Recent years have seen significant growth in the number of older adults living with HIV/AIDS. Since the beginning of the epidemic, 13% of all AIDS diagnoses have been among individuals aged 50 and above, and current reports estimate that 15.6% of new HIV/AIDS cases occur among this older cohort1
. Coupled with advances in the treatment of HIV infection (e.g., Highly Active Anti-Retroviral Therapy (HAART)), HIV/AIDS has transformed into a chronic condition with which increasing numbers of both younger and older adults are aging. As is the case with other chronic health conditions, individuals with HIV often experience challenges that tax coping resources and impact quality of life, including changes in neuropsychiatric functioning,2
a reduced ability to participate in daily activities,3
adherence to complicated treatment regimens,4
and changes in social network composition.5
In part due to these physical and neuropsychiatric sequelae, individuals with HIV often experience co-occurring mental health issues. For example, approximately one-third to one-half of individuals with HIV experience depressive symptoms.6-8
Accordingly, depression is the most common mental health disorder among individuals living with HIV, with rates of diagnosable depression ranging from 20-54%.9-10
Depression and depressed affect are related to accelerated disease progression, as evidenced by declines in CD4+ cell counts and increases in viral load,11-12
higher frequencies of health care visits and hospitalizations,9-10
and reduced survival rates.13
Furthermore, depression is associated with poorer disease management, as depressive symptoms can interfere with medication adherence and compliance with treatment regimens.9,14
It is therefore important to identify protective factors and the mechanisms by which they are associated with sustained psychological wellbeing among individuals with HIV/AIDS. Such efforts may lead to reduced rates of depressive disorder and, ultimately, improve quality of life.
One important sociodemographic correlate of depression and overall wellbeing is age. Despite greater medical comorbidity, greater limitations in physical functioning (Nokes et al., 2000),15
and more rapid disease progression16-17
among older individuals with HIV, studies suggest that older adults may fare better and be more psychologically resilient than their younger counterparts. Comparisons of younger and older adults with HIV/AIDS, for instance, reveal that older adults experience either comparable or fewer depressive symptoms, as well as greater overall emotional wellbeing, than younger age groups.15,18
A number of explanations have been offered for these age differences, including greater wisdom, patience and contentment in old age, less threatening perceptions of illness, and less resentment due to being diagnosed with a chronic condition.19
Another mechanism that might account for fewer depressive symptoms and greater psychological resilience among older adults is the quality and perceived supportiveness of their social relationships. Both structural (e.g., network size, frequency of contact, living situation, etc.) and functional (e.g., perceived quality and availability of support and satisfaction with support) aspects of social ties have been shown to change over the lifespan. In spite of declining rates of social interactions and reductions in social network size with advancing age,20-21
research suggests that social ties are no less important in later life than at other points in the lifespan.22-23
Relationships in later life tend to be of better quality and characterized by greater emotional closeness and less negativity.24-26
One explanation for these findings is that older adults are more adept at selectively managing their social contacts in order to maximize positive affect. According to Socioemotional Selectivity Theory (SST), with increasing age comes the realization that time is limited.27
As a result, people are driven to satisfy emotional needs. Thus, as people age, they selectively prune their social networks and shape their social environments in order to spend time with emotionally rewarding partners. By doing so, older adults achieve increasing emotional closeness in significant relationships, thereby maximizing positive and minimizing negative affect.
Despite evidence for the association between age-related changes in social network functioning and enhanced psychological wellbeing, the literature on this association among individuals with HIV is sparse. Prior work on structural aspects of social ties suggests that older adults living with HIV are more likely to be socially isolated, live alone, and/or have smaller social networks than their younger counterparts.5,18,28
However, few studies have examined age-related differences in functional aspects of social ties, such as perceived quality and availability of support, and the impact of such differences on depression and overall psychological wellbeing among individuals with HIV. In one of the only studies to specifically examine age group differences in the relationship between perceived social support and affect among HIV-infected men, social support was shown to have a greater impact on both negative and positive moods among older relative to younger men.29
The general lack of attention to age-related variability in functional aspects of social ties is unfortunate given that functional aspects have been shown to be just as, if not more, important for psychological wellbeing than structural aspects of social ties.30-31
Among individuals with HIV/AIDS, social support has been linked to factors such as less distress and greater positive affect,29,32
better medication adherence,14,33
more consistent medical appointment attendance,34
and slower disease progression.35
Furthermore, functional and structural features of social ties are often distinct, and in some cases uncorrelated. For example, Crystal et al. (2003) found that although older adults with HIV were more likely to live alone, there were no age group differences in perceived tangible or emotional support.18
Finally, functional and structural aspects of social ties can differentially impact health outcomes,36-37
further highlighting the need to study multiple facets of social relationships among individuals with HIV.
To address these gaps in the literature, the current study sought to explore the association between age and both functional and structural aspects of social network functioning among individuals aging with HIV. Specifically, we were interested in examining the extent to which functional and structural aspects of social ties accounted for, or statistically mediated, age group differences in depressive symptoms and positive affect. A better understanding of the psychosocial processes underlying the relationship between age and psychological wellbeing can help inform the treatment and care of both younger and older adults living with the chronic stress of HIV infection, and potentially delay the onset and progression of depression among this vulnerable cohort. Thus, we first examined the association between age and various indices of physical and psychological wellbeing. We hypothesized that despite greater physical comorbidity and pain, older adults with HIV would report fewer depressive symptoms and more positive affect than their younger counterparts. Next, we examined whether functional and structural aspects of social ties played a role in the observed age group differences in psychological wellbeing. We hypothesized that older adults would report greater subjective support, or higher perceived quality of social support, from network members, and that this would account for age differences in depression and positive affect.