HIV among 50 yr Old Free Essay Samples & Outline

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Sample Essay On HIV among 50 yr Old


People that are aged 50 years and above are increasingly comprising the bulk of people living with HIV/AIDS. This is because most persons that had HIV/AIDS are turning 50 and there is also the incidence of new infections among these populations. Consequently, there is a need to do something in order to effectively reduce this get away number that is spiraling out of control. It is of importance to understand that although there has been great milestones that have been made regarding HIV/AIDS, there still exists stereotypes, prejudice and stigma that affect the people that are living with HIV/AIDS.

This case is no different for people that are living with HIV/AIDS and are above the age of 50 years, there still exists different experiences amongst these elderly persons in regards to HIV/AIDS infection and their general livelihood. There are also other groups such as men that have sex with other men that have a higher likelihood of being infected with the virus. This paper is going to explore the experiences of elderly persons that are fifty years and older and are living with HIV/AIDS.

Chapter One

Introduction

The number of persons aged 50 years and older living with HIV/AIDS has been increasing in recent years. It is important to note that this increase is partly due to high active antiretroviral therapy that has made it possible for many HIV-infected persons to live longer. Further, there has also been the newly diagnosed infections that have occurred in persons that are aged over 50 years. It is important to understand that in the year 2013, persons aged fifty years accounted for about 15% of new HIV/AIDS diagnoses. 24% of persons that were living with HIV/AIDS increased from about 17% in the year 2003.

The transmission rate is often very high and many older persons are sexually active but may not be practicing safer sex in order to reduce their risk for HIV infection. Older women are especially at risk because age-related vaginal dryness and thinning that often causes tears in the vaginal area. It is also of the essence to note that some older persons as compared to those that are younger, are often less knowledgeable about HIV/AIDS and consequently they are more likely not to protect themselves. In fact, many of the older persons do not perceive themselves as being at risk of HIV and for this reason, they do not get tested for HIV.

It is estimated that by the end of the year 2016, nearly half of all the people that will be living with HIV/AIDS will be aged 50 years and above. The studies of HIV testing has shown that indeed older persons often get sicker and die faster than young people. This might be because of their weak immune systems. These persons that are living with HIV/AIDS and are above the age of 50 years often face several different challenges and consequently they have different experiences regarding living with the disease.

Sexual transmission of HIV/AIDS is especially high in some groups of elderly persons that have elevated risk in terms of acquiring HIV/AIDS. For example, elderly men that have sex with other men are generally at a higher risk of contracting the disease as compared to heterosexual men. Black African males are also at an elevated risk of contracting HIV/AIDS as compared to any other race and this might be because of their culture and the promiscuity that is often associated with their culture. It is of the essence to note that indeed there is something that needs to be done in order to decrease the prevalence rates amongst the older people of over 50 years old.

This is because their immune systems are weak and they are in many cases not likely to live longer as compared to younger persons that contracted the virus the same time as them. There are several differences that exists in terms of different approaches and cultures in the world. There are those cultures that stereotypes and prejudice occur for the people that have HIV/AIDS and more especially elderly persons that have HIV/AIDS. On the other hand, there are caring societies that take care of the HIV/AIDS patient that are elderly. Therefore, in this regard, the experiences of the elderly people living with HIV/AIDS is often different as each of the concerned persons often have their own unique experiences.

Increasing HIV/AIDS incidence and prevalence rates are more disconcerting mainly because the older persons are often more likely to be at advanced stages of the disease. For this reason, it is often expected that persons that are older often have shorter periods of life expectancy. They also experience poor life qualities than the young persons and this is mainly because of the deleterious effects that the disease has on the comorbid health conditions that are often associated with normal aging.

Background of the Study

HIV (Human Immunodeficiency Virus) can affect everyone and does not discriminate against race, gender, ethnicity from where one lives and age. The virus has been ravaging the world and it has been declared a national disaster in many African countries. It is by far the most feared disease in the world currently, despite the existence of other more dangerous diseases. It can be argued that this might be so because of the stigma and prejudice that often accompanies the disease. This has resulted into persons refusing to go and be tested and assuming the notion of ‘what you do not know cannot hurt you’.

