Low- and middle-income countries are home to 80% of older people with HIV (OPWH). Ukrainian OPWH experience higher mortality and decreased antiretroviral therapy (ART) initiation than younger patients, but there is little data examining OPWH’s perspectives around new diagnosis and impact on care. In this study, we examined accounts of 30 newly diagnosed OPWH in Ukraine, exploring challenges faced in the peri-diagnosis period. Themes emerged representing the longitudinal coping process: OPWH (1) viewed themselves as low risk before diagnosis; (2) experienced HIV diagnosis as a traumatic event challenging their self-image; (3) used disclosure to seek support among a small circle of family, friends, or health care providers; (4) avoided disclosure to outsiders including primary care providers for fears of stigma and breaches in confidentiality; (5) viewed age as an asset; and (6) used HIV diagnosis as starting point for growth. These findings highlight the need for age-specific programming to increase HIV knowledge and coping, increase screening, and improve long-term planning.
AllenA. Z. O.PostnovO.RozanovaJ.LitzT.ZaviryukhaI.KiriazovaT.ShenoiS. (2020a). Correlates of antiretroviral therapy initiation among newly diagnosed older people with HIV [unpublished abstract]. Ukrainian Institute for Public Health Policy.
2.
AllenA. Z. O.PostnovO.RozanovaJ.LitzT.ZaviryukhaI.KiriazovaT.ShenoiS. (2020b). Correlates of lost to follow-up among newly diagnosed older people with HIV in Ukraine [unpublished abstract]. Ukrainian Institute of Public Health Policy.
3.
AltschulerJ.KatzA. D.TynanM. (2004). Developing and implementing an HIV/AIDS educational curriculum for older adults. The Gerontologist, 44(1), 121–126. https://doi.org/10.1093/geront/44.1.121
4.
AltschulerJ.KatzA. D.TynanM. A. (2008). Implications for HIV/AIDS research and education among ethnic minority older adults. Journal of HIV/AIDS & Social Services, 7(3), 209–228. https://doi.org/10.1080/15381500802307476
5.
AtkinsonJ.Nilsson SchönnessonL.WilliamsM.TimpsonS. (2008). Associations among correlates of schedule adherence to antiretroviral therapy (ART): A path analysis of a sample of crack cocaine using sexually active African–Americans with HIV infection. AIDS Care, 20(2), 253–262.
6.
AutenriethC. S.BeckE. J.StelzleD.MallourisC.MahyM.GhysP. (2018). Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000-2020. PLOS ONE, 13(11), Article e0207005. https://doi.org/10.1371/journal.pone.0207005
7.
BeuthinR. E.BruceA.SheildsL. (2015). Storylines of aging with HIV: Shifts toward sense making. Qualitative Health Research, 25(5), 612–621.
ChenD.DuanL.ChenX.ZhangQ.ChenY.YuanZ.LiX. (2020). Coping strategies and associated factors among older Chinese people living with HIV/AIDS. Psychology, Health & Medicine, 25(7), 898–907.
10.
ChenY.PengY.XuH.O’BrienW. H. (2018). Age differences in stress and coping: Problem-focused strategies mediate the relationship between age and positive affect. The International Journal of Aging and Human Development, 86(4), 347–363.
11.
ChiaoE. Y.RiesK. M.SandeM. A. (1999). AIDS and the elderly. Clinical Infectious Diseases, 28(4), 740–745.
12.
ColborneM. (2017). Ukrainians battle escalating HIV epidemic. Canadian Medical Association Journal, 189(26), E901–E902.
13.
DolgovaV.RokitskayaY. (2020). Factor structure of coping behavior of curious elderly people. Advances in Gerontology = Uspekhi Gerontologii, 33(1), 172–178.
14.
DudinaV. I.KingE. J.TsarevaA. V. (2020). Concealing an HIV-positive status in medical settings: Discussions in Russian online forums. Qualitative Health Research, 30(9), 1379–1391.
