Aging with HIV: Historical and Intra-Community Differences in Experience of Aging with HIV

Gay men living with HIV/AIDS face a complex of health issues, including those associated with the aging process, long-term HIV infection (25 years or more), and side effects from Highly Active Anti-Retroviral Therapy (HAART). If aging can increase marginalization, this is more likely for the aging HIV positive gay man, who is already marginalized for being queer and living with a stigmatizing disease. This article presents findings from a study of a long-running HIV support group. It locates the members, all gay men living with HIV, in a specific historical and political context to explore how feelings of loss and the struggle to sustain community affect long-term survivors and other older HIV+ gay men. We identify specific challenges presented by aging for men who contracted HIV early in the epidemic, contrasting them with those faced by men infected with the virus later in life. While both groups appear to struggle with a vision of what life could have been, had AIDS not forced loss and change, they also celebrate the community their shared plight has enabled.     

Lesbian Blood Drives as Community-Building Activism in the 1980s

As gay men began voluntarily withdrawing from blood donation in the early 1980s, lesbians in community with gay men in several U.S. cities organized drives to replenish the blood supply. These drives were sometimes the continuation of previously established drives by gay–lesbian organizations or faith communities, sometimes new initiatives in response to HIV/AIDS. However, after the initial publicity, mention of lesbian blood drives in print is both scarce and brief. Focusing on drives organized from 1983 to 1992 by a group known as San Diego Blood Sisters, this article is an initial step in documenting lesbian blood drives to inform and enrich conversations about histories of responses to HIV/AIDS, theoretical discussions of how community connections in the lesbian, gay, bisexual, transgender, and queer spectrum are enacted and understood, and emerging research on intersections of gender and sexuality as they are expressed through blood donorship.     

Midlife and Older Gay Men Living with HIV/AIDS: The Influence of Resiliency and Psychosocial Stress Factors on Health Needs

HIV/AIDS research has mostly focused on younger gay men. This cross-sectional study originated from a larger study of 316 respondents to include a subsample of 38 midlife and older gay men living with HIV/AIDS. The study explores physical and mental health utilization rates, including physical and mental health status. Resiliency, internal health locus of control beliefs, and psychosocial stressors of age and sexual orientation discrimination, stigma, and internalized homophobia were also examined. A total of 65.8% of the HIV/AIDS participants received no mental health services the past year, despite reporting higher mental health distress. Of those reporting an HIV status, 10.5% indicated having no health visits in the preceding year and more delays in seeking care when needed and unmet health needs for which services were not sought. Participants reporting higher resiliency indicated less mental health distress and better health access indicators. Stigma and internalized homophobia negatively affected resiliency. Implications for practitioners working with midlife and older gay men are provided.     

HIV Risk in Gay and Lesbian Adolescents

Adolescents, regardless of sexual orientations, are not increased risk for HIV infection. Although the number of infected adolescents remains small, the number of adolescent AIDS cases is approximately doubling each year. This suggests that the rate of HIV infection among adolescents is expanding in a similar fashion to that seen among gay men in the early years of the epidemic. The purpose of this paper is to provide a framework for understanding the problems of HIV infection as it related to the gay and lesbian adolescent. This framework is grounded in developmental theory, though key social, political, economic, and policy factors which are believed to contribute to the infection of HIV among gay and lesbian adolescents will also be presented. It will be argued that social practitioners who are working in the HIV and AIDS arena would do well to reexamine the paradigm, which governs existing practice methodology.     

HIV/AIDS Projects with and for Gay Men in Northern Thailand

Abstract

In this paper I look at three HIV/AIDS projects which were run by and for gay men, transsexuals and men who have sex with men (MSM) in northern Thailand in the early 1990s. These three projects were very different in format and in context, ranging from a rural village AIDS association to an urban drag beauty contest. The projects were located in settings as different as gay bars and cruising areas, shopping malls and rural villages. Aspects of the three Thai projects have important implications for those working in HIV/AIDS prevention and in the care and support of people living with HIV/AIDS (PLWHAs) across cultures, particularly in relation to education, outreach and counselling programs.     

