title: The diverse older HIV-positive population: a national profile of economic circumstances, social support, and quality of life.
abstract: The objectives of this study were to provide a national profile of socioeconomic circumstances of the middle-aged and older population living with HIV and to evaluate variations in social support and quality of life (QOL) across age and socioeconomic subgroups, controlling for indicators of disease progression. The design used was a cross-sectional analysis of nationally representative interview data on HIV-infected individuals collected in the HIV Cost and Services Utilization Study. Multiple measures of social support and QOL were used. Bivariate comparisons of outcomes across categories of age and exposure category were performed; multivariate analyses to isolate the effect of older age on outcomes within exposure categories were performed, controlling for socioeconomic and clinical co-variates. Study results indicate that older gay men with HIV/AIDS are a predominantly white population and more likely to have health insurance than their younger counterparts; 38% were employed and 48% reported incomes of more than $25,000. Older injection drug users (IDUs) with HIV/AIDS are a predominantly black population with a particularly high concentration of disadvantages; only 11% were employed and 74% reported incomes of less than $10,000. Older IDUs reported especially low levels of physical functioning and emotional support in comparison with their younger counterparts, whereas older gay men did not significantly differ from younger gay men in these respects. The authors conclude that characteristics and care needs of the older HIV-positive population are very diverse and vary sharply by exposure route. Interventions need to be tailored to the needs of these distinct subpopulations, with an emphasis on development of supportive care interventions for older IDUs.
authors.affiliation: Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey 08901, USA. scrystal@rci.rutgers.edu
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: Ayse
authors.initials: A
authors.lastname: Akincigil
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
authors.forename: Neil
authors.initials: N
authors.lastname: Wenger
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: David S
authors.initials: DS
authors.lastname: Zingmond
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Bozzette
authors.forename: Martin F
authors.initials: MF
authors.lastname: Shapiro
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics / Q000503:physiopathology / Q000523:psychology; D000368:Aged; D015331:Cohort Studies; D004522:Educational Status; D004651:Employment; D005260:Female; D006679:HIV Seropositivity / Q000191:economics / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D007182:Income; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011788:Quality of Life; D012944:Social Support; D012959:Socioeconomic Factors