Running Head: HIV/AIDS IN OLDER WOMEN

An Investigation of HIV/AIDS in Older Women Aged 50 and Older

Jada Brown Norfolk State University

Author Note: Jada Brown, Department of Interdisciplinary Studies, Norfolk State University. Correspondence concerning this paper should be addressed to Jada Brown, Department of Interdisciplinary Studies, Norfolk State University, 700 Park Avenue, Norfolk, VA 23504. Email j.t.brown18854@spartans.nsu.edu.

HIV/AIDS IN OLDER WOMEN

Abstract

This paper identifies two disciplinary theories that are integrated to create a new, hybrid theory. The hybrid theory is an explanation of why the problem exists. Rosenstocks health belief theory and Bronfenbrenners ecological systems theory work well by themselves. Once integrated, they can address why HIV/AIDS is so prevalent in older women.

HIV/AIDS IN OLDER WOMEN

Purpose: Why is HIV/AIDS so prevalent in older women?

Disciplines that are potentially relevant: Epidemiology- the study of the patterns, causes, and effects of health and disease conditions in defined populations. Physiology- deals with the functions and activities of life or of living matter (as organs, tissues, or cells). Sociology- the study of human social behavior. Health-the study of a person's mental or physical condition. Ecology- The study of the interaction of people with their environment.

Psychology: estrogen loss results in thinning of the vaginal mucosa. Epidemiology: shorter survival times among older persons. Ecology: addressing intrapsychic and interpersonal issues along with socioenvironmental influences. Sociology: Staying active causes older women to keep having sex. Health: Costs of health care are too high

Physiology: think older adults experience a natural senescence to their immune system that may be associated with more rapid disease progression. Epidemiology: think that older adults experience a variety of complicating factors with regard to treatment and outcomes as compared to their younger counterparts/co morbidity. Ecology: suggests the notion of reciprocity, or the interrelatedness of various contexts of an individual Sociology: Because of the use of highly active antiretroviral therapy (HAART), people diagnosed with HIV/AIDS are living longer and healthier, with the capacity to remain sexually active. Health: Women are not educated enough and seeking proper health care

Non-disciplinary sources are the older women themselves. They are ashamed. Nondisclosure and the secrecy that surrounds HIV/AIDS, indirectly contribute to the prevailing negative attitudes and stigma as attested by others (Reid and Walker 2003; Cameron 2005; Campbell et al. 2005; Steinberg 2008).

Ecological Theory Health Belief Theory Sociology and Health Older adult women are less educated about HIV. They take in medicine differently and live longer and healthier, therefore spreading the disease.

HIV/AIDS IN OLDER WOMEN

An Investigation of HIV/AIDS in Older Women Aged 50 and Older While the HIV/AIDS epidemic has historically affected men, more women are living with HIV than ever before in every region of the world (Joseph, Vincent, Jodi, Eileen, & Mustafa, 2009, p. 146). The human immunodeficiency virus (HIV) is a virus that attacks the cells of the immune system. The immune system fights all the diseases that enter the body. The moment the immune system gets frail, the body is prone to get infections, cancers, as well as other life-threatening diseases. After that phase, the human immunodeficiency virus progresses into the most advanced stage, called AIDS (acquired immunodeficiency syndrome). According to the Centers for Disease Control and Prevention, health researchers and providers, estimated that 14 to 15% of all individuals living with HIV infection are over the age of 50. Women age 50 and older have consistently constituted approximately 9% of all AIDS cases diagnosed in women since 1993 (Spearman & Bolden, 2005, p. 51). Of the 33.2 million people currently living with HIV worldwide, 15.4 million (46.4%) are female (Joseph, Vincent, Jodi, Eileen, & Mustafa, 2009, p. 146). It can take as little as a few weeks for symptoms to show or as long as ten years. In that, HIV/AIDS symptoms are often similar to those associated with aging (fatigue, weight loss, dementia, skin rashes, and swollen lymph nodes) (Spearman & Bolden, 2005, p. 54). Women aged 50 and older may not recognize symptoms early because they most times feel as though they are experiencing normal aging. The leading causes of AIDS for older women are heterosexual transmission, blood transfusions, and IV drug users. As a future nurse in the medical field, the high percentage of HIV/AIDS among older women is important. There have been many different perspectives on the high rise of HIV in older women, but two of them seem to stand out a little more. In order to

HIV/AIDS IN OLDER WOMEN

address why HIV/AIDS is so prevalent in older women, we must combine sociology and education. Bronfenbrenners ecological systems theory and Rosenstocks health belief theory combined, helped to address the issue more fully. Theory #1: Ecological Systems Theory The sociology perspective of HIV in older women explained that because of use of certain medicines, older women diagnosed with HIV/AIDS are living longer and healthier, with the capacity to remain sexually active and spread the disease. As estrogen
levels drop off after menopause, the vaginal and cervical tissues thin. This condition, called vaginal atrophy, makes the vaginal lining vulnerable to small tears and abrasions, which provide points of entry for viruses and bacteria (Sex and the older woman, 2012, p. 5) According to the

U.S. Department of Health and Human Services, the ecological systems theory recognize that successful activities to promote health, including HIV risk reduction, involve changing individual behaviors. According to Bronfenbrenners model, behavior is determined by intrapersonal factors of an individual, such as knowledge, attitudes, or behavior. Behavior is also determined by interpersonal processes, (including the family, work group, and friendships), institutional factors, community factors, and public policy.