The 50 years old and older group can be described as the fast growing population with HIV. It is imperative to note that there are older adults that have HIV but unfortunately they do not know it. The experiences of these elderly persons that have the sexually contracted the virus is increasing by the day. It is important to note that indeed the different people have different experiences regarding the disease, how they contracted it, the reason that they contracted and the stigma that they face in from families and the community at large.

It is imperative to understand that anyone that is facing a serious disease such as HIV/AIDS might become depressed, it is crucial to understand that this is a special problem for older people that most of the time do not have a strong network of family or friends that can help. At the same time, older people often cope with other disease such as high blood pressure, heart problems and diabetes and this might add to the depression. Older people are also more likely to take care of themselves as compared to younger person, this can especially be mentally, physical and financially draining. Therefore, these persons have different experiences about living with HIV/AIDS.

Problem Statement

After almost three decades of combating HIV/AIDS, medical practitioners have made advances that can be said to have helped the HIV-infected individuals live longer as well as better quality lives. Persons that were infected with the virus in the 1980’s are still living and others have demonstrated that indeed HIV can be managed and one can live comfortably even when one has it. However, there still exists several places that still has high stigma in regards to HIV/AIDS.

It is of the essence to understand that these advances have often created new challenges in the United States. The people that are above 50 and older and have HIV/AIDS often face different and diverse unique challenges that no other group faces. It is important to understand that early identification of HIV may often prevent irreversible damage to the immune system as well as reduce complications that are associated with the disease.

The early diagnosis often offers an opportunity to reduce the transmission of HIV through changed behaviors. However, because prevalence of HIV is lower in adults over the age of 55, the benefits relative to costs of screening may not be as high for older people as compared to younger ones. The contraction of this disease leads to several diverse experiences for this age group. This paper is going to explore the lived experience of adults 60 years and older contracting HIV/AIDS and the different special factors that are involved when it comes to this special group.
Significance of the study

In the year 2016, almost half of the population of the people living with HIV/AIDS will be over 50 years old. This research will be important as it will illuminate the experience of persons living with HIV/AIDS that are over the age of 50 years. The study will help give a perspective of about the different issues that affect HIV/AIDS amongst persons of persons that are aged 50 years above. It is the aim of the researchers that this research paper will go a long way in ensuring that these problems are fixed as they will be able to be brought to light. It is of the essence to also understand that the study will be able to encompass the different fundamentals and experiences that are involved with the persons aged 50 years and above.

Scope of the study

The research will focuses on the experiences and fundamentals regarding persons over the age of 50 years old that are living with HIV/AIDS. This scourge has been ravaging the world for almost three decades now and there has been no cure or preventive medicine. What exists in the market today is drugs that help in lengthening the life of the person. This might explain as to why there is still prejudice amongst people that have HIV/AIDS in the world. The research will examine the factors that lead to higher prevalence rates, the experiences of these older persons in the society, and their perceptions towards the scourge that is HIV/AIDS.

Chapter two

Literature Review

Okuno, Fram et al. (2012), assessed the knowledge and the attitudes about sexuality in the elderly with HIV/AIDS. The research was done in a specialized ambulatory clinic, and it was also used to identify the epidemiological profile of the patients. The study that was done by Okuna, Fram et al. (2012) and it included around 148 elderly persons, there were about male gender (63.5%), single (30.5%) and low socioeconomic class around 60%. Okuna, Fram et al. (2012) administered the ASKA knowledge exam in regards to HIV/AIDS awareness. ASKAS knowledge score was around 32.2, and the attitude scores were about 15.5. The study showed that there was a significant association that existed between knowledge of ASKAS with the female gender, further being a widow and having more than one comorbidity also increased the prevalence of one having knowledge about ASKAS.

