Adults with HIV infection are living into old age. It is critical we investigate positive constructs such as resilience and mastery to determine factors associated with psychological well-being.
We examine HIV-related factors, adverse conditions, and psychosocial characteristics that are associated with resilience the ability to bounce back and mastery sense of self-efficacy. We analyzed data from the longitudinal study Aging with Pride: Multivariate linear regression was used to identify factors that contributed Bisexual older men detracted from resilience and mastery in the sample recruited from 17 sites from across the United States.
Resilience and mastery were independently associated with psychological health-related quality of life. In multivariate analysis, adjusting for demographic characteristics, previous diagnosis of depression was negatively associated with resilience.
Time since HIV diagnosis was positively associated with mastery whereas victimization was negatively associated with mastery. Social support and community engagement were positively associated with both resilience and mastery. Individual and structural-environmental characteristics contributed to resilience and "Bisexual older men." These findings can be used to develop interventions incorporating an increased understanding of factors that are associated with both resilience and mastery.
HIV disease is now recognized as a phenomenon impacting older adults. This increase is Bisexual older men to the confluence of new infections and "Bisexual older men" increasing survival rates among HIV-positive adults Heckman and Halkitis, Gay and bisexual older men also
Bisexual older men unique psychological and social challenges as well.
Grossman notes that older MSM are often invisible—invisible to younger gay men due to agism, to health care providers as their sexuality is not recognized Bisexual older men to larger society due to continued homophobia. In addition, Wight and colleagues found that HIV-related bereavement can negatively impact mental health and can create a vulnerability to positive affect. Thus, gay and bisexual older men continue to be an important focus of research efforts Bisexual older men a population that is seriously impacted and HIV and social invisibility.
Still McLaren underscores the importance of the gay community, in particular having a sense of belonging as a means of moderating poor mental health, among older gay men, in particular those who live alone.
Additionally, HIV stigma and agism may be combined and doubly stigmatizing Emlet, b. These older adults may be more socially isolated than their younger counterparts Emlet, a or HIV-negative peers Fredriksen-Goldsen et al.
Despite the deleterious effects of HIV, there is a growing interest in understanding how individuals living with HIV can age successfully High et al. A deficiency-focused approach is insufficient to fully understand the strengths inherent in this population. Vance and colleagues defined successful aging as maximizing existing abilities and minimizing difficulties associated with age-related losses.
The HEPM is designed specifically to conceptualize mechanisms of health equity among lesbian, gay, bisexual and transgender LGBT adults, including HIV-positive gay and bisexual older men, highlighting the importance of psychological resources as key strengths, which contribute to health and well-being Fredriksen-Goldsen et al.
It also suggests that psychological resources can interplay with risk and protective factors. For example, psychological resources can be influenced by biological e. Two important constructs identified as potentially supporting successful aging with HIV are resilience and mastery Fang et al. Smith and Hayslip suggest that intrapersonal, interpersonal, and environmental including community resources can contribute to resilience.
There are, however, emerging consistencies across studies that focus on resilience among people living with HIV. Yu and colleagues found that among HIV-positive adults in China, resilience was negatively associated with depression, anxiety, and stress, whereas Lyons and colleagues
Bisexual older men that having been diagnosed with an anxiety or mood disorder was associated with decreased resilience among gay men living with HIV in Australia.
Fang and colleagues found social support interpersonal to be an important component of resilience among older adults living with HIV, whereas Emlet, Tozay, and Raveisin a qualitative study of older adults living with HIV, identified relational living involving formal and informal support and generativity as important elements Bisexual older men resilience. Studies have also identified the key role of community. De Santis suggests that both community and empowerment are important concepts to Bisexual older men in resilience, whereas Earnshaw, Bogart, Dovidio, and Williams suggest that resilience must include family and community resources.
Still, we have not found any studies to date that include community in the statistical modeling of resilience. Pruchno and colleagues suggest that no single variable exerts a dominant influence on resilience.
Adverse experiences and when possible, a life course perspective Bisexual older men adversity, should be taken into account when examining resilience in older people.
Smith and Hayslip suggest that persons showing resilience at one point in time may be much less or more resilient at a different time as adversity can accumulate.
