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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


     

HIV/AIDS Prevention Research Core

http://www.exporthealth.pitt.edu/core_hiv.htm

The literature suggests that African American women who are fifty years old and older are affected by HIV in three important ways. First, these women are at risk of being infected with HIV and diagnosed with AIDS. Nationally about 10% of AIDS cases are among seniors. Second, these women are often the caretakers of children with HIV infection or grandchildren whose parents can no longer care for them. Lastly, older African American women are often community leaders and must deal with HIV as it affects their local community.

In Allegheny County, a number of factors slowed the often-called second wave of the epidemic so that women in our county have not yet been diagnosed with HIV to the extent that African American women in other parts of the county have been. However, the risk of infection is clearly present and effective prevention interventions need to be supported. It is likely that our population of women is major caregivers for others infected or affected by HIV. The literature clearly shows that caregivers often suffer health consequences such as depression, stress, and physical problems as a result of the burdens they must bear.

Providers and affected women from the African American community are meeting to evaluate the problems facing African American women over fifty and to make recommendations about needed interventions and research. Their recommendations will be taken to the CRAB and the HIV working group for further discussion. At the end of the process, the Core will have a clear direction and will work to implement the recommendations of the community with continued community involvement.

Literature Review Summary

HIV Infected / HIV Affected


Psychosocial


Co-existing Medical Conditions

 
  • Stress
  • Stigma
  • Financial problems
  • Parenting
  • Low social supports
  • Violence
  • Risky sexual behavior
  • Unstable housing
  • Unemployment
 
  • Poor Adherence to HIV medications
  • Drug and Alcohol Abuse
  • Psychiatric disorders, especially depression
  • STDs
  • Chronic diseases
  • Pregnancy

    

Recommendations

Integrate mental health, substance abuse and medical care, may improve the adherence and health of HIV+ women, particularly in multistressed populations with substantial parenting and other life demands.

Caregiver / Custodian


Psychosocial


Co-existing Medical Conditions

 
  • Stress
  • Stigma
  • Parenting (child, grandchild)
  • Caregiving
  • Low social support
  • Financial problems
 
  • Depression
  • Chronic diseases, such as diabetes, high blood pressure, heart disease

Recommendations

Support services are needed to address both the psycho-social and caregiving needs of these individuals (mostly women) -- someone needs to care for the caregivers - and also their won health needs.

Community Leaders

AA women represent an important intermediate layer of leadership that is critical to micromobilization for promoting change.

AA churches have a leadership role to politically empower AA. However, they are sometimes seen as sexist.

Context of equality and empowerment, AA churches create on racial issues might lead to a similar dynamic on gender issues.

Church attendance is an important correlate of positive health care practices, especially for most vulnerable sub-groups, the uninsured and chronically ill.

    



Selected Bibliography

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Theall, K. P., K. W. Elifson, et al. (2003). "Perceived susceptibility to HIV among women - Differences according to age." Research on Aging 25(4): 405-432.

Theall, K. P., C. E. Sterk, et al. (2003). "Factors associated with positive HIV serostatus among women who use drugs: Continued evidence for expanding factors of influence." Public Health Reports 118(5): 415-424.

Poindexter, C. C. and T. S. Lane (2003). "Choices and voices: Participation of people with HIV on Ryan White Title II Consumer Advisory Boards." Health & Social Work 28(3): 196-205.

Mellins, C. A., E. Kang, et al. (2003). "Longitudinal study of mental health and psychosocial predictors of medical treatment adherence in mothers living with HIV disease." Aids Patient Care and Stds 17(8): 407-416.

Lechner, S. C., M. H. Antoni, et al. (2003). "Cognitive-behavioral interventions improve quality of life in women with AIDS." Journal of Psychosomatic Research 54(3): 253-261.

Klein, H., K. W. Elifson, et al. (2003). ""At risk" women who think that they have no chance of getting HIV: Self-assessed perceived risks." Women & Health 38(2): 47-63.

Johnson, W. A. and C. E. Sterk (2003). "Late-onset crack users: An emergent HIV risk group." Jaids-Journal of Acquired Immune Deficiency Syndromes 33: S229-S232.

Goodkin, K., T. Heckman, et al. (2003). ""Putting a face" on HIV infection/AIDS in older adults: A psychosocial context." Jaids-Journal of Acquired Immune Deficiency Syndromes 33: S171-S184.

Elifson, K. W., H. Klein, et al. (2003). "Religiosity and HIV risk behavior involvement among "at risk" women." Journal of Religion & Health 42(1): 47-66.

Clark HJ, L. G., Armistead L, Austin BJ. (2003). "Stigma, disclosure, and psychological functioning among HIV-infected and non-infected African-American women." Women Health 38((4):): 57-71.

