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In 1998, approximately 30 million people worldwide were living with HIV/AIDS, about 5 million of whom became infected that year. The epidemic continues to expand, with an estimated doubling time of 10 years, making AIDS the leading infectious cause of death ahead of tuberculosis and malaria. Even in the U.S.A. where the death rate from AIDS is declining as a result of effective drug therapies, HIV infection rates continue to climb in several population groups. The prevalence of AIDS among people over the age of 50 is steadily increasing, and most older people are unprepared to address it for a number of reasons, including the widespread discomfort with matters sexual and homosexual and the belief that elderly people are not sexually active and therefore not at risk.This guide for care providers seeks to educate and inform readers about the difficulties and complications that accompany the disease in older people. Thus, while the appendix includes technical descriptions of methodology, data, and results, the narratives in the chapters describing the findings and their practical implications are written in layman's language. Topics covered include biomedical aspects, demographics, sexuality, stressors, mental health, older women, and patient care, all of which are supported by case studies.
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PREFACE Since it was ®rst identi®ed in the United States in 1981, HIV (human immunode®ciency virus) disease has typically been considered a disease of the young. It is commonly thought that older individuals are not involved in behaviors that put people at risk for HIV infection. In fact, older adults themselves often do not recognize their own risk for HIV disease. Even so, the incidence of AIDS cases among older adults continues to rise. As members of our research team began to develop this awareness, we also noted the relative lack of research being carried out within this population. Our concern led to the research project described in this volume, a grass roots effort involving representatives from area health care and social service agencies, and older adults living with HIV disease. This book is largely based on the ®ndings of our survey research, coupled with in-depth narrative interviews with older adults who have been diagnosed with HIV disease. In addition, we include observations from our own experiences with this population, the experiences of other care and service providers in the study area, and pertinent information from recent HIV research literature. Since there has been relatively little systematic research focusing on older adults with HIV disease, we report ®ndings from research conducted on younger or age-heterogeneous groups and then incorporate ®ndings from studies of older adults, noting differences and consistencies where they are apparent in the available literature. The information presented in this book will be helpful to a wide range of people involved in both HIV-related issues and issues pertaining to aging. It is intended to be of use to researchers, policy makers, practitioners, service providers, and students. Our hope is that it will serve as a basic reference on the mental health, health and social challenges of living with HIV as an older adult, and as a springboard for further research. xviii Preface The book opens with a discussion of the signi®cance of our topic, the incidence and prevalence of HIV disease among older adults, and an overview of the development of our project. Our survey ®ndings are summarized in Chapter 2, with an elaboration of the methodology and statistical analysis of those ®ndings presented in Appendix A. Chapter 3 focuses on the experience of living with HIV disease. It is comprised of selected ®ndings from narrative interviews, re¯ecting both the wide range of experiences and many of the issues commonly raised by research participa