ANTICIPATORY AND ACTUALIZED IDENTITIES: A Cultural Analysis of the Transition from AIDS Disability to Work

Throughout the course of their lives, many people living with HIV/AIDS have prematurely retired onto AIDS disability. A new trend, however, has swept across the nation. Where once people were getting sick, leaving work, and embracing inevitable death, now, with advances in medical technology, many people with HIV/AIDS are renewing their lease on life and discovering a desire to go back to work. To learn how gay men's identities are impacted as they transition from AIDS disability back to the labor market, I conducted three months of fieldwork at an employment placement agency in San Francisco. During fieldwork I distributed informal questionnaires to 120 gay men and then formally interviewed 10 additional gay men who had either transitioned or were considering transitioning from AIDS disability back to work. Analyses reveal that cultural, structural, and medical contradictions typify the return to work. As gay men experience and live through these contradictions, their identities split into anticipatory and actualized components. By facilitating a reassessment of meanings and values, anticipatory identities cognitively and emotionally prepare individuals as they brave the road back to work. This version of identity represents a romanticized confluence of worker (role) identity, gay (status/master) identity, and overall sense of self (self-concept). Personal experiences with stigma, shame, and discrimination along with complexities of the workplace and medical services, however, prevent the maturation of anticipatory identities when seeking reemployment. This results in loosely coupled and situationally informed actualized identities . The relationship between these two identities suggests that many people living with HIV/AIDS—and indeed others who experience stressful life transitions—face complex choices between quality-of-life issues and the ability to survive according to external cultural and structural constraints.     

Still Among the Missing? A Content Analysis of LGBT Articles in Social Work Journals, 1998–2009

In 2002, Van Voorhis and Wagner published an article that examined how often, between 1988 and 1997, four major social work journals published content on gay and lesbian people. This content analysis is a follow-up to the previous one to see if the findings were different when the same four journals were examined between 1998 and 2009. As with the Van Voorhis and Wagner study, articles were coded depending upon their focus on HIV/AIDS and the gay community or other issues impacting gays and lesbians. Similarly, articles were coded depending on whether they focused on the client, worker, or macro system. This study found a decrease in the number of same-sex articles from 77 in the first analysis to only 50 in the present one. Furthermore, there was a decrease of almost 90% in the number of articles on HIV/AIDS, from 51 to 5. Van Voorhis and Wagner indicated that social work educators would not be able to easily find gay and lesbian content if they had to rely only on the four major journals. This study reaches a similar conclusion.     

The Second Closet: A Qualitative Study of HIV Stigma Among Seropositive Gay Men in a Southern U.S. City

ABSTRACT

Objectives: Stigma connected with HIV/AIDS has decreased considerably since the early epidemic yet affects those living with HIV in many ways. Little research, particularly qualitative research, concerning HIV stigma from the perspective of gay men has emerged. The present qualitative study aimed to fill this evidence gap by examining how HIV stigma is perceived and experienced by gay men who have become HIV-infected and how they respond to this stigma. Methods: Thematic analysis of 19 gay men's narratives identified six main themes. Results: Encountering HIV stigmatization was common and was linked to the physical stigmata identifying respondents as HIV-positive. Overwhelmingly, they found stigmatization to be most intensely felt within gay communities. One profound theme was internalized HIV stigma, referring to respondents’ internalized negative feelings about their HIV status. A related theme was the closeted nature of HIV. Lastly, regarding how the men dealt with the HIV diagnosis and experiences of HIV stigma, a theme of adaptation became clear. Conclusions: Although exploratory, the results can serve as a beginning framework for understanding and assisting seropositive gay men who experience HIV stigma. The findings are important because it is realistic to expect that in a climate in which HIV has become increasingly invisible and closeted and in which infections are on the rise, gay and bisexual men will be increasingly affected and infected by HIV.     

Experience of Older Gay and Bisexual Men Living with HIV/AIDS

Although HIV/AIDS definitely impacts gay and bisexual men of all ages, the impact on people in their later years has not been actively investigated. This exploratory study obtained detailed narratives from 14 adults between the ages of 51-72, all of whom were infected with HIV. Ten of the participants were potentially infected through male to male sexual contact. The subjects reported living with HIV for substantial periods with an average of 13 years of life since diagnosis, estimating a duration of HIV seropositivity from 1-20 years. Most had significant health problems, which may be related to aging, in addition to a number of HIV-related symptoms. They expressed community identification as people living with HIV; some were highly identified as gay men, while other were closeted or in denial regarding their same-sex activity. Half felt to some extent bisexual, and described relationships with wives or other women. Although many participants maintained active social lives, others expressed feelings of loneliness and isolation. This group was minimally active sexually and several of the participants expressed reservations about safer sex, especially condom usage. A strong theme was the sense of having lived a full life, which may help the individual cope with his diagnosis. The findings suggest the need to examine the diversity among older gay and bisexual men living with HIV, how these experiences vary by race and ethnicity, and identification of issues related to prevention and services.     