Lovejoy, Heckman, Sikkema et al. (2008) also identified the fact that there was decrease knowledge in regards to HIV/AIDS amongst elderly men as compared to younger men. This was because they were not exposed much to current trends and sexual topics. They still considered them as being taboo, and consequently this was the reason as to why they had little information regarding how to protect themselves adequately against the virus.

The study showed that patients with HIV.AIDS showed favorable knowledge and attributed about sexuality when it came to an elderly person, and women that were housewives showed a lot of significant knowledge. The research also showed that women that had lower income were more susceptible to the disease and in fact women with the disease died faster than the men. Further, the study showed that indeed persons that had the higher level of education and practiced physical activity, and they had the more favorable attitude when it came to sexuality of the elderly.

Williams, Amico et al. (2012) examined in a qualitative manner the different barriers and facilitators that are associated with attending HIV medical care visits for people living with HIV/AIDS. From the study, there were five themes that emerged and they included the impact of competing demands, aspects of the system of care, the influence of stigma, the experience of negative effect, the different aspects of system care and the various beliefs about the need for or the role of HIV treatment. In terms of facilitators Amico et al. (2012)argued that there four themes that emerged and they included social support, positive aspects of health care visits, perceived vulnerability in regards to the negative consequences and activation around healthcare. Most of the participants in this study argued that they had strong intentions to attend the scheduled medical visits.

The study determined that regularly attending scheduled health care visits was essential to the quality of life for people living with HIV/AIDS. The study showed that there existed an array of issues such as employment and family that made it difficult for patients to make scheduled medical visits. The study also found out that the elderly was more consistent with their medication and regularly attended the scheduled health care visits as compared to young persons.

The authors stated that indeed there existed several socioeconomic conditions such as racism, lack of education and poverty that existed in the Deep South and this further confounded the ability of patients to regularly attend scheduled medical visits by the strengthening the impact of demands. This is the same with Liu, He, Levy et al. (2014) that argue that living with HIV/AIDS can often be extremely challenging at any age, however, the people living with HIV/AIDS often have to be contended with the physical declines of their aging body. It is of crucial importance to understand that although both aging as well as HIV infection can often work separately on in an interactively manner to reduce the human immune response, older people that are living with HIV/AIDs are particularly susceptible to AIDS related or non-AIDS related chronic diseases.

Lovejoy, Heckman, Sikkema et al. (2008) characterized rates of sexual activity and identified several psychosocial and behavioral that correlated with sexual activity and condom use in a metropolitan sample. There were about 290 HIV-infected adults that were sampled in this research, and they infected adults that were above the age of 50 years. According to the research, 33% of the participants that were sexually active in the past three months had at least one occasion of vaginal or anal intercourse that was not condom protected. The rates and correlation of sexual activity and condom use differed between bisexual/gay men, heterosexual men, and heterosexual women.

It is of the essence to note that according to the study, 72% of heterosexual men were sexually active and compared to only 36% of bisexual/gay men and 22% of heterosexual women. It is of the essence to note that amongst sexually active persons, only about 27% of heterosexual men reported inconsistent condom use compared to around 37% of gay/bisexual men and about 35% of the heterosexual women. The study noticed that as the number of old adults that lived with HIV/AIDS in the United States continue to increase; age-appropriate secondary risk reduction interventions were urgently needed.

However, this research by Lovejoy, Heckman, Sikkema et al. (2008) had several limitations, the first was that all the data that was collected was through self-report measures and consequently, it was possible that indeed some participant’s under-reported socially stigmatized behaviors such as drug abuse as well as unprotected sexual activities. However, despite the limitations the study by Sikkema et al. (2008) provided what can be described preliminary data on rates and correlated sexual behavior in HIV-infected older adults.

The research recommended that as the population of middle aged and other older adults that are living with HIV/AIDS continues to rise, there is a need for several secondary risk-reduction interventions for HIV-infected older persons in order to effectively mitigate the spread of HIV/AIDS. The findings from this study argued that there is a need for the secondary risk interventions to be age appropriate and tailored to one’s gender and sexual orientation if at all they are to effectively reduce risk behavior in the increasing growing and vulnerable population of older adults that live with HIV/AIDS. Thiede, Jenkins et al. (2014) also explored the use of condoms and argued that older men were not likely to use condoms as compared to younger men.

