Resilience to HIV-related stigma may be key to ending the AIDS epidemic

Failing to address the psychological trauma experienced by many older people living with HIV/AIDS will make it difficult—if not impossible—to end the epidemic, according to a Rutgers University study.

Once considered a death sentence, HIV/AIDS has evolved into a manageable illness—with the availability of antiretroviral treatments—and people with the disease are living longer. But as this population ages, they are facing mental and psychosocial health challenges that could have a profound impact on their well-being—and on the trajectory of the virus.

"Our findings support the need to target post-traumatic stress disorder and substance dependence and use among older HIV/AIDS-positive people, and suggest that resilience might help increase adherence to antiretroviral therapy regimes," said Kristen D. Krause, an instructor of urban health at the Rutgers School of Public Health and lead author of the study, which was published in the Journal of Gay & Lesbian Mental Health.

In 2016, the United Nations set a global target to end HIV as a public health threat by 2030. To succeed, however, antiretroviral therapy (ART) adherence—taking medication as directed and avoiding so-called "pill fatigue"—would need to be maintained. Krause said resilience, namely the ability to thrive amid challenge situations, may play an important role in ART adherence.

To understand the association between HIV-related resilience and mental health, Krause and colleagues at the Rutgers Center for Health, Identity, Behavior and Prevention Studies (CHIBPS) surveyed 250 HIV-positive gay men ages 50 to 69 living in the New York City area between April 2017 and October 2018. Participants were recruited from dating apps, gay-related events, community-based organizations and word of mouth.

Using an HIV-related resilience assessment tool that Krause helped create, participants were asked a series of questions about their ability to deal with adversity, whether they had or were experiencing post-traumatic stress disorder (PTSD), how the viewed HIV-related stigma and whether they'd ever had suicidal thoughts.

The researchers found that people with higher levels of HIV-related resilience were more likely to have lower levels of PTSD and substance dependence and were more likely to feel financially secure.

About 16 percent of participants were symptomatic for PTSD, 14 percent met the criteria for severe depression, 18 percent reported a substance dependency, 18 percent suffered generalized anxiety disorder and nearly 33 percent expressed suicidal tendencies.

A majority of the sample (64.4 percent) indicated they could barely or could not get by on the money they have.

Krause said the findings point to major gaps in mental health coverage for older people living with HIV/AIDS and support calls for a more holistic approach to health care for this population.

"More and more people are surviving with HIV, and we don't really know what the long-term effects of that will be," Krause said. "We're finding out in real time. Any piece of information that we can collect will help mitigate the negative impacts of HIV later in life."

She added: "As we wait for a vaccine or a cure, it's important to continue building a toolbox of methods and best practices to bring this epidemic to an end. Resilience is one tool in that box."