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Stigma, isolation and depression among older adults living with HIV in rural areas

Published online by Cambridge University Press:  24 January 2019

Katherine G. Quinn*
Affiliation:
Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Molly K. Murphy
Affiliation:
Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Zack Nigogosyan
Affiliation:
School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Andrew E. Petroll
Affiliation:
Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research Medical College of Wisconsin, Milwaukee, Wisconsin, USA Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
*
*Corresponding author. Email: [email protected]

Abstract

There is a growing population of ageing individuals living with the human immunodeficiency virus (HIV). Older adults living with HIV often contend with intersecting stigmas including HIV stigma, ageism and, for some, homonegativity and/or racism. Although the HIV stigma literature is quite robust, research on the relationship between HIV stigma, social support and mental wellbeing among older adults living with HIV is limited. This study begins to address this gap by examining how intersectional stigma affects social support and mental wellbeing among rural-dwelling older adults living with HIV. Qualitative interviews were conducted by phone with 29 older adults living with HIV, over the age of 50, living in rural areas of the United States of America. Interviews were transcribed verbatim and analysed using thematic content analysis in MAXQDA qualitative analysis software. Analysis revealed three primary themes. The first had to do with gossip and non-disclosure of HIV status, which intersected with ageism and homonegativity to exacerbate experiences that fell within the remaining themes of experiences of physical and psychological isolation and loneliness, and shame and silence surrounding depression. The prevalence of social isolation and the effects of limited social support among older adults living with HIV are prominent and indicate a need for tailored interventions within the HIV care continuum for older adults living with HIV.