15.
EdwardsJ.ColeS.WestreichD.MugaveroM.EronJ.MooreR.MathewsW.HuntP.WilliamsC. (2015). Age at entry into care, timing of antiretroviral therapy initiation, and 10-year mortality among HIV-seropositive adults in the United States. Clinical Infectious Diseases, 61(7), 1189–1195.
16.
EmletC. A. (2006a). A comparison of HIV stigma and disclosure patterns between older and younger adults living with HIV/AIDS. AIDS Patient Care STDS, 20(5), 350–358. https://doi.org/10.1089/apc.2006.20.350
17.
EmletC. A. (2006b). “You’re awfully old to have this disease”: Experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. The Gerontologist, 46(6), 781–790. https://doi.org/10.1093/geront/46.6.781
18.
EmletC. A. (2007). Experiences of stigma in older adults living with HIV/AIDS: A mixed-methods analysis. AIDS Patient Care STDS, 21(10), 740–752. https://doi.org/10.1089/apc.2007.0010
19.
EmletC. A. (2008). Truth and consequences: A qualitative exploration of HIV disclosure in older adults. AIDS Care, 20(6), 710–717. https://doi.org/10.1080/09540120701694014
20.
EmletC. A.BerghuisJ. P. (2002). Service priorities, use, and needs: Views of older and younger consumers living with HIV/AIDS. Journal of Mental Health and Aging, 8, 307–318.
21.
EmletC. A.TozayS.RaveisV. H. (2011). “I’m not going to die from the AIDS”: Resilience in aging with HIV disease. The Gerontologist, 51(1), 101–111. https://doi.org/10.1093/geront/gnq060
22.
FangX.VincentW.CalabreseS. K.HeckmanT. G.SikkemaK. J.HumphriesD. L.HansenN. B. (2015). Resilience, stress, and life quality in older adults living with HIV/AIDS. Aging & Mental Health, 19(11), 1015–1021. https://doi.org/10.1080/13607863.2014.1003287
23.
FolkmanS. (2010). Stress, health, and coping: Synthesis, commentary, and future directions. In FolkmanS. (Ed.), The Oxford handbook of stress, health, and coping (pp. 453–462). Oxford University Press.
24.
FolkmanS.LazarusR. S.PimleyS.NovacekJ. (1987). Age differences in stress and coping processes. Psychology and Aging, 2(2), Article 171.
25.
FumazC. R.AyestaranA.Perez-AlvarezN.Munoz-MorenoJ. A.MoltoJ.FerrerM. J.ClotetB. (2015). Resilience, ageing, and quality of life in long-term diagnosed HIV-infected patients. AIDS Care, 27(11), 1396–1403. https://doi.org/10.1080/09540121.2015.1114989
26.
FurlotteC.SchwartzK. (2017). Mental health experiences of older adults living with HIV: Uncertainty, stigma, and approaches to resilience. Canadian Journal on Aging/La Revue canadienne du vieillissement, 36(2), 125–140.
27.
GirardiE.SabinC. A.MonforteA. D. (2007). Late diagnosis of HIV infection: Epidemiological features, consequences and strategies to encourage earlier testing. Journal of Acquired Immune Deficiency Syndromes, 46(Suppl. 1), S3–S8. https://doi.org/10.1097/01.qai.0000286597.57066.2b
28.
GoodkinK.HeckmanT.SiegelK.LinskN.KhamisI.LeeD.LecusayR.PoindexterC. C.MasonS. J.SuarezP. (2003). Putting a face” on HIV infection/AIDS in older adults: A psychosocial context. Journal of Acquired Immune Deficiency Syndromes, 33(Suppl. 2), S171–S184.
29.
GrahamL. J. (2015). Integration of the interaction model of client health behavior and transactional model of stress and coping as a tool for understanding retention in HIV care across the lifespan. Journal of the Association of Nurses in AIDS Care, 26(2), 100–109.