Development of the Gay and Lesbian Relationship Satisfaction Scale

This article describes the development and evaluation of the Gay and Lesbian Relationship Satisfaction Scale (GLRSS) as a measure of individuals' gay and lesbian same‐gender relationship satisfaction and social support. Clinicians and researchers administer relationship satisfaction scales to persons in gay and lesbian relationships with a heteronormative assumption that scales developed and validated with opposite‐gender couples measure identical relationship issues. Gay and Lesbian couples have unique concerns that influence relationship satisfaction, most notably social support. Using online recruitment and data collection, the GLRSS was evaluated with data from 275 gay and lesbian individuals in a same‐gender relationship.     

HIV Risk Behavior in Gay Men with Unstable Self-Esteem

This article describes a model of interpersonal factors that may help to explain why some gay men have difficulty in adopting or maintaining safer sex habits. These men may have self-esteem that is unstable. The condition of self-esteem fragility is likely to lead to deficits in the experience of intimacy and social support, and to feelings of loneliness, among these men. When they use avoidant Coping to deal with the stress associated with such experiences, these men may engage in unsafe sex. The article considers implications of this model for HIV prevention efforts, counseling, and research. Prevention must stress the importance of gay men's identification and involvement with a gay/lesbian community.     

Influence of Social Support on Gay Men Living with HIV

This article examines the social support networks of gay men living with HIV. Many people do not realize that HIV is still a significant health concern. The rate of HIV infection has not decreased substantially in over 15 years, and in the United States alone health care practitioners see approximately 40,000 cases per year. Some of the literature on this topic suggests that gay men with HIV receive more social support from friends than from family members. Research also suggests that these men sometimes experience losses of social support after they are diagnosed as HIV positive. Five gay men with HIV participated in in-depth interviews for this study. During these interviews 14 open-ended questions were posed with several of these questions having follow-up probes/questions. The questions focused on specific aspects of the participant's support network. Participants' responses to the interview questions were transcribed and content analyzed for relevant themes. Results indicated that whereas many of the men maintained their supportive contacts with family members and friends, others experienced changes in their support networks after they were diagnosed as HIV positive. Further results revealed that all men interviewed were satisfied with the level of support they received from the people in their support networks.     

HIV/AIDS Orphans' Education in Uganda

Abstract

The HIV/AIDS epidemic in most sub-Saharan African countries has created a crisis in the African family structure. In Uganda, older people's roles have been reversed from being provided for to providers. Older people, who are already poor, face the loss of economic support from their adult children and unexpected social, psychological and economic burden due to the care-giving role they assume. In this study, we used cross-sectional data from Kayunga district in Central Uganda to examine the impact of HIV/AIDS on the role of older persons. We found that there were HIV/AIDS related deaths in 82.3% of the surveyed households. In almost 34% of the households, the care-givers of HIV/AIDS orphans were older people over 50 years old. Almost all households headed by older people (97.8%) had on average three school-going orphaned children living in the household.     

Lesbian Desire in the Age of AIDS: From the Head of Medusa Sprung

In the age of AIDS, lesbians' sexualities were strangely protected from the epidemic spread of the HIV virus, even while many lesbians' social and political lives were deeply impacted by its catastrophic effects on the gay community. The “so close but yet so far” phenomenon defining lesbian experience during the AIDS crisis evoked mixed and complicated emotions unique to that sector of the gay community. This article highlights the manifold emotional experience for lesbians, which paralleled an equally complex web of identifications and disidentifications with gay men. Although this perpetuated a sense of invisibility for lesbians during the epidemic's crisis years, it may have contributed to opening a space for new possibilities of feminine sexualities and identities as the crisis receded.     

