CATIE News

7 February 2011 

Examining resilience and aging in HIV infection

As people age they naturally experience a variety of health challenges. Long-term infection with HIV carries not only physical and medical burdens but also poses psychosocial issues from time to time. All of these factors can affect HIV-positive people’s quality of life and ability to manage their health and may ultimately have an impact on their survival.

Some HIV-positive people display an ability to cope and thrive—resilience—despite having to carry the burdens of a complex chronic health condition. As part of a study, researchers at the University of Washington in Seattle have been interviewing HIV-positive people who display resilience. Their findings have helped identify a strength among some HIV-positive people that the research team described as successful aging. This finding may be important, as it has the potential to inform psychosocial support services for HIV-positive people, particularly as they grow older.

Study details

Researchers recruited 25 participants and conducted structured interviews. Their basic profile was as follows:

  • eight females and 17 males
  • age – between 50 and 70 years
  • major ethno-racial groups – 60% White, 36% Black

Results—Emerging themes

In analysing their data, the researchers found that participants’ responses to questions could be divided into seven major themes, which the team labeled as follows:

  • self-acceptance
  • optimism
  • will to live
  • generativity (caring about younger generations of people)
  • self-management
  • relational living (formal and informal support from other people)
  • independence

We now explore some of these themes.

Self-acceptance

According to the researchers, several participants found that self-acceptance was “central to overcoming the negative effects of HIV/AIDS and the complexities of aging with such a stigmatizing disease.”

One of the participants said: “It has been fine for me because I just accept growing older. I don’t [want] to act like or think that I’m still 25…”

Another participant explained his feelings to researchers by saying: “Be who you are, and be glad you’re still here.”

The researchers found that self-acceptance helped participants to realize their strengths and limitations. In turn, this allowed participants to “move forward with their lives, rather than remaining stuck and mired on regrets from prior actions and behaviors.”

Optimism

A large majority of participants had a positive outlook on aging with HIV. They continued to have goals about the future and wanted to age well in the years ahead. According to the study team, most participants disclosed that it required some effort on their part “not to have living with HIV/AIDS substantially impact future plans and feelings of well-being.” Indeed, many participants envisioned living with HIV as just one of several barriers they had to overcome, as they had successfully done in the past.

One interviewee said: “You know that there’s gonna be hurdles in anybody’s life. You know, you have to learn to get over the hurdle… If everybody let every hurdle bring them down we wouldn’t have half the people here that we have now.”

One woman outlined her approach to aging to the researchers: “It’s not really a big deal to me. I mean, I take my medicines; I go on with my life. I don’t think about the AIDS anymore.”

Will to live

Several participants stated strongly that thanks to advances in HIV treatment they now expect to live for several more decades. One woman told interviewers that she was grateful for having lived to be 57 years, but, she said: “I’ve had a good life and I’m already looking at the second half of life. So, it does sadden me, but you know, no one leaves the planet without dying.”

Generativity

Ten participants told interviewers that they wanted to give something back to their communities and to the larger society. One woman said that older HIV-positive people have important experience and a responsibility to share that and educate younger people regardless of their HIV status. “We can give them advice [because] we’ve been through what they’re going through now,” she said.

Self-management

Researchers found that many participants raised issues related to caring for themselves, such as taking medicines as prescribed, having a balance of sleep, rest and activity and eating a healthy diet. As participants took greater control of their lives, researchers found that they were better able to manage HIV disease.

One 72-year-old woman said: “I maintain a very healthy lifestyle, I diet, exercise, the whole thing, and doing well is what counts. So I’m in pretty good shape for being this far along with the diagnosis.”

The woman posed the following question for other HIV-positive people: “What are you doing as an individual to cope with this condition? I think that it is how a person handles it (HIV infection) himself. You could either give in to it or you can fight it.”

Relational living

The study team used this term to describe the relationships participants formed with other people and organizations. Many participants found their families to be a source of support. One man found his grandchildren particularly helpful because they accepted him unconditionally.

Participants who were in long-term relationships found them to be a great source of support. One man said: “I’ve been in a relationship for 21 years and because of that have not had to deal with a lot of the loneliness that is a very large part of being gay and older.”

Some people found their support networks through religion, theatre or other groups to be particularly helpful.

Researchers found that participants’ social connections made them “feel valued as a person and…gave them a sense of contributing and feelings of self-worth while knowing that they are not facing this situation alone.”

Independence

About half of the participants were living alone. They expressed feelings of being self-reliant and self-supporting and this helped them feel “in control of aging and HIV disease.”

Summary

All participants in the study displayed a number of psychological strengths. The study team found that participants were able to turn negative experiences into opportunities for personal growth and development. Furthermore, interviewees also expressed feelings of hopefulness. The researchers said that although participants were aging with HIV, their attitudes and statements made it clear that “it was possible to retain meaning in life, psychological well-being and maintenance of valued activities and relationships.”

Implications

The study team encourages gerontologists, psychologists, social workers, counsellors and health-care practitioners to integrate an assessment of strengths into their strategies for helping older HIV-positive adults.

Additional studies are needed to explore the presence/absence of resilience in more HIV-positive people. The researchers suggests that such studies could be used to help develop strategies for enabling resilience “to promote successful aging” among HIV-positive people.

                                                                                                            —Sean R. Hosein

REFERENCE:

Emlet CA, Tozay S, Raveis VH. “I’m Not Going to Die from the AIDS”: Resilience in Aging with HIV Disease. The Gerontologist. 2011 Feb;51(1):101-11.