Chaudoir, Norton, Moneyham et al. (2012) argue that although HIV stigma is often a significant predictor of depression and consequently It often depresses persons that have it. However, the authors contend that very little is often known about which factors might be most effectively buffer or even attenuate the effect. Chaudoir, Norton, Moneyham et al. (2012) in their research examined whether two coping-related factors-proactive coping and the spiritual peace often modified the effect if HIV stigma on a likelihood of depression amongst around 465 people that are living with HIV/AIDS. The study conducted hierarchical logistic regressions in order to examine the effect of HIV stigma, proactive coping, as well as spiritual peace. The spiritual peace was seen in the study to moderate the effect of HIV stigma on depression at high but not low levels of several HIV stigma.

It is important to understand that there was no effect that was seen with the proactive coping. Therefore, the study showed that indeed spiritual peace may at times counteract the different and negative effects of HIV stigma on depression. Consequently, there is a need for intervention components that often enhance spiritual peace and might, therefore, potentially be effective strategies for helping people that are living with HIV/AIDS cope with HIV stigma. The research is important for the elderly persons as they can be able to cope effectively with the effect of stigma and depression that often comes with HIV/AIDS with proactive coping, as well as spiritual peace.

Emlet (2007) argues that older adults are often increasingly being impacted with the dreaded HIV disease, both newly infected individuals as well as long-term survivors living into old age. Chaudoir, Norton, Moneyham et al. (2012) and Emlet (2007) both contend that an HIV-related stigma impacts the quality of life of all persons with HIV/AIDS. However, little is known about HIV-related stigma in order studies because of the fact that many studies do not include older subjects or even ignore the important age factor as variable. The study by Emlet (2007) used mixed methods study and was able to examine the experiences of HIV-related stigma in about a sample of 25 older adults that were living with HIIV/AIDS. The quantitative methods were able to measure HIV stigma and depression while in-depth qualitative interviews were able to capture lived experiences of these different individuals.

According to the research, stigma was most positively as well as significantly correlated with depression. In fact, stigma was found to be significantly higher in African American as compared to different white informants. The black society did not embrace persons with HIV/AIDS as compared to the white society. However, the study showed that there were correlations between high levels of education and accepting people with HIV/AIDs amongst black societies.

The qualitative interviews yielded about 11 themes that corresponded to the four categories that were constructed in the stigma instrument. Disclosure concerns, rejection, stereotyping as well as protective silence was common experiences of these individual adults that were living with HIV. The HIV stigma according to the author should be routinely assessed when working with persons that are older, and HIV-infected interventions and clients should often be tailored to the different individual experiences of stigma. This would help alleviate the situation with older citizens that are living with HIV/AIDS.

Bluthental, Mendel et al. (2012) argued that HIV-related stigmas in many cases have been seen by many as a barrier to greater religious congregation involvement in HIV prevention and care in the United States and also elsewhere. The research explored several congregational and community norms and attitude regarding sexuality, HIV and drug use through extensive qualitative case study of around 14 diverse religious congregations.

The data included semi-structured interviews with around 57 clergy as well as lay leaders across different congregations. It is of the essence to note that through the structured observations of congregational activities, the different review of archival documents, as well as the questionnaire on several congregational characteristics. It is of the essence to understand that across and within congregations, the research found the wide range of views towards HIV, people with HIV as well as the different populations that were at risk of HIV.

The views came from highly judgmental and exclusionary to what can be described as ‘loving the sinner and not the sin’ and accepting as well as affirming. The research also found that attitudes and norms about HIV, homosexuality, as well as substance abuse, appeared to be related to the intensity and type of congregation HIV-related activities. It is also crucial to understand that even among higher activity congregations, there were several range of perceptions, and these were extremely stigmatizing.

