk management among HIV-positive adults over 50. Sex Transm Dis 37(10):615–620PubMedGoogle Scholar
  68. 68.
    Negin J et al (2016) sexual behavior of older adults living with HIV in Uganda. Arch Sex Behav 45(2):441–449CrossRefPubMedGoogle Scholar
  69. 69.
    Taylor TN et al (2017) “The pleasure is better as I’ve gotten older”: sexual health, sexuality, and sexual risk behaviors among older women living with HIV. Arch Sex Behav 46(4):1137–1150CrossRefPubMedGoogle Scholar
  70. 70.
    Grant RM et al (2014) Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis 14(9):820–829CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Brennan-Ing M et al (2014) Service utilization among older adults with HIV: the joint association of sexual identity and gender. J Homosex 61(1):166–196CrossRefPubMedGoogle Scholar
  72. 72.
    Brown L, Macintyre K, Trujillo L (2003) Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Educ Prev 15(1):49–69CrossRefPubMedGoogle Scholar
  73. 73.
    Smith DM, Mathews WC (2007) Physicians’ attitudes toward homosexuality and HIV. J Homosex 52(3–4):1–9.  https://doi.org/10.1300/J082v52n03_01 CrossRefPubMedGoogle Scholar
  74. 74.
    Cohen MS et al (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365(6):493–505CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    The Lancet HIV (2017) U=U taking off in 2017. Lancet HIV 4(11):e475.  https://doi.org/10.1016/S2352-3018(17)30183-2 CrossRefPubMedGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  1. 1.Brookdale Center for Healthy AgingHunter College, The City University of New YorkNew YorkUSA

Personalised recommendations