Magazine Article on HIV+AIDS
Jessica Bennett (2008) reported in a Newsweek article that while advances in medicine slows the progress of the disease and, in turn, allow more people living with HIV+AIDS (PLWHA) to live longer, it brought on new sets of challenges. The author described how a near-death patient bounced back to life after having successfully recovered with the introduction of a new antiretroviral drug, Crixivan. Today, at 59, Lee Chew looks healthy and appeared to have gotten over the worst. However, new worries come up as more people living with HIV+AIDS age. The doctors are not quite certain on how the aging body reacts to antiretroviral drugs. The doctors and researchers are only beginning to understand the implication of aging on HIV+ individuals.
Aside from the uncertainties facing senior PLWHA, the local health departments have to deal with the increasing number of PLWHA turning 50. The article reported that the number of people diagnosed with disease aged over 50 increased by 700 percent (Bennett). What physicians now know regarding the health impact of the disease is that PLWHA ages faster, not to mention the lack of immunity from diseases. Complications may be brought about by the combination of drugs taken to maintain their health.
Aside from the health issue, the article also mentioned the lack of adequate social support aging PLWHA. In the report, it mentioned that older PLWHA patients are twice more likely to live alone when compared to other older, straight individuals. The report recognizes the importance of social support. Charles Emlet, a social worker, indicated that “[p]eople with better social networks are more adherent to their meds, less likely to be depressed, and we know from the gerontological literature that those with better social networks live longer—outside of HIV disease.” (Cited in Bennett, 2008).
Psychological Concepts
The need for better psychosocial interventions to help senior PLWHA cope with their present situation is highlighted in the report. For example, the increase in older PLWHA is not exclusively the consequence of better medicines. Some men who are gay contracted the disease when they are older. This implies some high-risk sexual behavior among older gay men. In the clinical care setting, several approaches are proposed to reduce risky behavior. Schriebman and Friedland (2003) suggested behavioral counseling as a prevention strategy. The authors cited the study conducted by the National Institute of Mental Health’s (NIMH) Multisite HIV Prevention trial where they assessed the effectiveness of behavioral counseling to initiate change among high-risk, heterosexual, low-income patients (p.1172). The study noted the changes in behavior within the one-year study period, and risk behaviors were substantially reduced. The subjects reported fewer occasions of unprotected sex, the use of condoms and more likely to use condoms over an extended period (p.1172).
Social Cognitive Theory proposed the human behaviors are directed and encouraged by what was happening in the surroundings as well as events in the society. Bandura’s theory “emphasizes the roles of outcome expectancies, self-efficacy beliefs, and reinforcement value for instituting behavior changes.” (Kalichman, Rocha and Cage, 2005, p. 264) The theory further suggested that, “behavior change occurs as a direct result of observation and interpretation of behavioral performances.” (p.264) Moreover, this theory assumes that individual feelings and the interpretation of thoughts explain how one behaves. People always think about the possible outcomes, results, and future consequences of their behavior. The study of this theory can help identify where problems associated with risk behaviors were rooted. Since this theory was based on the individual’s use of the feelings and thoughts to influence behavior, behavioral change comes directly from the individual.
The fear of the unknown will continuously challenge both the patients and the medical practitioners. The circumstances of aging HIV+AIDS patients need to be explored. Physicians and researchers need to understand the impact of the disease on the aging body as well as the side effects or complications of medication. One must also acknowledge the psychology of an aging PLWHA may be quite different from that of normal individuals. Issues such as fear, loneliness, isolation, persistent social stigma and the uncertainties about the future add to the burden of having HIV+AIDS.
Research article on HIV+Aids
Emlet’s (2006) study revealed that the social patterns between the two groups (younger and older) were similar. However, the research also yielded that older people were more likely to live in isolation than their younger counterparts. Older and colored adults were more at risk of social isolation compared to other groups and ethnicity. The study found that the ethnic group most likely to suffer from stigma was older African-Americans. The group could suffer from rejection from family, friends, and religious institutions where most associate stigmatized behaviors with HIV transmission (Emlet, 2006, p.306).
The purpose of the study was to compare the social networks of younger patients with the older ones. The information gleaned from the study could help determine ways to prevent social isolation among older patients and other issues that may positively or negatively affect HIV-AIDS patients. The study was also conducted to “determine the potential role of social networks in mediating HIV stigma and evaluate the risk of social isolation among the study population.” (Emlet, 2006, p.305). Stigma, in some cases could be reinforced in “societies with strong bonds and allegiances to family, village, neighborhood and community.” (Chen et al, 2007,p.666)
The author conducted the research primarily for the improvement of social work practice in dealing with older HIV patients. Although the research was addressing social workers, in general, it is also applicable to other professionals tasked to care for aging HIV patients. Medical practitioner extending their help need not stop at providing pharmacological therapies. Previous research also revealed that “adequate emotional and social support…improve[d] compliance with HIV medications.” (Emlet, 2006, p.300).