A sense of bouncing back from an adverse event, such as an HIV diagnosis, could be hampered by intrapersonal, interpersonal, and environmental contexts, including experiences of discrimination, Bisexual older men, internalized stigma, and depression.
Because the empirical evidence pertaining to effects of these adverse experiences on resilience is still largely unavailable on gay and bisexual older men, there is a considerable gap Bisexual older men our knowledge about how such experiences contribute to and detract from resilience in this population. Conceptually, mastery differs from resilience in several distinct ways. First, mastery is a cognitive or affective resource that helps one develop a sense of self-control Rueda et al.
Second, although resilience requires experiences of adversity, mastery requires no such supposition. Mastery and self-control can develop without adverse experiences.
Mastery has been examined among people living with HIV, including studies of older adults. Acquiring mastery is found to be important to improve mental health Gibson et al. This association may be partly attributed to the direct negative correlation between mastery and stigma Emlet et al. Correlates of mastery Bisexual older men rarely examined. The direct consequence is that we are left with a significant knowledge gap about what factors contribute to a sense of mastery among this population.
In this study, guided by the HEPM, we assess what risk and protective factors in both individual and structural-environmental contexts are associated with increased feelings of mastery.
This information may, in turn, lead to improved knowledge of how to foster mastery in HIV-positive gay and bisexual older men, thus improving quality of life. The purpose of this study, therefore, is to examine HIV-related factors, adverse experiences, and psychosocial characteristics that are associated with resilience and mastery in HIV-positive gay and bisexual older men. We examine resilience and mastery as separate psychological resources that relate to each other but may be influenced by different factors in structural-environmental and individual contexts.
We use data from the survey of the Aging with Pride: NHAS for this analysis. Finally, both resilience and mastery will independently be associated with psychological health-related quality of life HRQOL. The data for this analysis were obtained from a subsample from Aging with Pride: We utilized survey data. For the purposes of this study, our subsample met the following inclusion criteria: The final sample size for the analyses was Variables included in the analysis are categorized into five distinct domains consistent with the conceptual framework.
These include demographic and background characteristics, HIV-related factors, adverse experiences, psychosocial characteristics, and outcome variables. Items from both scales measured how many times participants experienced different types of discriminatory and victimization events throughout their lifetime.
Depression diagnosis was a single item, asking participants whether they were ever told by a doctor or medical professional that they had depression. Psychosocial characteristics included four measures to assess
Bisexual older men characteristics, including identity
Bisexual older men, spirituality, social support, and engagement in the LGBT community.
Bisexual older men in LGBT community was evaluated with a 4-item scale. First, we computed the descriptive statistics to investigate the overall distributions of demographic and background characteristics, HIV-related factors, adverse experiences, psychosocial characteristics, and outcomes among the HIV-positive gay and bisexual older men. Second, to evaluate the relationships between resilience, mastery, and psychological HRQOL, we used hierarchical model and entered resilience and mastery in a step-wise fashion along with other control covariates.
We used seemingly unrelated regression to integrate different models and used Wald test to test the changes in beta coefficients across models.
Third, to investigate the relationships among resilience and mastery, we used the hierarchical model and entered the selected independent variables as blocks into the model according to the hypotheses based on the conceptual model. An advantage of this approach allows researchers to examine the structure of the relationships between independent and dependent variables across different outcome variables. In
Bisexual older men to reduce sampling bias and increase the generalizability of the findings, we Bisexual older men survey weights to statistical analyses.
In the first step, the Aging with Pride: NHAS sample by using a logistic regression model with age, sex, sexual orientation, Hispanic ethnicity, race, education, region, and home ownership as covariates. Bisexual older men the second step, we further calibrated the weights for those in same-sex partnerships, another indicator of sexual orientation. See Fredriksen-Goldsen and Kim for detailed information regarding the postsurvey adjustment procedures.
All statistical analyses were conducted in commercial statistical software, Stata 14 StataCorp. Table 1 summarizes the weighted estimates of the demographic and background characteristics in the sample. The mean age was 58 years with a range of 50— The length of time living with HIV
Bisexual older men from less than 1 to 35 years, with a mean of Having CD4 cells less than per cubic millimeter of blood or being diagnosed with opportunistic infections can result in a diagnosis of AIDS.