30.
GraneheimU. H.LundmanB. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105–112.
31.
GrovC.GolubS.ParsonsJ.BrennanM.KarpiakS. (2010). Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care, 22(5), 630–639.
32.
Hanass-HancockJ.MyezwaH.CarpenterB. (2015). Disability and living with HIV: Baseline from a cohort of people on long term ART in South Africa. PLOS ONE, 10(12), Article e0143936. https://doi.org/10.1371/journal.pone.0143936
33.
HeckmanT. G.BarcikowskiR.OglesB.SuhrJ.CarlsonB.HolroydK.GarskeJ. (2006). A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Annals of Behavioral Medicine, 32(1), 27–38.
34.
HeckmanT. G.KochmanA.SikkemaK.KalichmanS.MastenJ.BergholteJ.CatzS. (2001). A pilot coping improvement intervention for late middle-aged and older adults living with HIV/AIDS in the USA. AIDS Care, 13(1), 129–139.
35.
HeckmanT. G.SikkemaK. J.HansenN.KochmanA.HehV.NeufeldS., & The AIDS and Aging Research Group. (2011). A randomized clinical trial of a coping improvement group intervention for HIV-infected older adults. Journal of Behavioral Medicine, 34(2), 102–111.
36.
HendersonS. J.BernsteinL. B.GeorgeD. M.DoyleJ. P.ParanjapeA. S.Corbie-SmithG. (2004). Older women and HIV: How much do they know and where are they getting their information?Journal of the American Geriatrics Society, 52(9), 1549–1553. https://doi.org/10.1111/j.1532-5415.2004.52421.x
HorterS.ThabedeZ.DlaminiV.BernaysS.StringerB.MazibukoS.DubeL.RuschB.JobanputraK. (2017). “Life is so easy on ART, once you accept it”: Acceptance, denial and linkage to HIV care in Shiselweni, Swaziland. Social Science & Medicine, 176, 52–59. https://doi.org/10.1016/j.socscimed.2017.01.006
39.
How Kyiv fights the HIV/AIDS epidemic. (2017). AFEW International.
40.
HughesA. K.LewinsonT. D. (2015). Facilitating communication about sexual health between aging women and their health care providers. Qualitative Health Research, 25(4), 540–550.
41.
IllaL.EcheniqueM.JeanG. S.Bustamante-AvellanedaV.MetschL.Mendez-MuletL.EisdorferC.Sanchez-MartinezM. (2010). Project ROADMAP: Reeducating older adults in maintaining AIDS prevention: A secondary intervention for older HIV-positive adults. AIDS Education and Prevention, 22(2), 138–147. https://doi.org/10.1521/aeap.2010.22.2.138
42.
JacksonF.EarlyK.SchimS. M.PenpraseB. (2005). HIV knowledge, perceived seriousness and susceptibility, and risk behaviors of older African Americans. Journal of Multicultural Nursing & Health, 11(1), Article 56.
KiriazovaT.PostnovO.BinghamT.MyersJ.FlaniganT.VitekC.NeduzhkoO. (2018). Patient and provider perspectives inform an intervention to improve linkage to care for HIV patients in Ukraine. BMC Health Services Research, 18(1), 1–9.
45.
KirkJ. B.GoetzM. B. (2009). Human immunodeficiency virus in an aging population, a complication of success. Journal of the American Geriatrics Society, 57(11), 2129–2138. https://doi.org/10.1111/j.1532-5415.2009.02494.x
46.
LazarusR.FolkmanS. (1984). Stress, appraisal, and coping. Springer.
47.
LeblancN. M.FloresD. D.BarrosoJ. (2016). Facilitators and barriers to HIV screening: A qualitative meta-synthesis. Qualitative Health Research, 26(3), 294–306.
48.
LibanovaE. (2014). Situation of older women in Ukraine [Analytical report]. Ukraine Centre for Social Reforms, United Nations Population Fund.