HIV/AIDS IN OLDER WOMEN

HIV/AIDS IN OLDER WOMEN Bronfenbrenners ecological systems theory consists of the macrosystem, exosystem, and microsystem. The macrosystem consists of influences from political systems, culture, nationality, society, and economics. The exosystem shows influences from school, the media, health agencies, and the community. Finally yet importantly, the microsystem consists of influencing by family, peers, classroom, and religious setting. The article, National Institutes of Health: Theory at a Glance: A guide for health promotion practice, explained that all of these systems have a major impact on an individual. This theory applies to the spread of HIV among older adults, because they choose not to wear condoms. Women 50 years and older do not insist on condom use by their partners because the risk of pregnancy is no longer present; they do not perceive

themselves at risk, either, from sexually transmitted diseases (Spearman & Bolden, 2005, p. 51). Theory #2: Health Belief Theory The health perspective of HIV/AIDS in older women explains that health education is the only defense against the spread of HIV. The lack of education is the key to the spread of HIV among older women. Developed in the 1950s by I.M. Rosenstock, the Health Belief Model (HBM) asserts that people will change behavior depending upon their knowledge and attitudes (Rosenstock, Strecher, and Becker, 1994) According to this model, a person must hold beliefs such as perceived susceptibility, perceived seriousness, and belief in effectiveness, cues to action, perceived benefits, and barriers to taking action, in order to be able to change behavior.

HIV/AIDS IN OLDER WOMEN

HIV/AIDS IN OLDER WOMEN 1. Perceived susceptibility to a particular health problem (I am at risk for HIV).

2. Perceived seriousness of the condition (AIDS is serious. My life would be hard if I got it). 3. Belief in effectiveness of the new behavior (Condoms are effective against HIV transmission). 4. Cues to action (Witnessing the death or illness of a close friend or relative due to AIDS). 5. Perceived benefits of preventive action (If I start using condoms, I can avoid HIV infection). 6. Barriers to taking action (I dont like using condoms). (Rosenstock, Strecher, and Becker, 1994) Rosenstocks theory applies to the high prevalence of HIV among older women, because it argues that behavior can best be understood if beliefs about health are clear. Older women need the education about HIV in order to avoid it. For example, older women would more likely practice safe sex if they believe that they are at risk of HIV infection, if they knew the serious consequences, they can actually avoid it by using condoms, and the benefits of safe sex outweigh the potential costs and barriers.

HIV/AIDS IN OLDER WOMEN

10

Hybrid Theory

HIV/AIDS IN OLDER WOMEN

11

The ecological-health theory is a hybrid theory combining both Bronfenbrenners ecological systems theory and Rosenstocks health belief theory. The lack of interpersonal factors (attitude), lack of education, less doctor visits, and the perceived seriousness of the situation leads the spread of HIV. If older women were more aware and solemn about the disease, there would be a major decrease in HIV/AIDS of older women. Discussion Bronfenbrenners ecological systems theory and Rosenstocks health belief theory work well by themselves, but once integrated; they can explain why this societal issue exists. With this hybrid theory, people can become more knowledgeable and understand why this issue is a major problem in todays society. Education and behavioral change can greatly improve this disparity.

HIV/AIDS IN OLDER WOMEN

12

References

Joseph, I., Vincent, M., Jodi, B., Eileen, M., & Mustafa Z., Y. (2009). HIV Testing Among Women in the United States. Public Administration & Management, 14(1), 145-155. Rosenstock, I.M., V.J. Strecher, and M.H. Becker. 1994. The Health Belief Model and HIV risk behavior change, in DiClemente, R.J. and Peterson, J.L. (eds) Preventing AIDS: Theories and Methods of Behavioral Interventions. New York: Plenum Press, pp. 524. Sex and the older woman. (2012). Harvard Womens Health Watch, 19(5), 4-6.

Spearman, M. S., & Bolden, J. A. (2005). Identification of Factors That Reduce Rates of Detection of HIV/AIDS among Women 50 Years and Older. Journal Of African American Studies, 9(2), 51-59.

U.S. Department of Health and Human Services. "National Institutes of Health: Theory at a Glance: A guide for health promotion practice," http://oc.nci.nih.gov/services/theory_at_a_glance. Accessed November 14, 2012.