The results from the research showed that affirming norms and attitudes were not a prerequisite for a congregation to initiate different HIV activities such as finding relevant for HIV service providers as well as seeking person to be able to engage the congregation on the issue. The HIV stigma reduction cannot also be described as a prerequisite for congregational HIV involvement, and there are times that this may occur simultaneously one before the other. However, the researchers emphasized the point that they often dynamically affect each other. Bluthental, Mendel et al. (2012) in their finally stated that there different strategies that are acceptable to the different congregation’s levels of comfort and openness around HIV can themselves facilitate a process of normative and attitudinal change.

Outlaw, Philips et al. (2011) argued that average reported age of sexual debut in the United States is around 14.4 years, with approximately 7% of children reporting their sexual debut prior to the age of 13. However, it is important to understand that a lot of literature on sexual debut on the youth often addresses ethnic and gender differences. However, there is limited data regarding factors that are associated with sexual debut for young men that have sex with men (YMSM). It is of importance to note that early sexual debut often poses potential health risks, such as contraction of HIV with an increased risk of unprotected intercourse. In fact, it is important to note that given the current high HIV infection rates for ethnic/racial minority YMSM. Therefore, it is important to note that the sexual debut that often occur for the YMSMS should be documented as it is of great importance.

Outlaw, Philips et al. (2011) through their research postulated that indeed participants that had sex with other men before the age of 16 generally reported more exchange sex, drug use, psychological and emotional problems relating to substance use as well as history of suicide attempts as compared to participants with later MSM sexual debuts. The research by Outlaw, Philips et al. (2011) recommends that there is a need for more comprehensive interventions that are ethnically, and racially sensitive, inquiry about initial sexual experiences as well as a general focus on sexual health in order to generally improve the health outcomes for this specific population.

Kelly, Amirkhaninan, et al. (2010) states that past studies have often focused mainly on the individual-level of factors influencing the HIV risk practices of bisexual or gay men. It is of the essence to note that the role of one’s social network has often been less explored. The study by Kelly, Amirkhaninan, et al. (2010) identified 75 indexes in venues frequented by men that have sex with men. 255 unique network members were able to complete assessments of risk-related characteristics, and there also existed some sociometric measures that were mainly used in the determination of the influence of a leader in each network.

It of crucial importance to understand that white and African men networks were composed primarily of men of the same race. The research showed that over 70% of men reported casual sexual partners. In fact, about one-fourth of men that were studied engaged in unprotected anal intercourse with a casual partner or different multiple partners in the past three months. It is of the essence to note that the social network that a man belonged to, the weaker risk reduction intentions and greater substance use independently predicted a range of several high-risk sexual behaviors. The study showed that there were modest, but significant correlations that existed between the risk related characteristic of members and the leaders of the networks.

Therefore, it can be seen that indeed the social network level approaches are extremely feasible when it comes to reaching hidden subgroups of MSM that are at a high risk of contracting HIV.
Liu, He, Levy et al. (2014) notes with a lot of concern that the HIV epidemic has increased among older adults in China. The number has been increasing over the years because of persons reaching the age of 50 with HIV, as well as new infections. However, there is little research in that exists about the psychological impacts among younger and older people that live with HIV/AIDS. Liu, He, Levy et al. (2014) observed that as compared to young persons living with HIV/AIDS, older people that lived with the virus reported lower levels of well-being, higher levels of depression and poorer quality of life.

The researchers argued that a higher level of depression among the older People living with HIV/AIDS was associated with much lower levels of subjective well-being and quality of life (Physical health and psychological health). Most of them felt like they had failed in life, and consequently they were more likely to be depressed than the young men who still believed they had a bright future ahead of them. Further, most of the Chinese adults that were infected with the virus had a tendency not to take the required medicine. This was especially true for the elderly persons that had low education and those that were above 64 years old.