49.
LindbomS. J.LarssonM.AgardhA. (2017). The naked truth about HIV and risk taking in Swedish prisons: A qualitative study. PLOS ONE, 12(7), Article e0182237.
50.
LongoB.CamoniL.BorosS.SuligoiB. (2008). Increasing proportion of AIDS diagnoses among older adults in Italy. AIDS Patient Care and STDs, 22(5), 365–371.
51.
LutsenkoA. M. (2020). Coping strategies and personality profile characteristics of people whose parents were alcohol addicts. Behavioral Sciences, 10(1), Article 32.
52.
MaesC. A.LouisM. (2003). Knowledge of AIDS, perceived risk of AIDS, and at-risk sexual behaviors among older adults. Journal of the American Academy of Nurse Practitioners, 15(11), 509–516. https://doi.org/10.1111/j.1745-7599.2003.tb00340.x
53.
MartinC. P.FainM. J.KlotzS. A. (2008). The older HIV-positive adult: A critical review of the medical literature. The American Journal of Medicine, 121(12), 1032–1037.
54.
MazhnayaA.MeteliukA.BarnardT.ZelenevA.FilippovychS.AlticeF. L. (2017). Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes. International Journal of Drug Policy, 47, 187–195.
MoskowitzJ. T.HultJ. R.BussolariC.AcreeM. (2009). What works in coping with HIV? A meta-analysis with implications for coping with serious illness. Psychological Bulletin, 135(1), 121–141. https://doi.org/10.1037/a0014210
57.
NachegaJ. B.HsuA. J.UthmanO. A.SpinewineA.PhamP. A. (2012). Antiretroviral therapy adherence and drug-drug interactions in the aging HIV population. AIDS, 26(Suppl. 1), S39–S53. https://doi.org/10.1097/QAD.0b013e32835584ea
58.
NamS. L.FieldingK.AvalosA.DickinsonD.GaolatheT.GeisslerP. W. (2008). The relationship of acceptance or denial of HIV-status to antiretroviral adherence among adult HIV patients in urban Botswana. Social Science & Medicine, 67(2), 301–310. https://doi.org/10.1016/j.socscimed.2008.03.042
59.
OrelN.SpenceM.SteeleJ. (2005). Getting the message out to older adults: Effective HIV health education risk reduction publications. Journal of Applied Gerontology, 24, 490–508. https://doi.org/10.1177/0733464805279155
60.
PittsM.GriersonJ.MissonS. (2005). Growing older with HIV: A study of health, social and economic circumstances for people living with HIV in Australia over the age of 50 years. AIDS Patient Care STDs, 19(7), 460–465. https://doi.org/10.1089/apc.2005.19.460
61.
RanjitY. S.AzbelL.KrishnanA.AlticeF. L.MeyerJ. P. (2019). Evaluation of HIV risk and outcomes in a nationally representative sample of incarcerated women in Azerbaijan, Kyrgyzstan, and Ukraine. AIDS Care, 31(7), 793–797.
62.
RemienR. H.ExnerT.KertznerR. M.EhrhardtA. A.Rotheram-BorusM. J.JohnsonM. O.WeinhardtL. S.KittelL. E.GoldsteinR. B.PintoR. M. (2006). Depressive symptomatology among HIV-positive women in the era of HAART: A stress and coping model. American Journal of Community Psychology, 38(3), 275–285.
63.
RomaniukP.SemiginaT. (2018). Ukrainian health care system and its chances for successful transition from Soviet legacies. Globalization and Health, 14(1), 1–11.
64.
RosenfeldD.CatalanJ.RidgeD., & HIV and Later Life (HALL) Team. (2018). Strategies for improving mental health and wellbeing used by older people living with HIV: A qualitative investigation. AIDS Care, 30(Suppl. 2), 102–107.
65.