To provide a framework for the study, the author used the concept of social networks and how they change over time. The convoy theory of social support lent credence to the research. The convoy could be “constructed from a variety of sources including family, friends and others” at a given situation or circumstances (Emlet, 2006, p.300). Other sources rendering support to the study include references to similar studies done previously. These researches showed how adequate or inadequate social support affects the patient. However, majority of the studies had been conducted on young HIV positive patients. This was where the author saw the gap. The author proposed that if practitioners dealing with older and ageing HIV positive patients had more knowledge concerning social networks, the social worker, medical practitioners or care providers can provide measures that could prevent isolationism and social stigma.
The author acknowledged some limitations and biases to the study. First, the respondents were selected purposively. Second, most of the respondents came from an AIDS service organization, so the results may not yield an accurate view of the perceived availability or lack of social support. Finally, all the respondents came from the same area, Pacific Northwest. The study may not be applicable to areas outside the region.
The strength of the study lies in the inclusion of older HIV-AIDS patients that had been long neglected. The author associated the increase in older HIV positive patients to the availability of better intervention strategies that extended the lives of the afflicted. The author recognized that pharmacological interventions were not enough to improve the chances of survival for those affected. Social support is important especially when the AIDS patient finds comfort in the social network he had formed.
The study is weak in the selection of respondents. A broader selection process could have given the practitioners a wider perspective. However, the study is replicable and could be repeated. Emlet’s (2006) is timely because of the increasing population of elderly HIV-AIDS patients and health practitioners need to consider strategies that would mitigate cost, fear, stigma, and isolation.
How the Study Relates to Real-World Issues
Solving the HIV-AIDS problem goes beyond the pharmacological interventions. In Emlet’s (2006) research, he considered the social aspects that affect the well-being of people living with HIV-AIDS (PLWHA). Pharmacological interventions like the highly active antiretroviral therapies (HAART) introduced in the 90’s had extended the life expectancy of the afflicted. Thus, increasing the number of older patients. With the increase in older HIV-AIDS patients, the author acknowledges the gaps concerning issues that may affect them. Practitioners are beginning to recognize the effects of HIV-AIDS on older adults. Previously, HIV-AIDS was considered a disease that primarily affects the youth. Social networks are important in alleviating the effects of the disease. Social support from family and friends are crucial to improve the lives of the people living with HIV-AIDS. Learning more about the gaps and circumstances of social networks, especially in older HIV patients would lessen the negative impacts of the disease like stigma, homophobia, discrimination, and isolation.
Jenkins and Guarnaccia (2003) found several patterns of patients seeking social support. “Gay/bisexual men were more likely to seek the HIV community than broader social-emotional support… Heterosexual men were least likely to seek either form of support, and the lesbians in the private clinic sample were most likely to seek both.” (p.420) These patterns would elevate the importance of social networks to improve the lives of people living with HIV-AIDS.
When risk behaviors associated with HIV+/AIDS infections are unbridled, they could become the reasons why the increase in HIV+/AIDS cases will continue unabated despite the many programs and interventions in place to reduce the incidence. Knowing that there are strategies to reduce the risk behaviors is important. Changing or reforming risky behavior associated with HIV+/AIDS could take several forms. Cognitive social and behavioral theories provide the framework to ensure change in HIV+/AIDS patient behavior.
The presence of other risk factors that have been overlooked, such as the possibility that sexual violence and high conflict areas could drive up the number of HIV+/AIDS infections globally. While numerous efforts are exerted to stop the violence and conflict in these places, it would also be a wise decision to include HIV+/AIDS prevention strategies. Women and children are the most affected segment of society in these situations.
Once a person gets infected with the HIV, some clinical signs may occur. An HIV infected person has several physical manifestations such as having headaches, fever, stomach ache, sore muscles and joints as well as skin rash. that can last for two weeks.
(What is Aids). Even if an infected person is tested to be negative, but found out to be positive later, he can already infect other people. This manifestation may take ten years or more depending on the ability of the antibodies to react or combat the virus before it becomes a full blown disease categorized as AIDS. An HIV infection becomes AIDS when the CD4 cells count is less than 200 or less than 14%. Proper treatment helps the CD4 cells maintain its number or lowers them down gradually. Oftentimes, the disease shows no symptoms at all. In most cases, an infected person never knows about his illness until the virus has already severely damaged his immune system (What is Aids).
AIDS is a lethal disease that causes everyone and all sectors of the society, particularly the government and civic-spirited groups to adopt a high degree of awareness on the effects it brings to the individual and the society in general. Once a person is infected with HIV, which eventually leads to AIDS, the following effects shall be evident.
