Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) continues to be a growing epidemic throughout the world. Older adults represent one of the fastest growing segments of people living with HIV/AIDS, with men accounting for 72% of the overall population with the condition (Emlet & Shippy, 2008). HIV/AIDS within a span of 2 decades has become one of the most important public health concerns throughout society (McElrath, 2002). From the beginning of this epidemic, more than 120,000 individuals over the age of 50 have been diagnosed with HIV/AIDS (Sormanti, 2007). The National Institute of Aging estimates that individuals over the age of 50 comprise 19% of the nations HIV/AIDS cases (Krisberg, 2006) and the size of this group is expected to grow within the next 50 years (Lieberman, 2000). Incidence and Prevalence of HIV/AIDS
Current statistics suggest that the number of persons over the age of 50 and older living with HIV/AIDS has been increasing in recent years (Centers for Disease Control and Prevention [CDC], 2008). The Centers for Disease and Prevention statistics from 2005 showed that persons aged 50 and older accounted for 15% of new HIV/AIDS diagnosis, 24% of persons living with HIV/AIDS, 19% of all AIDS diagnosis, 29% of persons living with AIDS (CDC, 2008). A general statistical overview of those living with HIV/AIDS with recent data from 2006 found that 70% with HIV were between the ages of 25 and 49 (770,000 persons), where as 25% were age 50 and older (280,000 persons), and 5% were between the ages of 13 and 24 (56,500 persons; CDC, 2008). Therefore data suggests that older adults over the age of 50 make up 25% of the population living with HIV/AIDS. According to the CDC (2008), deaths for individuals with HIV/AIDS under the age of 50 decreased approximately 8% from 2000 to 2004; however for adults 50 years and older deaths from AIDS had increased (CDC, 2008). Although current data shows that fewer people are being diagnosed with AIDS in the United States and deaths continue to decline, the number of adults 50 and older who are living with HIV/AIDS is larger than ever (Emlet & Shippy, 2008).
Older adults face a number of obstacles that include declining health, reduced income, job status, and multiple losses which may include a spouse, other family members, and friends (Kail & Cavanaugh, 2004). For older adults with HIV/AIDS they too will suffer all these challenges in addition to the potentially terminal diagnosis and social stigma associated with HIV/AIDS. The HIV/AIDS epidemic has been around for three decades and yet the stigma associated with HIV continues to affect the lives and well-being of those living with the disease especially older adults (Emlet, 2006; Herek et al., 1998; Valdiserri, 2002). Emlet (2006) confirmed that a considerable amount of knowledge has been gathered on the understanding of stigma among younger people living with HIV/AIDS; however, less is understood about stigma for older adults. Older adults experience the stigma associated with HIV/AIDS in many ways that may affect their psychosocial needs. For instance, older adults with HIV may be reluctant to disclose their diagnosis due to fear of rejection by their current social support system (Peate, 2007). Fear of rejection can lead to increased isolation.
For older adults with HIV/AIDS lack of social support and increased isolation are compounded (Emlet, 2006). All adults can benefit from support groups more as they age (Shippy & Karpiak, 2005). Persons who participate in health care and social service systems have better treatment outcomes and the spread of HIV/AIDS is lessened. Social support does have a direct relationship to higher physical and psychological functioning in an older adult’s life and can be effective interventions for those with HIV/AIDS (Catz, Gore-Felton, & McClure, 2002). Support groups help individuals cope with stressful events, emotional support, education, and socialization and can counterbalance stigma and permit members to practice new behaviors (Toseland & Rivas, 2005; Wood, 2007).
The grant proposal seeks to find funding for the purposes of designing a support group that will offer both education and social support for older adult males 55 and older who have been diagnosed with HIV/AIDS within the last year. The purpose of this project is to identify potential funding sources, compose and submit a grant proposal on behalf of AIDS Project Los Angeles’s (APLA) national office located in Southern California. If funded, the project would include a closed, confidential, curriculum-guided formatted support group led by both a licensed Clinical Social Worker and Nurse Practitioner and would specifically focus on both educational, psychological, and emotional issues for older adult males with HIV/AIDS who reside in Southern California. The proposed goals for the males over the age of 55 in the support group will include:
The Centers for Disease Control and Prevention (2008) defines Human Immunodeficiency Virus (HIV) as the disease that causes Acquired Immune Deficiency also known as AIDS. The HIV virus can be passed when infected semen, vaginal secretions or blood come into contact with another’s mucous membranes or broken skin (CDC 2008). HIV attacks the immune system by destroying a type of white blood cell called a T cell, also known as CD4 cells, which is a highly identifiable trait of the virus (CDC, 2008).
