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Article Excerpt
This article outlines a strength-based assessment and treatment model applicable for the mental health counseling of those aging with HIV. By focusing on the specific areas of life where clients are functioning effectively, this model works to decrease attention to pathology and stigma and, subsequently, works to empower clients to concentrate on areas of their lives that are controllable.
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As HIV infection rates rise in today's society, there is an increased focus on HIV disease in older adults. Recent estimates suggest that 11% of new AIDS cases have been identified in people 50 years of age and older (Centers for Disease Control and Prevention, 2001). It is projected that this number will continue to increase as prevention efforts are not effectively reaching older adults involved in high-risk behaviors (Ory & Mack, 1998; Zablotsky, 1998). In addition, with the advent of protease inhibitors, persons with AIDS are living longer and moving into older stages of life (Manton & Stallard, 1998). As a result, many are facing new and complex stressors, such as comorbid health conditions and fewer resources (Kalichman, Heckman, Kochman, Sikkema, & Bergholte, 2000; Meadows, Le Marechal, & Catalan, 1998), and thus there has been an increase in psychological symptomatology among older adults with HIV (Heckman et al., 2002). Subsequently, mental health interventions that enhance the coping skills of older persons with HIV/AIDS are urgently needed (Heckman, Kochman, Sikkema, & Kalichman, 1999; Linsk, 1994). As the face of AIDS continues to evolve, mental health practitioners are being called upon to respond to the psychosocial needs of this growing group of older adults (Crisologo, Campbell, & Forte, 1996), which includes sensitivity to these clients' age cohort, cultural beliefs, values, and practices (Sankar, Luborsky, Rwabuhemba, & Songwathana, 1998; Zablotsky).
In response to the AIDS epidemic and the unique psychosocial issues that impact persons with HIV, there has been a large emphasis placed on the training of mental health practitioners regarding appropriate and effective intervention strategies (Britton, Cimini, & Rak, 1999; Britton, Rak, Cimini, & Shepherd, 1999; Hunt, 1996; Knox, Dow, & Cotton, 1989). As a result, more therapists are willing and prepared to deal with the multitude of issues surrounding HIV infection. However, mental health practitioner training and subsequent treatment regarding older adults is less developed than the assessment and treatment efforts with other groups afflicted with HIV/AIDS. Therefore, effective training and treatment models that focus on the unique and diverse presentations of older adults are urgently needed.
This article outlines a strength-based, biopsychosocial assessment and treatment model applicable for the mental health counseling of those aging with HIV. By focusing on the specific areas of life where clients are functioning effectively, this model works to decrease attention to pathology and stigma, and thus empowers clients to concentrate on areas of their lives that are controllable.
POPULATION OVERVIEW
Early in the HIV epidemic, infection occurred disproportionately among older persons as a result of transmission through the receipt of contaminated blood. However, this is no longer the case, due to routine screening of blood donations (CDC, 1998). Among older adults, men who have sex with men is the highest exposure category, but heterosexual contact and injecting drug use have dramatically increased as modes of transmission (CDC). Of those with AIDS aged 50 or over in 1996, 48% were aged 50-54, 26% were 55-59, 14% were aged 60-64, and 12% were 65 or older. The gender and ethnic distribution among older adults with AIDS is similar to that of the younger age groups, with a majority of cases being male and minority populations being over-represented (Brown & Sankar, 1998; CDC; Ory & Mack, 1998). For older adults, the emergence of HIV/AIDS evolves along two distinct pathways: those who are considered long-term survivors and those who are infected later in life.
Long-Term Survivors
This group includes persons who have been living with HIV for a long period of time and have since entered into older adulthood. This number continues to increase as new drugs and treatments make it possible for more persons to live with HIV/AIDS long enough to enter into the older age groups (Ory & Mack, 1998). Through the years, many long-term survivors have found successful ways of coping and living with HIV and, thus, have had limited exposure to mental health interventions (Barroso, 1996; Remien, Rabkin, & Williams, 1992). However, as long-term survivors enter older adulthood, a new set of mental health issues related to the aging process may emerge and generate the need for mental health treatment. For example, as survivors age, their support systems may change as a result of loss or isolation. Other persons may find that their HIV infection has accelerated since reaching a later stage...
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