RotilyM.BentzL.PradierC.ObadiaY.CavaillerP. (2000). Factors related to delayed diagnosis of HIV infection in southeastern France. International Journal of STD and AIDS, 11(8), 531–535.
66.
RozanovaJ. (2018, July23–27). Newly increasing HIV incidence among adults aged 50 years or older in Ukraine [Poster, Abstract, Conference session]. International AIDS Conference, Amsterdam, The Netherlands.
67.
RozanovaJ.ShenoiS.ZaviryukhaI.ZeziulinO.KiriazovaT.RichK.MamedovaE.YariyV. (2020). Social support is key to retention in care during COVID-19 pandemic among older people with HIV and substance use disorders in Ukraine. Substance Use & Misuse, 55(11), 1902–1904. https://doi.org/10.1080/10826084.2020.1791183
68.
RubtsovaA. A.KempfM.-C.TaylorT. N.Konkle-ParkerD.WingoodG. M.HolstadM. M. (2017). Healthy aging in older women living with HIV infection: A systematic review of psychosocial factors. Current HIV/AIDS Reports, 14(1), 17–30.
69.
RuedaS.LawS.RourkeS. (2014). Psychosocial, mental health, and behavioral issues of aging with HIV. Current Opinion in HIV and AIDS, 9(4), 325–331.
70.
SankarA.NevedalA.NeufeldS.BerryR.LuborskyM. (2011). What do we know about older adults and HIV? A review of social and behavioral literature. AIDS Care, 23(10), 1187–1207.
71.
SeeC. M.EssauC. A. (2010). Coping strategies in cross-cultural comparison. In MayerB.KornadtH.-J. (Eds.), Psychologie–Kultur–Gesellschaft (pp. 161–173). Springer.
72.
SiegelK.RaveisV.KarusD. (1998). Perceived advantages and disadvantages of age among older HIV-infected adults. Research on Aging, 20(6), 686–711. https://doi.org/10.1177/0164027598206004
73.
SiegelK.SchrimshawE. W. (2002). The perceived benefits of religious and spiritual coping among older adults living with HIV/AIDS. Journal for the Scientific Study of Religion, 41(1), 91–102.
74.
SlomkaJ.LimJ.-W.GripshoverB.DalyB. (2013). How have long-term survivors coped with living with HIV?Journal of the Association of Nurses in AIDS Care, 24(5), 449–459.
TanJ.AlticeF. L.MaddenL. M.ZelenevA. (2020). Effect of expanding opioid agonist therapies on the HIV epidemic and mortality in Ukraine: A modelling study. The Lancet HIV, 7(2), e121–e128.
77.
TorschV. L.MaG. X. (2000). Cross-cultural comparison of health perceptions, concerns, and coping strategies among Asian and Pacific Islander American elders. Qualitative Health Research, 10(4), 471–489.
VanceD. E.MugaveroM.WilligJ.RaperJ.SaagM. (2011). Aging with HIV: A cross-sectional study of comorbidity prevalence and clinical characteristics across decades of life. Journal of the Association of Nurses in AIDS Care, 22(1), 17–25.
80.
VanceD. E.WoodleyR. A. (2005). Strengths and distress in adults who are aging with HIV: A pilot study. Psychological Reports, 96(2), 383–386. https://doi.org/10.2466/pr0.96.2.383-386
VitekC. R.ČakaloJ.-I.KruglovY. V.DumchevK. V.SalyukT. O.BožičevićI.BaughmanA. L.SpindlerH. H.MartsynovskaV. A.KobyshchaY. V. (2014). Slowing of the HIV epidemic in Ukraine: Evidence from case reporting and key population surveys, 2005–2012. PLOS ONE, 9(9), Article e103657.
XuY.LinX.ChenS.LiuY.LiuH. (2018). Ageism, resilience, coping, family support, and quality of life among older people living with HIV/AIDS in Nanning, China. Global Public Health, 13(5), 612–625. https://doi.org/10.1080/17441692.2016.1240822
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