Protective and Risk Factors Associated with Stigma in a Population of Older Adults Living with HIV Charles A. Emlet 1 ; David J. Brennan 2 ; Sarah Brennensthul 3 ; Sergio Rueda 4 ; Trevor A. Hart 5 ; Stephanie Karapita 6 ; Francisco Ibanez-Carrasco 4 ; Sean B. Rourke 4,7 ; Ontario HIV Treatment Network Cohort Study (OCS) team. 1. Social Work, University of Washington, Tacoma; 2 Factor-Inwentash Faculty of Social Work, University of Toronto; 3. Dalla Lana School of Public Health, University of Toronto; 4. The Ontario HIV Treatment Network; 5. Department of Psychology, Ryerson University; 6.Casey House; 7. Program in Neuroscience, University of Toronto.
Acknowledgements OCS Study Team Sean B Rourke (PI) Ahmed M Bayoumi Jeffrey Cohen Fred Crouzat Kevin Gough Mona Loutfy Janet Raboud Edward Ralph Irving E Salit Marek Smieja OCS/OHTN Staff Kevin Challacombe Mark Fisher Lucia Light Veronika Moravan Samantha Robinson Ann N Burchell (Co-PI) John Cairney Curtis Cooper Sandra Gardner Don Kilby Nicole Mittmann Anita Rachlis Sergio Rueda Roger Sandre Wendy Wobeser Stephanie Choi Robert Hudder Michael Manno Nahid Quereshi Munim Saeed Data Linkage Public Health Laboratories, Ontario Agency for Health Protection and Promotion OCS Governance Committee Tony Di Pede (Chair) Adrian Betts Tracey Conway Brian Finch Clemon George Claire Kendall Ken King Carol Major Colleen Price We thank all interviewers, data collectors, research associates and coordinators, nurses and physicians who provide support for data collection and extraction Evan Collins Patrick Cupido Michael Hamilton Troy Grennan Rick Kennedy John MacTavish Shari Margolese Lori Stoltz Funding AIDS Bureau, Ontario Ministry of Health and Long Term Care The International Council for Canadian Studies (ICCS) the Canadian Embassy, Washington, D.C. (C. Emlet) Social Sciences and Humanities Research Council Internal Grant OHTN Scholarship Award (D. Brennan)
Acknowledgements Community Partners
Conflicts of Interest We report no conflicts of interest
The Graying of HIV Disease Older adults with HIV are increasing due to a combination of factors PHAC suggest an increase in the proportion of positive HIV testing among adults 50 and over from 10.6% in 1999 to 15.3% in 2008 Increasing number of individuals are living into older age with HIV disease. In Canada, the number of people living with HIV (including AIDS) has increased by 14% from an estimated 57,000 persons in 2005 to 65,000 in 2008 (PHAC, 2011)
HIV Stigma Among Older Adults HIV related stigma impacts quality of life, social support and service access. Meta-analysis by Logie and Gadalla (2009) found HIV stigma associated with Poorer physical health Poorer mental health Decreased social support and Lower income
HIV Stigma Among Older Adults Research on older adults have found HIV stigma to be associated with: Depression (Emlet, 2007; Grov, Golub, Parsons, Brennan, Karpiak, 2010) Loneliness (Grov, et al, 2010) Social Isolation (Emlet, 2006a; Karpiak, Shippy, & Cantor, 2006) Secrecy (non-disclosure) (Foster & Gaskins, 2009) Layering of stigma (HIV stigma Ageism) (Emlet, 2006b)
Purpose of the Research Determine characteristics that contribute to or protect against HIV stigma in a population of older adults from Ontario. Sociodemographic Characteristics Psychosocial Characteristics Health-related variables
Methods Sample, OHTN Cohort Study (OCS) Participants 50 years and over from the OCS Who completed an assessment battery between September, 2007 and March, 2010 Measures Sociodemographic age, partner status, income and race
Methods (continued) Measures Psychosocial Depression (CESD-20; Radloff, 1977; α =.91) Coping (COPE; Carver, 1997; α =.77) Mastery (Pearlin s Mastery Scale; Pearlin & Schooler, 1978 α =.78) Social Support (MOS-HIV; Sherbourne & Stewart, 1991; α =.97) Health Related Variables self-rated health (excellent, very good, good, fair, poor) alcohol use (AUDIT; Allen, Litten, Fertig, & Babor, 1997) years since diagnosis Dependent variable: HIV stigma measured using 36-item HIV Stigma scale (Berger, Ferrans, & Lashley, 2001; α =.90)