The sickness is said to physically affect an infected person through the symptoms being manifested. An infected person feels ill because of the pains and difficulties brought by the infections and the response of the antibodies to the virus. The effects could be lessened if the infected person is tested immediately after the acquisition of the virus. Most appropriate, it is being advised that complete annual examinations and laboratory tests should be undergone by any individual who is exposed to the virus or in contact with infected persons.
AIDS is one of the most pressing social problems being addressed by government leaders and authorities. The US government, through the Public Health Service has been allocating annually a huge amount of public funds for the treatment and rehabilitation of HIV-infected persons and AIDS victims. In 1993, it is estimated that around $119,000 has been spent for the treatment of AIDS victims (Grolier Encyclopedia of Knowledge 190). With the increasing number of AIDS victims, the appropriation shall likewise increase, thereby sacrificing the funding of some basic services that should go to the whole constituents and the in-need.
A society with a large number of HIV positive and AIDS cases is considered unhealthy. It reflects the performance of leaders and legislators. It signifies that the efforts being done by authorities do not correspond to the demand for performance. This situation calls for more appropriate and responsive programs with financial requirements in order to minimize if not stop the growing number of AIDS cases. Side by side, these programs are the moral recovery orientations that should be conducted in order to reinforce the values of self-preservation, responsibility, and morality.
In closing, Emlet (2006) believed social networks are important in alleviating the effects of the disease. Social support from family and friends are crucial to improve the lives of the people living with HIV+AIDS. Learning more about the gaps and circumstances of social networks, especially in older HIV+AIDS patients would lessen the negative impacts of the disease. Intervention programs should fit the specific population. The intervention policies and programs of the government, for example, must now address the needs of this particular group, taking into consideration its linguistic and cultural values, social behavior, education, and economic circumstances. Without these considerations, the intervention and prevention programs might as well go to waste.
References
Bennett, J. (2008). ‘A Lot of Unknowns’ Medical advances are helping many HIV patients live into old age. But that blessing presents its own unique set of tribulations. Web.
Chen, J. et al (2007). The effects of individual- and community-level knowledge, beliefs, and fear on stigmatization of people living with HIV/AIDS in China. AIDS Care, 19(5), 666-673.
Emlet, Charles (2006). An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health & Social Work,31(4), 299-308.
Jenkins, S.R. and Guarnaccia, C.A. (2003). Concerns and coping with HIV: Comparisons across groups. AIDS Care, 15 (3); 409-421.
Kalichman, S.C., Rocha, D. and Cage, M. (2005). Group intervention to reduce HIV transmission risk behavior among persons living with HIV/AIDS, Behavior Modification,29(2), 256-285.
Schreibman, T. and Friedman, G. (2003). Human immunodeficiency virus infection prevention: strategies for clinicians, Clinical Infectious Diseases, 36, 1171–1176.
‘A Lot of Unknowns’ Medical advances are helping many HIV patients live into old age. But that blessing presents its own unique set of tribulations. Jessica Bennett.
Newsweek Web Exclusive
There was a time when Lee Chew was so sick, he’d lost all feeling in his lower body—forcing him to wear diapers and get around by wheelchair. At 6 feet 2 inches, the once-robust actor was a skeletal 135 pounds, with severe pain in his hands that prevented him from even holding a fork. It was 1996, nearly 10 years after his diagnosis, and AIDS was all around him: friends, lovers, even his doctor, all died of the disease. Funerals were a monthly ritual. “In a way, living through the AIDS crisis of the 1980s was like living through our own version of the Holocaust,” he says. “It was a nightmare.”
Chew slowly began to wake from that nightmare with the approval of a new antiretroviral drug, Crixivan, that would help nurse him back to health. Slowly but surely, he went from wheelchair to walker, walker to cane, and finally, back to the gym. Today, Chew, a New Yorker, by way of Roanoke, Va., is happy and healthy, tan and fit. At 59, he looks about 40. “I can be pretty vain,” Chew jokes. “I like to make sure my pecs look good.”
In reality, Chew worries about a lot more. He is a social worker for aging HIV-positive gay men, so AIDS remains a constant character in his life. And though he’s healthy, Chew is getting older—which brings a whole new set of worries. His is the first generation to age with HIV. As he ages, there are changes in how his medications will interact. And doctors and researchers are only beginning to figure out what, exactly, that means.
What doctors do know is that despite infection rates that remain level, people over 50 now make up the fastest-growing segment of those living with HIV—part of the reason why the AIDS Institute this week announced Sept. 18 as national HIV/AIDS and Aging Awareness Day. It’s perfect timing: between 1990 and 2005, local Department of Health studies show that the number of AIDS cases in people over 50 shot up by more than 700 percent—today, 35 percent of people with HIV are aged 50 and older, and 70 percent are over 40, according to the AIDS Community Research Initiative of America (ACRIA). A large portion of those, say advocates, are gay men. Some of these older patients are newly infected, while most are long-term survivors.