Type
Article
Copyright
Copyright © Cambridge University Press 2019

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References

Baltes, P and Baltes, M (1990) Psychological perspectives on successful aging: the model of selective optimization with compensation. In Baltes, PB and Baltes, MM (eds), Successful Aging: Perspectives from the Behavioural Sciences. New York, NY: Cambridge University Press, pp. 134.CrossRefGoogle Scholar
Boeije, H (2002) A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality and Quantity 36, 391409.CrossRefGoogle Scholar
Catalan, J, Tuffrey, V, Ridge, D and Rosenfeld, D (2017) What influences quality of life in older people living with HIV? AIDS Research and Therapy 14, 2232.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (2013) HIV Among Older Americans. National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. Available at http://www.cdc.gov/hiv/pdf/library_factsheet_hiv_-amongolderamericans.pdf.Google Scholar
Centers for Disease Control and Prevention (2015) HIV Surveillance in Urban and Nonurban Areas Through 2013. Available at http://www.cdc.gov/hiv/pdf/2013-Urban-Nonurban-slides_508-REV-5_6-5.pdf.Google Scholar
Centers for Disease Control and Prevention (2016 a) Diagnoses of HIV Infection in the United States and Dependent Areas, 2016 (HIV Surveillance Report No. 28). Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
Centers for Disease Control and Prevention (2016 b) HIV Surveillance in Urban and Nonurban Areas Through 2016. Available at https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-urban-nonurban-2016.pdf.Google Scholar
Centers for Disease Control and Prevention (2017) HIV Among People Aged 50 and Over. Available at https://www.cdc.gov/hiv/group/age/olderamericans/index.html.Google Scholar
Centers for Disease Control and Prevention (2018) HIV and Women. Available at https://www.cdc.gov/hiv/pdf/group/gender/women/cdc-hiv-women.pdf.Google Scholar
Chronister, J, Chou, C-C and Liao, H-Y (2013) The role of stigma coping and social support in mediating the effect of societal stigma on internalized stigma, mental health recovery, and quality of life among people with serious mental illness. Journal of Community Psychology 41, 582600.CrossRefGoogle Scholar
Corbin, J and Strauss, A (2015) Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, 4th Edn.Thousand Oaks, CA: Sage.Google Scholar
Crystal, S, Akincigil, A, Sambamoorthi, U, Wenger, N, Fleishman, JA, Zingmond, DS, Hays, RD, Bozette, SA and Shapiro, MF (2003) The diverse older HIV-positive population: a national profile of economic circumstances, social support, and quality of life. Journal of Acquired Immune Deficiency Syndromes 33, supplement 2 S76S83.CrossRefGoogle ScholarPubMed
De Koning, JL, Stathi, A and Richards, S (2017) Predictors of loneliness and different types of social isolation of rural-living older adults in the United Kingdom. Ageing & Society 37, 20122043. Available online doi:10.1017/S0144686X16000696.CrossRefGoogle Scholar
Earnshaw, VA, Smith, LR, Cunningham, CO and Copenhaver, MM (2013) Intersectionality of internalized HIV stigma and internalized substance use stigma: implications for depressive symptoms. Journal of Health Psychology 10, 10831089.Google Scholar
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. The Gerontologist 46, 781790.CrossRefGoogle Scholar
Emlet, CA (2017) Stigma in an aging context. Interdisciplinary Topics in Gerontology and Geriatrics 42, 144158.CrossRefGoogle Scholar
Emlet, CA, Fredriksen-Goldsen, KI and Kim, H-J (2013) Risk and protective factors associated with health-related quality of life among older gay and bisexual men living with HIV disease. The Gerontologist 53, 963972.CrossRefGoogle ScholarPubMed
Glasgow, N and Berry, EH (2013) Rural Aging in 21st Century America. Dordrecht, The Netherlands: Springer.CrossRefGoogle Scholar
Goffman, E (1963) Stigma: Notes on the Management of Spoiled Identity. Garden City, NY: Anchor Books.Google Scholar
Grace, C, Kutzko, D, Alston, WK, Ramundo, M, Polish, L and Osler, T (2010) The Vermont model for rural HIV care delivery: eleven years of outcome data comparing urban and rural clinics. Journal of Rural Health 26, 113119.CrossRefGoogle Scholar
Grov, C, Golub, SA, Parsons, JT, Brennan, M and Karpiak, SE (2010) Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care 22, 630639.CrossRefGoogle ScholarPubMed
Hall, HI, Li, J and McKenna, MT (2005) HIV in predominantly rural areas of the United States. Journal of Rural Health 21, 245253.CrossRefGoogle ScholarPubMed
Hubach, RD, Dodge, B, Li, MJ, Schick, V, Herbenick, D, Ramos, WD, Cola, T and Reece, M (2015) Loneliness, HIV-related stigma, and condom use among a predominantly rural sample of HIV-positive men who have sex with men (MSM). AIDS Education and Prevention 27, 7283.CrossRefGoogle Scholar
Hughto, JMW, Reisner, SL and Pachankis, JE (2015) Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Social Science and Medicine 147, 222231.CrossRefGoogle Scholar
Katz, IT, Ryu, AE, Onuegbu, AG, Psaros, C, Weiser, SD, Bangsberg, DR and Tsai, AC (2013) Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Society 16, 1864018665.CrossRefGoogle ScholarPubMed
Kinsler, JJ, Wong, MD, Sayles, JN, Davis, C and Cunningham, WE (2007) The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care and STDs 21, 584592.CrossRefGoogle ScholarPubMed