Support for gay and lesbian rights among social work students in Greece

This study explores social work students’ level of support for gay and lesbian rights. Respondents were all the students (N?=?460) attending classes in a Social Work Department in Greece. While students were generally supportive of gay and lesbian rights, a significant percentage believed that social workers should support gay and lesbian rights only when lesbians and gay men do not offend or upset others and their rights do not contradict the prevalent religion and societal values. Religiosity was an important correlate of students’ level of support for gay and lesbian rights. Findings are discussed in relation with social work education.     

“And then AIDS came along”: A life course turning point and sub-cohorts of older gay men

Research on life course turning points focuses on heterosexuals. Scholars acknowledge that the early AIDS epidemic was a period of crisis for current older gay men, and that this period has shaped and will likely continue to impact their lives. However, few studies have considered the range of early AIDS-related experiences within this group. In this article, I use a life course perspective and in-depth interviews with 40 gay men (60+) in Atlanta to address the following questions: (1) How did current older gay men's experiences vary during the AIDS years? (2) What social factors shaped this variation? I identified three AIDS-related sub-cohorts, which were defined by how participants' social and spatial relationships to urban gay communities influenced their experiences of personal loss, community loss, personal support, and community support between 1981 and 1996. The results suggest that scholars and service providers interested in how early life experiences impact later life should consider the divergent early AIDS-related experiences within the group “older gay men.”     

Social Work Educators’ Attitudes Toward Gay Men and Lesbians: A National Assessment

A sample of 927 U.S. social work educators expressed limited negative attitudes toward lesbians and slightly more negative attitudes toward gay men in this cross-sectional, national study using standardized survey instruments with proven psychometric properties. Faculty most likely to express negative attitudes toward lesbians included those employed at a religiously affiliated university (whether sectarian or non-sectarian), identifying as African-American and male, working in an urban or suburban setting (rather than a rural one), and having probationary tenure-track status. These individual and institutional characteristics accounted for 7.8% of the variance in social work educators’ negative attitudes toward lesbians. Faculty most likely to express negative attitudes toward gay men included those identifying as African-American, employed at a religiously affiliated university, identifying as heterosexual and male. These variables explained 12.4% of the variance in social work educators’ negative attitudes toward gay men. Implications for social work education are addressed and suggestions generated regarding how social work educators and their educational programs can ensure that they are preparing competent, unbiased practitioners who can advance social justice and reduce oppression among gay and lesbian clients.     

Gay, Lesbian, and Bisexual Aging into the Twenty-First Century: An Overview and Introduction

This paper provides an introduction and overview for the papers in the special issue of this Journal devoted to the latter half of life among gay men, lesbians, and bisexuals. Key issues are highlighted in terms of their impact on gay, lesbian, and bisexual cultural communities: the impact of the large aging population of baby boomers; the significance of age as a social organizer; and the areas of research included in this special issue (intimacy and relationships, HIV and AIDS among elders, and the identities and needs of those growing into middle and later life).     

Health Strategies of HIV-Infected,Homosexually Active Men in Sydney,Australia

Drawing from a sample of gay and bisexual men who participated in large-scale surveys, and exploring issues derived from a smaller-scale study on working-class gay men, this close-focus study explores the relation between sexual identity, attachment to gay community and responses to HIV infection. Ten long-term HIV-infected, homosexually active men were interviewed using the open-ended life history method. A typology of four health strategies desribes these men's relations to medicine and the type and range of responses developed. These strategies are informed by class background, form and degree of attachment to the gay community, and age. Implications are discussed for existing AIDS service organizations, and for the possible future development of health services within gay and lesbian communities.     

Realities and Hopes for Older Gay Males

Abstract

Data about gay men in the Midwest over the age of 50 are extracted from a larger study of gay men and lesbian women. Information is sought regarding the role of sexual orientation, social networks, and social programs and activities in personal assessments of both the aging process and life satisfaction. The sample was divided into two groups: men 60 years of age and older, and men between the ages of 50 and 60. Differences were found between these subgroups, especially regarding acceptance of the aging process; yet these men were more similar than different in most aspects of life. Participation in gay community activities, social and religious, was found to be important for the quality of life of these men. Those integrated into the community, formally and informally, were also more likely to believe that their sexual orientation had helped their aging process.