Correlates of HIV Stigma Among Older Adults Living with HIV Disease In Ontario, Canada

Background and Purpose: Advances in HIV treatment and therapy has extended the life expectancy of persons living with HIV disease. Data from the Centers for Disease Control and Prevention (2011) indicate that the number of persons, age 50 and over living with HIV disease continues to increase. Canada has seen similar patterns including an increase in the number of annual positive HIV tests among older adults (PHAC, 2010). Evidence suggests that HIV stigma negatively impacts the mental health, quality of life and social experiences of older people with HIV/AIDS (PHAs) (Grov, et al 2010). The primary objective of this study was to determine sociodemographic, psychosocial and health-related variables that contribute to HIV-related stigma in a sample of older PHAs living in Ontario, Canada.

Methods: The OHTN Cohort Study is a community-governed, multi-site longitudinal observational cohort study that collects data on the clinical profile and social determinants of health of people with HIV in the province of Ontario, Canada. The study currently includes 1103 men and women 50 years and over who were interviewed at all clinical sites that currently participate in the OCS. This cross-sectional study analyzed data from older PHAs who participated in the Ontario Cohort Study. The present study analyzed data from 377 participants (age 50+) who completed an extended assessment battery between September, 2007 and March, 2010. Sociodemographic (age, income, marital status, race), psychosocial (depression, maladaptive coping, social support, mastery) and health-related (hazardous alcohol use, time since diagnosis, self-rated health) data were analyzed using multiple linear regression. The total HIV stigma scale score was the dependent variable

Results: Older women and heterosexual men had significantly higher scores of HIV stigma as compared to men who have sex with men (MSM). When controlling for socio-demographic, psychosocial and health-related factors, older women scored almost 5 points (b =4.72; S.E. = 1.88; p<.05) and heterosexual men about 4 points (b =4.06; S.E. = 1.84; p<.05) higher on the stigma scale than MSM. In a final model adjusting for all factors simultaneously, emotional and informational social support (p<.001), and mastery (p<.001) served as protective factors against stigma while maladaptive coping (p<.01), less time since diagnosis (p<.01), younger age (p<.01) and fair/poor self-rated health (p<.05) were associated with greater stigma. Psychosocial variables accounted for a much larger proportion of variance in HIV stigma scores (R² = .18) compared to sociodemographic (R² = .04) or health-related (R² = .02) variables. The final model adjusting for all factors (including gender and sexual orientation) accounted for more than 30% of the variance (R² = .31) for HIV stigma.

Implications: Findings suggest the importance of healthy internal mechanisms (mastery), and external factors (emotional and informational support) as protective factors against the deleterious effects of HIV stigma in older adults. Interventions are needed that reduce the impact of stigma and strengthen protective components among HIV-positive older adults.