Lahey, T, Lin, M, Marsh, B, Curtin, J, Wood, K, Eccles, B and Von Reyn, CF (2007) Increased mortality in rural patients with HIV in New England. AIDS Research and Human Retroviruses 23, 693698.CrossRefGoogle ScholarPubMed
Logie, CH, James, Ll, Tharao, W and Loutfy, MR (2011) HIV, gender, race, sexual orientation, and sex work: a qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLOS Medicine 8, e1001124.CrossRefGoogle ScholarPubMed
Loutfy, M, Tharao, W, Logie, C, Aden, MA, Chambers, LA, Wu, W, Abdelmaseh, M and Calzavara, L (2015) Systematic review of stigma reducing interventions for African/Black diasporic women. Journal of the International AIDS Society 18, 19835.CrossRefGoogle ScholarPubMed
Mavandadi, S, Zanjani, F, Ten Have, TR and Oslin, DW (2009) Psychological well-being among individuals aging with HIV: the value of social relationships. Journal of Acquired Immune Deficiency Syndromes 51, 9198.CrossRefGoogle ScholarPubMed
McFadden, RB, Bouris, AM, Voisin, DR, Glick, NR and Schneider, JA (2014) Dynamic social support networks of younger black men who have sex with men with new HIV infection. AIDS Care 26, 12751282.CrossRefGoogle ScholarPubMed
Ohl, M, Tate, J, Duggal, M, Skanderson, M, Scotch, M, Kaboli, P, Vaughan-Sarrazin, M and Justice, A (2010) Rural residence is associated with delayed care entry and increased mortality among veterans with human immunodeficiency virus infection. Medical Care 48, 10641070.CrossRefGoogle ScholarPubMed
Pellowski, JA (2013) Barriers to care for rural people living with HIV: a review of domestic research and health care models. Journal of the Association of Nurses in AIDS Care 24, 422437.CrossRefGoogle ScholarPubMed
Quinn, K, Voisin, DR, Bouris, A, Jaffe, K, Kuhns, L, Eavou, R and Schneider, J (2017) Multiple dimensions of stigma and health related factors among young black men who have sex with men. AIDS and Behavior 21, 207216.CrossRefGoogle Scholar
Ritter, LJ and Ueno, K (2018) Same-sex contact and lifetime sexually transmitted disease diagnoses among older adults. Journal of Aging and Health. Available online doi:10.1177/0898264317754028 .Google ScholarPubMed
Rosenfeld, D, Ridge, D, Catalan, J, Delpech, V, Anderson, J, Asboe, D and Collins, S (2016) Age and life course location as interpretive resources for decisions regarding disclosure of HIV to parents and children: findings from the HIV and later life study. Journal of Aging Studies 38, 8191.CrossRefGoogle ScholarPubMed
Rueda, S, Mitra, S, Chen, S, Gogolishvili, D, Globerman, J, Chambers, L, Wilson, M, Logie, CH, Sh, Q, Morassaei, S and Rourke, SB (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, e011453.CrossRefGoogle Scholar
Saldana, J (2016) The Coding Manual for Qualitative Researchers. Thousand Oaks, CA: Sage.Google Scholar
Sheth, SH, Jensen, PT and Lahey, T (2009) Living in rural New England amplifies the risk of depression in patients with HIV. BMC Infectious Diseases 9, 1.CrossRefGoogle ScholarPubMed
Skinner, MW and Winterton, R (2018) Interrogating the contested spaces of rural aging: implications for research, policy, and practice. Gerontologist 58, 1525.CrossRefGoogle Scholar
Smith, R, Rossetto, K and Peterson, BL (2008) A meta-analysis of disclosure of one's HIV-positive status, stigma and social support. AIDS Care 20, 12661275.CrossRefGoogle ScholarPubMed
Stangl, AL, Lloyd, JK, Brady, LM, Holland, CE and Baral, S (2013) A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? Journal of the International AIDS Society 16, 1873418748.CrossRefGoogle ScholarPubMed
Sweeney, SM and Vanable, PA (2016) The association of HIV-related stigma to HIV medication adherence: a systematic review and synthesis of the literature. AIDS and behavior 20, 2950.CrossRefGoogle ScholarPubMed
US Department of Health and Human Services (2013) HIV/AIDS in Rural America. Available at https://narhc.org/wp-content/uploads/2013/12/Rural-HIV-AIDs-Handout.pdf.Google Scholar
US Department of Health and Human Services (2017) Defining Rural Population. Available at https://www.hrsa.gov/rural-health/about-us/definition/index.html.Google Scholar
Vance, DE, McGuinness, T, Musgrove, K, Orel, NA and Fazeli, PL (2011) Successful aging and the epidemiology of HIV. Clinical Interventions in Aging 6, 181192.CrossRefGoogle ScholarPubMed
Wallach, I and Brotman, S (2018) The intimate lives of older adults living with HIV: a qualitative study of the challenges associated with the intersection of HIV and ageing. Ageing & Society 38, 24902518.CrossRefGoogle Scholar
Webel, AR, Longenecker, CT, Gripshover, B, Hanson, JE, Schmotzer, BJ and Salata, RA (2014) Age, stress, and isolation in older adults living with HIV. AIDS Care 26, 523531.CrossRefGoogle Scholar
Weis, KE, Liese, AD, Hussey, J, Gibson, JJ and Duffus, WA (2010) Associations of rural residence with timing of HIV diagnosis and stage of disease at diagnosis, South Carolina 2001–2005. Journal of Rural Health 26, 105112.CrossRefGoogle ScholarPubMed
White House Office of National AIDS Policy (2015) National HIV/AIDS Strategy for the United States: Updated to 2020. Washington, DC: The White House. Available at https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf.Google Scholar
World Health Organization (2015) World Report on Ageing and Health. Geneva: World Health Organization.Google Scholar
Zukoski, AP and Thorburn, S (2009) Experiences of stigma and discrimination among adults living with HIV in a low HIV-prevalence context: a qualitative analysis. AIDS Patient Care and STDs 23, 267276.CrossRefGoogle Scholar