Older Men Living with HIV: The Importance of Spirituality

Spirituality potentially can play an important role in the circumstances of men aging with HIV/ AIDS. The extent to which this is the case and the lessons that can be learned from examination of the surrounding issues have larger implications than might be generally thought, for a number of reasons. First, while it may be surprising to many, older adults represent one of the fastest growing segments of people living with HIV/AIDS, with men accounting for 72 percent of the overall population with the condition. In addition, as HIV/AIDS has become a chronic rather than a fatal condition, attention has increasingly focused on long-term health and quality of life and thus on the possible effects of such factors as spirituality. The latest estimates from the Centers for Disease Control and Prevention (CDC) indicate that adults 50 years of age and older account for 24 percent of all people living with HIV in the United States (CDC, 2007). As a result of the sharp decrease in AIDS-rdated mortality following the introduction of highly active antiretroviral therapy (HAART) in 1996, it is highly probable that the majority of people living with HIV in the next decade will be over the age of 50 if HIV infection rates remain stable (Karpiak, Shippy, and Cantor, 2006). While information on age-bygender breakdowns is not available nationally, as noted above, overall men account for 72 percent of people living with HIV. This statistic is in line with data from New York City, one of the epicenters of the HIV/AIDS pandemic, where men account for 68 percent of this population over the age of 50 and constitute the vast majority of older adults living with HIV/AIDS (New York City Department of Health and Mental Hygiene, 2007). With the availability of HAART and the improved long-term outlook for people with HIV, the perception of this disease has changed from that of an inevitably terminal condition to that of a chronic, but still serious, illness requiring continual vigilance and medical intervention (Karpiak, Shippy, and Cantor, 2006). As a result, concerns have broadened mom questions of survival to those of physical health, disease management, and quality of life (McKelroy and Vosvick, 2006). Concurrently, the field of health research is paying increasing attention to the role of spirituality, inclusive of religiousness, and its impact on a variety of outcomes from physical and mental health to psychological well-being. In general, spirituality is defined as a personal sense of transcendence over one's immediate circumstances, a sense of purpose and meaning in one's life, and a connection to others (Howden, 1992; Lindgren and Coursey, 1995; Moberg, 1967; Pargament, 1997). In contrast, religiousness pertains to adherence to a set of ideological beliefs, ritual, and practice associated with a particular creed, denomination, or sect (Lindgren and Coursey, 1995; Moberg, 1967). Not surprisingly, there is a burgeoning literature on spirituality and HIV/AIDS. However, few studies have focused on older adults living with HIV, and a review of the literature was unable to locate any work that specifically addressed spirituality related to older men living with HIV. This absence is significant for a number of reasons. From a lifespan perspective, late adulthood brings with it a set of unique challenges; transitions in social roles such as from work to retirement, the greater probability of living with multiple health problems, changes in the social network due to loss of members or relocation, and psychological adjustment to the process of aging and inevitable mortality. Gender itself affects how these challenges may be experienced, given well-documented gender differences in a number of domains, such as life expectancy, health and disease status, and social roles. Finally, spirituality and related constructs such as religiousness and spiritual well-being very likely also differ by age and gender. For example, one study of a sample of 1,399 adults ranging in age from 17 to 68 years found a significant, nonlinear increase of spirituality with age that did not appear to result from cohort effects (Argue, Johnson, and White, 1999). …