Therefore, the findings of this study showed with great effect that older people living with HIV/AIDS often face psychological problems and mental health challenges beyond those that are experienced by younger people living with HIV/AIDS. The intervention programs should often be dedicated to the improvement of mental health as well as improving the quality of life for the HIV-infected older adults. They should take into consideration the special problems that are often faced by this particular age group living with HIV/AIDS and respond directly to them.
Baumgartner L., (2014) investigated the experiences of African American men that were living with HIV/AIDS.

Twelve self-identified African American men that were living with HIV/AIDS participated in a two-hour interview that were in-depth. The participants had a disclosure session, and they all argued that they had a four or five-step incorporation process. The contexts that they believed influence their incorporation occurred at the interpersonal level, and they included support and stigma. Some of them argued that they families were supportive, and they made their lives better by giving those words of encouragement and doing deeds that supported the same. However, this was not the case with other families that showed stigma and avoided the persons at all costs.

This was especially true with families that had lower education levels. The next context that influenced their incorporation was the sociocultural context that consisted of race, class and sexual orientation. Gays/Bisexual men had a hard time as compared to heterosexual men in regards to stigma, temporal context (historical time) was another context that influenced the incorporation of these men into the society. Men that were infected in the 1980’s felt different about themselves as compared to those that were infected in the 21st century.

Those that were infected in the 21st century saw it as no big deal as compared to those that were infected in the 1980’s that still had misconceptions about it despite having adequate knowledge about the disease. The situational context was another important incorporation factor and it included things such as a personal history with chemical dependency. Persons that had previous experiences with chemical dependency most likely blamed their infection on the chemical dependency as compared to themselves engaging in risky behavior under the influence of drugs. It is important to note that these contexts intersected, and they ultimately affected the participant’s integration of HIV/AIDS identity into the self. Baumgartner L., (2014) argues that the study is important, and it has deep implications for health professionals as well as HIV educators.

Ramesh, Mehrotra, et al. (2014) argue that mobility is an important factor that contributes to the spread of HIV among different populations that are at risk for HIV. The authors contend that indeed there has been very little research that has linked the relationship amongst men who have sex with other men in the country of India. Their study examined the association between mobility and sexual risk behavior as well as HIV infection among men who have sex with other men in the South of India.

Most of the males had sex with other men with no protection. Further, most of them when on travel had unprotected sex with other males in other different regions. This, therefore increased their likelihood of spreading the virus. The society in India does not condone homosexuality and consequently, it was difficult for the persons to purchase condoms if they had no female companion and the study also found out that there were levels of knowledge regarding transmission of HIV/AIDS through anal sex.

There was a high correlation between increased levels of education and decreased mobile unprotected sex in the Southern India. Ramesh, Mehrotra, et al. (2014) made a conclusion that mobile men that have sex with other men often have a higher likelihood of contracting HIV/AIDS and that there is a need for different interventions in India to effectively extend the ways to reach these men that have sex men. The current taboo in India for homosexual sex makes it difficult to educate the people on the differences and the dangers that exists in regards to greater mobility of Men who have sex with other men. Further, the increased mobility also augments the ongoing efforts in India that are intended to reduce the spread of the deadly virus HIV/AIDS in the country of India.

Nelson, Thiede, Jenkins et al. (2014) state that delayed HIV diagnosis amongst men that have sex with other men in the United States has over the years been a significant public as well as personal health issue. They are described as the group that it is at an elevated risk of contracting HIV/AIDS and is often expected that they are the ones that are supposed to have the quickest diagnosis. Unfortunately, this is not the case and this is the reason it has generated a lot of concern. The study by Nelson, Thiede, Jenkins et al. (2014) can be said to echo the same effects that were seen in the study by Mehrotra, et al. (2014) that stated that indeed men that have sex with other men do not usually go to be diagnosed and consequently are at an increased level of getting delayed diagnosis.

This is the same case with Nelson, Thiede, Jenkins et al. (2014) who sought to elucidate on the potential personal as well as the contextual factors that may be contributing to delayed HIV diagnosis among men that have sex with other men. Their findings indicated that men that have sex with other men often experience multiple life stressors be it personal or contextual that eventually leads to an elevated likelihood of delayed HIV diagnosis.