Acquired Immune Deficiency, known as AIDS, is the second and final stage of HIV infection (CDC, 2008). An individual diagnosed with HIV is considered to have AIDS when the immune system is weakened to the point at which the body cannot fight off infection which results in a lower number of T cells (CDC, 2008). To reach the stage the diagnosis of AIDS can take many years even if the patient is not consistently on an antiviral medication treatment plan (CDC, 2008).
When the deterioration of the immune system reaches a certain level, the infected individual begins to experience, with increasing frequency, periodic bouts of illnesses and infections with which an uninfected body would normally be able to cope. Strained by the HIV infection, the individual lacks a viable immune response to these further infections. Because these infections use the opportunity provided by the body’s weakened defense system to establish themselves, they are referred to as opportunistic infections (M. J. Kelly, 2000).
Older Adults may be defined as “Age 65, [it] is generally agreed on as the beginning of old age only because it has been the traditional retirement age and not because there is a specific social or biological reason for this choice” (Mclnnis-Dittrich, 2005, p. 8). Therefore, for the purpose of this study, the term older adults when used will consist of adults 55 years and older.
The occurrence of HIV/AIDS within the United States has greatly impacted people of color (Emlet & Nokes, 2006). The disproportionate number of cases of HIV/AIDS infection among people of color across all ages appears to hold true for adults over the age of 50 (CDC, 2002). Recent data show that HIV infection among African Americans was 7 times the rate among Whites, consisting of 45% of new infections; and Hispanics HIV infection as 3 times the rate among Whites consisting of 17% of new infections (California Department of Public Health, Office of HIV/AIDS, 2008). Analyzing statistical information that focuses on new infections shows the increased prevalence of HIV/AIDS among minority populations. However despite the increased prevalence of HIV/AIDS among minorities, the number of Whites affected by HIV/AIDS is greatest within the State of California (Los Angeles County Department of Public Health, HIV Epidemiology Program, 2008). Data suggests that Whites with HIV/AIDS make up 47.6% of all cases reported. Data suggests that other minority groups make up the reported cases including; Hispanics comprising 29.4%, African Americans comprising 18.7% Asian/Pacific Islander comprising 3.2%, American Indian/Alaska Native comprising 0.5%, and other comprising 0.6%.
Currently, older Americans comprise over one eighth of the United States population, and this number is expected to double over the next 50 years. This older population has been largely ignored in the battle against HIV/AIDS, as most prevention and treatment activities have been geared toward the younger population (Lieberman, 2000). Research has shown that older adults with HIV/AIDS who have an instrumental support system were correlated with reduced amount of HIV/AIDS stigma (Emlet, 2006). Unfortunately, eliminating the stigma surrounding HIV/AIDS is not possible, but through implementing a support system that older adults can utilize can help diminish the devastating consequences of isolation that older adults with HIV/AIDS encounter. Therefore, providing ongoing support groups would work towards eliminating isolative behaviors for older adults and ensuring that a support system is available in their lives.
Social work services are changing. More services are delivered within health care and community based settings (Berkman & Harootyan, 2003). Because of an aging society in the United States effective social work practice now entails engagement with intersecting biological, psychological, socio-environmental, and cultural contexts (Berkman & Harootyan). Social workers need to be able to meet the challenge of an aging population in a society that lacks proper awareness and resources. Social workers are trained to implement programs, advocate for unmet needs, encourage resource utilization, and offer emotional support. Therefore social workers can provide emotional support and encourage the development of coping skills for the infected individuals. If funded, the proposed project will allow a licensed clinical social worker to enhance his or her group work skills while assisting a marginalized group of individuals.
HIV/AIDS within the United States with specific emphasis on older adults is on the rise. Even though the 21st century brings the HIV/AIDS epidemic into its 3rd-decade stigma still exists surrounding the disease. For older adults the stigma and challenges are greater which puts this population at a greater risk. The proposed project will increase quality of life for the participants by increasing their medical knowledge regarding their disease and providing ongoing social support to meet their emotional needs.
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