On average, they had experienced 10 lifetime discriminatory and victimizing events. Participants had, on average, relatively low levels of identity stigma and moderate-to-high levels of spirituality, social support, and community engagement. Table 2 summarizes the model fitting results of linear regression that investigated the relationships between psychological HRQOL and resilience and mastery. As shown in Table 2in Models 1 and 2 with resilience or mastery entered into the model along with other covariates, both resilience and perceived mastery were significantly and positively associated with psychological HRQOL, even when all other covariates were controlled.
In Model 3 with both resilience and mastery simultaneously entered into the model, it was shown that they still remained significantly associated with psychological HRQOL, despite that beta coefficients were significantly reduced as suggested by Wald tests resilience: The summaries of model fitting results are presented in Table 3. As shown, most of the demographic factors were not significantly associated with either resilience or mastery. The only exception was that those with lower educational
Bisexual older men had lower levels of resilience in the model.
In contrast, years of Bisexual older men with HIV had significant positive relationships with mastery in the model, although having an AIDS diagnosis was not significantly related to either resilience or mastery.
Having ever received a diagnosis of depression was negatively associated with resilience, but not mastery. In contrast, Bisexual older men victimization was negatively associated with mastery but not resilience. Lifetime discrimination was not associated with either resilience or mastery. As presented in the full models, social support was positively associated with both resilience and mastery as was community engagement.
Identity stigma and spirituality, in contrast, were not significantly associated with either resilience or mastery at the. Many HIV-positive gay and bisexual older men are part of a cohort who did not expect to live into middle and older age Halkitis, Those who did survive have often experienced AIDS-related bereavement.
Although much of the focus on aging with HIV has been on its deleterious impacts, the results of this study provide an enhanced understanding of resilience and mastery and characteristics that contribute to those psychological resources. We hypothesized that resilience and mastery relate independently to psychological HRQOL while their relationships with psychological HRQOL would diminish when both were entered in the same model.
We also hypothesized that HIV-related factors, adverse experiences such as depression, lifetime victimization, and discrimination, and psychosocial characteristics would independently contribute to resilience and mastery.
Perhaps not surprisingly, gay and bisexual older men are more likely than heterosexual older men to have poor general health and live alone. Behav Med. ;40(3) doi: / Substance use and sexual risk differences among older bisexual Bisexual older men gay men with HIV.
Gay and bisexual older men also face unique psychological and social challenges as well. Grossman () notes that older MSM are often.
Substance use and sexual...
The positive outlook study—A randomised controlled trial evaluating the effectiveness of an online self-management program targeting psychosocial issues for men living with HIV: The results of this study have important practice implications as well.
Internalized stigma was also a predictor of disability and depression. Another interesting finding is that social support and social network size seem to suppress the relationship between obesity and depression among LGB older adults in the study. Gay and bisexual older men also face unique psychological and social challenges as well. We utilized survey data.
Reconceptualization of lesbian, gay, bisexual, and transgender LGBT health disparities.
For those of us who identify as bisexual, relationship status has been a defining aspect of our identities from the perspectives of other people in our lives since long before the advent of social media. Kinsey, Klein, and Everything In Between Participants will be able to ask questions and discuss the variance and fluidity of sexual orientation.
I am a woman who is married to a woman. At casual glance, I appear to be a lesbian. For many years before I got involved with the woman who is now my wife, I was married to a man. During those years again, at casual glance I appeared to be heterosexual.
Since my late teens, I have been serially monogamous. I have had more relationships with men than I have had with women. But there were women, and those relationships were important. I have always since age 10 or so, when I first learned the word and realized that it described me identified as bisexual.
And so, my sexual orientation identity has evolved, dependent upon current relationship status. I never wanted to be closeted.
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- Behav Med. ;40(3) doi: / Substance use and sexual risk differences among older bisexual and gay men with HIV.
- The Physical and Mental Health of Lesbian, Gay Male, and Bisexual (LGB) Older Adults: The Role of Key Health Indicators and Risk and. Gay and bisexual older men also face unique psychological and social challenges as well. Grossman () notes that older MSM are often.
- Substance use and sexual risk differences among older bisexual and gay men with HIV.
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