In particular, men that have sex with other men and in addition experience multiple life stressors without having the scaffolding of social support, self-efficacy and stable mental health that is meant to engage protective health behaviors may be more vulnerable to delaying diagnosis. Outlaw, Philips et al. (2011) through their study also showed that indeed there is a need to support different groups based on their specific needs as compared to generalized needs.

The study concluded that there is a need for several interventions that target these factors as well as structural interventions by effectively targeting physiological as well as safety concerns that are often needed to help men that have sex with other men to be able to handle their life stressors more effectively and consequently seek HIV testing in a manner that can be described as timely. This will improve their lives as early diagnosis especially in regards to HIV/AIDS cannot be overemphasized.

References

Baumgartner, L (2012). “I heard he got a package”: African American men’s experiences of living with HIV/AIDS. Qualitative Report, 19(58), 1-22
Kelly, J., Amirkhanian, Y., Seal, D., Galletly, C., & DiFranceisco, W., et., al. (2010). Levels and predictors of sexual HIV risk in social networks of men who have sex with men in the Midwest. AIDS Education and Prevention, 22(6), 483-495
Liu, H., He, X., Levy, J., Xu, Y., & Zang, C., et., al. (2014). Psychological impacts among older and younger people living with HIV/AIDS in Nanning, China. Journal of Aging Research, 576592, 1-6
Nelson, K., Thiede, H., Jenkins, R., Carey, J., & Hutcheson, R., et., al. (2014). Personal and contextual factors related to delayed HIV diagnosis among men who have sex with men. AIDS Educ. Prev, 26(2), 122-133
Polit, D., & Beck, C. (2010). Nursing research: Appraising evidence for nursing practice. Philadelphia: Lippincott Williams & Wilkins. 7, 4-327
Ramesh, S., Mehtotra, P., Mahapatra, B., Ganju, D., & Nagarajan, K., et., al. ( 2014). The effect of mobility on sexual behavior and HIV infection: a cross-sectional study of men who have sex with men in southern India. Sex Transm Infect, 90, 491-497
Outlaw, A., Phillips, G., Hightow-Weidman, L., Fields, S., & Hidalgo, J., et., al. (2011). Age of MSM sexual debut and risk factors: results from a multisite study of racial/ethnic minority YMSM living with HIV. AIDS Patient Care and STDs, 25(1), 23-29
Bluthenthal, R., Corbin, D., Derose, K., Kanouse, D., & Mendel,P., et al. (2012) . Attitudes and beliefs related to HIV/AIDS in urban religious congregations: Barriers and opportunities for HIV-related interventions. Social Science and Medicine, 74(10), 1520
Chaudoir, S., Norton, W., Earnshaw, V., Moneyham, L., Mugavero, M., & Hiers, K. (2012). Coping with HIV stigma: do proactive coping and spiritual peace buffer the effect of stigma on depression?. AIDS And Behavior, 16(8), 2382-2391. doi:10.1007/s10461-011-0039-3
Emlet, C. (2007). Experiences of stigma in older adults living with HIV/AIDS: a mixed-methods analysis. AIDS Patient Care & Stds, 21(10), 740-752.
Lovejoy, T., Heckman, T., Sikkema, K., Hansen, N., & Kochman, A., et., al. (2008). Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS and Behavior, 12, 943-956
Okuno, M., Fram, D., Batista, R., Barbosa, D., & Belasco, A. (2012). Knowledge and attitudes about sexuality in the elderly with HIV/AIDS. Acta Paul Enferm, 25(1), 116-121
Polit, D., & Beck, C. (2010). Nursing research: Appraising evidence for nursing practice. Philadelphia: Lippincott Williams & Wilkins. 7, 4-327
Williams, B., Amico, R., & Konkle-Parker, D. (2011). Qualitative assessment of barriers and facilitators to HIV treatment. J. Assoc. Nurses AIDS Care, 22(4), 307-312