Researchers know that HIV and age make for a complicated balancing act—a convoluted interplay of the disease itself, natural aging symptoms and the side effects of antiretroviral medication that may enhance those symptoms. Part of the aging process is already about a loss of immunity. So the fact that HIV is an immune disease may be one reason why its sufferers tend to age fast, in everything from body changes to cardiovascular disease, says Dr. Richard Havlik, an epidemiologist and former chief of the epidemiology, demography and biometry laboratory at the National Institute on Aging, in Bethesda, Md. But patients can also be plagued by ongoing side effects of drug cocktails, which range from high blood pressure to neuropathy—a painful nerve disorder that causes numbness in the hands and feet. And they must often fight fire with fire: a medication may heal one ailment, but in many cases, it only causes another. “All of those are bonuses—the side dishes—to the main course of HIV,” Chew says.
With multiple HIV drugs on the market, allowing for physicians to mix and match to limit side effects and resistance, the medical community can often only make educated guesses as to what causes a particular ailment: Is it the virus? The meds? Aging itself? “From a health care viewpoint, that’s one of the great black boxes,” says Stephen Karpiak, ACRIA’s associate director of research and the author of one of the only comprehensive studies on HIV and aging. “And the reality is we just don’t know.” Scientists didn’t begin using the drug cocktails that turned AIDS from death sentence to chronic illness until 1996; prior to that, it was still considered a young person’s disease, with everybody focused simply on survival.
Experts say that’s not enough history to grasp the drugs’ impact on the body, particularly in older patients. Clinical trials until now have been virtually nonexistent, and most big drug companies don’t use older patients in trials—because of the possibility that those already at high risk for disease would complicate the results. “It’s very much to me kind of a good news-bad news situation right now,” says Dr. Bill Stackhouse, director of the New York-based Gay Men’s Health Crisis, the world’s oldest AIDS service organization. “The good news is that the meds are great, and people are living longer. But now there’s a whole new set of issues to be faced.”
Chew and his patients know that reality all too well. On a recent Wednesday in New York, Chew led an HIV-support group for Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE). The group regularly vents about doctor’s visits, pill regiments and the laundry list of side effects that are becoming more complicated with age. For this session, Ernest Krysty, 61, has traveled from Connecticut; he says there isn’t a support group closer to him. He describes the painful lesions on his stomach from the acid in his drug cocktail—12 different pills each day: six for HIV, and the rest for heart problems and lipodystrophy, a degenerative tissue disorder that redistributes fat, which commonly occurs in those being treated for HIV.
Another member of the group, Bruce Miller, 59, takes up to 20 pills on some days—and recounts the painful hip-replacement surgery he had to have last year. Miller isn’t sure what caused the bone degeneration in the first place—as Havlik puts it, “there are a lot of unknowns”—but the procedure caused a hematoma that had to be surgically removed, resulting in nerve damage. During his rehabilitation, he was prescribed an antidepressant that he’s now struggling to wean himself from. And now he needs a replacement in his knee, too. “It’s sort of like a house of cards,” Miller says softly. “The more pills you take, the more possibility for interaction. And as you grow older, there’s more of a chance of that collision.”
Chew himself has diabetes, high cholesterol, and neuropathy—all ailments he never thought he’d be around to see. “Having been HIV-positive for so long, and lived through the earliest part of the epidemic, I think the notion was that it would kill us long before there was any question of any other physical ailments,” says 53-year-old Mark Stewart of Manhattan. “Part of what’s helpful about this group is that we share notes about … all those things you never thought you’d have to deal with, because you thought you’d be dead.”
Those issues, of course, extend far beyond the physical. Stigma related to disease and age—and, in many cases, sexual orientation, too—has been shown to cause depression and anxiety. (In a 2006 study, ACRIA found rates of depression in HIV survivors to be nearly 13 times higher than in the general population.) Many of those aging with HIV don’t have social networks they can count on, either: gay seniors, who make up a big chunk of this group, are twice as likely as their straight counterparts to live alone. “People with better social networks are more adherent to their meds, less likely to be depressed, and we know from the gerontological literature that those with better social networks live longer—outside of HIV disease,” says Charles Emlet, a social worker at the University of Washington who studies the virus and aging.
In many ways, HIV-positive people over 50 are like guinea pigs, says Chew: they are the first to age with HIV, and the first to experience that process truly out of the closet. “With each step along the road, from the ’80s to the ’90s to now, every step has been a step in the dark,” Chew says. “And there was always the thought that, well, this medication might result in heart disease, but if it keeps me alive now, then so be it.” Sometimes a step forward can feel very much like a step back.