Somlai AM, Kelly JA, McAuliffe TL, Ksobiech K, Hackl KL. "Predictors of HIV sexual risk behaviors in a community sample of injection drug-using men and women." AIDS Behav. 2003 Dec;7(4):383-93.

Jones DJ, Beach SR, Forehand R, Foster SE. "Self-reported health in HIV-positive African American women: the role of family stress and depressive symptoms" J Behav Med. 2003 Dec;26(6):577-99.

[No authors listed] Community groups push for a greater role in stemming epidemic. Barriers, including lack of funding, still exist. Aids Alert. 2003 Nov;18(11):133, 135, 137.

Bogart LM, Bird ST. Exploring the relationship of conspiracy beliefs about HIV/AIDS to sexual behaviors and attitudes among African-American adults. J Natl Med Assoc. 2003 Nov;95(11):1057-65.

Poindexter, C. C., T. S. Lane, et al. (2002). "Teaching and learning by example: Empowerment principles applied to development, delivery, and evaluation of community based training for HIV service providers and supervisors." Aids Education and Prevention 14(5): 391-400.

Mason, S. and N. Linsk (2002). "Relative foster parents of HIV-affected children." Child Welfare 81(4): 541-569.

Joslin, D. and R. Harrison (2002). "Self-reported physical health among older surrogate parents to children orphaned and affected by HIV disease." Aids Care-Psychological and Socio-Medical Aspects of Aids/Hiv 14(5): 619-624.

Feaster, D. J. and J. Szapocznik (2002). "Interdependence of stress processes among African American family members: Influence of HIV serostatus and a new infant." Psychology & Health 17(3): 339-363.

Tuck, I., N. L. McCain, et al. (2001). "Spirituality and psychosocial factors in persons living with HIV." Journal of Advanced Nursing 33(6): 776-783.

Tolliver, D. E. (2001). "African American female caregivers of family members living with HIV/AIDS." Families in Society-the Journal of Contemporary Human Services 82(2): 145-156.

Poindexter, C. (2001). ""I'm still blessed": The assets and needs of HIV-affected caregivers over 50." Families in Society-the Journal of Contemporary Human Services 82(5): 525-536.

Hinkin, C. H., S. A. Castellon, et al. (2001). "Neuropsychiatric aspects of HIV infection among older adults." Journal of Clinical Epidemiology 54: S44-S52.

Hessol, N. A., M. Schneider, et al. (2001). "Retention of women enrolled in a prospective study of HIV infection: Impact of race, unstable housing, and use of HIV therapy." American Journal of Epidemiology 153(11): S192-S192.

Hessol, N. A., M. Schneider, et al. (2001). "Retention of women enrolled in a prospective study of human immunodeficiency virus infection: Impact of race, unstable housing, and use of human immunodeficiency virus therapy." American Journal of Epidemiology 154(6): 563-573.

Heckman, T. G., A. Kochman, et al. (2001). "A pilot coping improvement intervention for late middle-aged and older adults living with HIV/AIDS in the USA." Aids Care-Psychological and Socio-Medical Aspects of Aids/Hiv 13(1): 129-139.

Sterk, C. E., K. W. Elifson, et al. (2000). "Women and drug treatment experiences: A generational comparison of mothers and daughters." Journal of Drug Issues 30(4): 839-861.

Linsk, N. L. and C. C. Poindexter (2000). "Older caregivers for family members with HIV or AIDS: Reasons for caring." Journal of Applied Gerontology 19(2): 181-202.

Klein, K., L. Armistead, et al. (2000). "Socioemotional support in African American families coping with maternal HIV: An examination of mothers' and children's psychosocial adjustment." Behavior Therapy 31(1): 1-26.

Poindexter, C. C. and N. L. Linsk (1999). "HIV-related stigma in a sample of HIV-affected older female African American caregivers." Social Work 44(1): 46-61.

Poindexter, C. C., N. L. Linsk, et al. (1999). ""He listens ... and never gossips": Spiritual coping without church support among older, predominantly African-American caregivers of persons with HIV." Review of Religious Research 40(3): 230-243.

Poindexter, C. C. and N. L. Linsk (1999). ""I'm just glad that I'm here": Stories of seven African-American HIV-affected grandmothers." Journal of Gerontological Social Work 32(1): 63-81.

Dorsey, S., K. Klein, et al. (1999). "Parenting self-efficacy of HIV-infected mothers: The role of social support." Journal of Marriage and the Family 61(2): 295-305.

Poindexter, C. C. and N. L. Linsk (1998). "Sources of support in a sample of HIV-affected older minority caregivers." Families in Society-the Journal of Contemporary Human Services 79(5): 491-503.