Understanding Patterns of Healthy Aging among Men Who Have Sex with Men
This project is supported by an R01 from the National Institute on Minority Health and Health Disparities.
One of the happy consequences of HAART is that HIV-positive (HIV+) individuals now have available to them medications that allow them to reach old age. This means that we have the previously unexpected challenge of finding ways to support healthy aging in communities with high HIV prevalence rates. This challenge is likely to be particularly difficult among men who have sex with men (MSM) due to not only their very high background HIV prevalence rates but also the general dearth of proven models to promote healthy aging among older MSM. To meet this challenge, we need to develop health promotion programs that are more potent than the efficacious but time-limited effects found among HIV prevention interventions. Thus, we need to identify mechanisms to raise levels of intervention efficacy to support healthy aging beyond those that have already been tapped to support health promotion efforts among MSM.
In our previous research conducted with the Multicenter AIDS Cohort Study, we documented the unanticipated finding that specific resiliencies among MSM appear to have robust health-promoting properties. The goal of the current proposal is to identify additional resiliencies, untapped in current health promotion efforts for MSM, that function to improve HIV, substance abuse, and other psychosocial health outcomes. This will test, for the first time, whether a theoretical model that includes measures of resiliencies captures more variance to explain patterns of health among older MSM than does a model that focuses on deficits.
Resiliencies research conducted among aging MSM is an innovative agenda on several counts. The dominant approach to explaining patterns of health among MSM has been to study the effects of deficits in creating health disparities. For example, one of the theories used to explain health disparities among MSM, syndemic theory, proposes that the early and lifelong experience of cultural marginalization results in the creation of an interlocking set of psychosocial health conditions that cascade to raise HIV risk levels (i.e., a syndemic) [1, 2]. While an emphasis on deficits is useful in explaining the life course trajectories of men who have multiple psychosocial health problems that result in poor health outcomes, this focus is less helpful in explaining the trajectories of the far larger proportion of MSM who have also experienced cultural marginalization and yet remain healthy into later life. Thus, the current dominant focus on deficits among MSM ignores the large body of evidence for resiliencies that exists in this population [3, 4], evidence that may be crucial to designing interventions to support healthy aging. This application proposes to expand upon syndemic theory so that we can also take into account resiliencies to explain patterns of health and illness among aging MSM. The specific aims of this project are to:
- Specific Aim #1: To measure, within a cohort of older MSM enrolled in the MACS, changes in prevalence rates of both substance use and other specific psychosocial health problems (e.g., drug, alcohol, and tobacco use, depression, partner violence, sexual compulsivity) and resiliencies (e.g., management of internalized homophobia, self-monitoring, interpersonal bonding, community/institution building) over six waves of data collection taken over a 3-year period.
- Specific Aim #2: To test if changing rates of resiliencies over time are associated with subsequent changes in substance use and other psychosocial health problems important to the health of aging MSM and to test whether resiliencies moderate the pathway to the creation of a syndemic.
- Specific Aim #3: To test if changing rates of resiliencies over time are associated with better HIV-related outcomes and biomarkers among HIV+ MSM (i.e., treatment adherence, cognitive functioning, HIV viral loads, CD4 and CD8 cell counts) and to test whether resiliencies moderate the harmful impact of syndemics on these same outcomes and biomarkers.
Findings from this study will identify resiliencies that function to disrupt syndemic production, and in the process promote healthy aging. By identifying the resiliencies already used by some aging MSM to stay healthy but which have yet to be incorporated in current health promotion efforts for MSM, we can progress to the testing of potentially efficacious health promotion programs to support healthy aging among MSM.
Co-Investigators: James E Egan, Mackey R Friedman