OCS over 50 sample characteristics Total N (%) SD = Standard Deviation MSM = Men who Have Sex with Men Note: Total numbers vary due to missing data Women N (%) Straight Men N (%) MSM N (%) Socio-Demographic Variables Age (mean, SD) 405 57.0 (6.2) 44 56.6 (4.7) 50 58.1 (6.7) 311 56.9 (6.26) Income < $30,000 $30,000 Marital Status Married/Common- Law/Committed Relationship 206 (50.9%) 26 (60.5%) 36 (75.0%) 144 (46.6%) 194 (47.9%) 17 (39.5%) 12 (25.0%) 165 (53.4%) 169 (41.7%) 11 (25.0%) 28 (56.0%) 130 (41.8%) Separated/Divorced 45 (11.1%) 18 (40.9%) 10 (20.0%) 17 (37.8%) Single 191 (47.2%) 15 (34.1%) 12 (24.0%) 164 (52.7%) Race White 314 (77.5%) 24 (54.5%) 26 (52.0%) 264 (84.9%) African or Black 36 (8.9%) 13 (29.5%) 13 (26.0%) 10 (3.2%) Other/ mixed race 55 (13.6%) 7 (15.9%) 11 (22.0%) 37 (11.9%)
OCS over 50 sample characteristics Total N (%) Women N (%) Straight Men N (%) MSM N (%) Psychosocial Variables Maladaptive Coping (mean, SD) 1 385 29.9 (8.4) 44 23.3 (6.3) 50 23.5 (6.8) 306 20.6 (5.2) Emotional Informational Social Support 385 21.2 (5.6) 44 29.8 (8.3) 49 27.9 (9.5) 306 30.3 (8.2) (mean, SD) 2 Mastery (mean, SD) 3 385 20.1 (3.3) 42 19.3 (3.9) 50 19.3 (3.2) 305 20.4 (3.2) Depression (CES-D) Yes (Score 16) 117 (28.9%) 22 (51.2%) 17 (35.4%) 78 (25.6%) No (Score < 16) 279 (68.9%) 21 (48.8%) 31 (64.6%) 227 (74.4%) Health-Related Variables Hazardous Alcohol Use Yes 128 (31.6%) 9 (20.5%) 19 (38.0%) 100 (32.2%) No 277 (68.4%) 35 (79.5%) 31 (62.0%) 211 (67.8%) 405 15.3 (6.1) 44 13.7 (5.8) 50 11.5 (6.1) 311 16.2 (5.7) Time Since HIV+ Diagnosis (mean, SD) Self-Rated Health Excellent/very good/good 333 (82.2%) 37 (84.1%) 37 (74.0%) 259 (83.3%) Fair/poor 72 (17.8%) 7 (15.9%) 13 (26.0%) 52 (16.7%) SD = Standard Deviation MSM = Men who Have Sex with Men Note: Total numbers vary due to missing data 1 Range for maladaptive coping scale is 12 to 48, higher scores represent greater maladaptive coping 2 Range for Emotional-Information Social Support is 8 to 40, higher scores represent greater social support 3 Range for Mastery is 7 to 28, higher scores represent greater mastery
Results Stigma Zero Order Correlations Maladaptive coping Emotional- Information al Social Support Stigma 1.00.33** -.34** -.42** Maladaptive Coping Emotional Social Support.33** 1.00 -.21** -.39** -.34** -.21** 1.00.42** Mastery -.42** -.39**.42** 1.00 Mastery
Unstandardized coefficients for regression of HIV stigma on gender and sexual orientation among adults over 50 living with HIV/AIDS (n=377). a p<.001 b p<.01 c p<.05 Full Model Focal Variable b (S.E.) Gender/Orientation (ref = MSM) Women 4.72 (1.88) c Heterosexual men 4.06 (1.84) c Socio-demographic Variables Age at Interview (in years) -0.25 (0.09) b Personal gross yearly income (ref= 30,000) 0.76 (1.13) Marital Status (ref = married) Divorced/Separated 2.62 (2.00) Single 0.13 (1.16) Race 1 (ref = white) Black or African 1.21 (2.06) Other/mixed race -2.89 (1.62) Psychosocial Variables CES-D score 16-1.43 (1.42) Maladaptive coping 0.33 (0.11) b Emotional-Informational Social Support -0.31 (0.07) a Mastery -0.81 (0.19) a Health-related Variables Hazardous alcohol use -1.06 (1.16) Time since HIV+ diagnosis -0.26 (0.09) b Self-rated health (ref = excellent/good) 3.01 (1.48) c Adjusted R 2.31
Discussion Findings reinforce the importance and impact of stigma on older HIV positive adults Non-MSM reporting greater stigma Age and less time since diagnoses associated with greater stigma Importance of internal mechanisms such as mastery Importance of external mechanisms Emotional social support Informational social support Research is needed to better understand what this resilience means and how to enhance it Interventions are needed to reduce stigma (particularly, for non MSM and recently diagnosed) and strengthen these protective components
Contact Charles A. Emlet, PhD Professor, Social Work Program University of Washington, Tacoma, WA caemlet@u.washington.edu