1. 1 Emlet, C.A., 2 Brennan, D. J., 3 Brennenstuhl, S., 4 Rueda, S., 5 Hart, T. A., 6 Rourke, S.B., 4 OCS Study Team Data 1. Social Work, University of Washington I Tacoma, Tacoma, WA; 2. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON; 3. Dalla Lana School of Public Health, University of Toronto, Toronto, ON; 4. The Ontario HIV Treatment Network, ON; 5. Department of Psychology, Ryerson University, Toronto, ON; 6. Program in Neuroscience, University of Toronto, Toronto, ON. Background Analysis The Impact of HIV Stigma on Older and Younger Adults Living with HIV: Does Age Matter? Acknowledgements: the OCS Study team, Staff, and Governance Committee Table 2. Unstandardized Coefficients for Regression of HIV stigma on Age in a Sample of Adults Living with HIV from the OHTN Cohort Study (n=960). Final Model bS.E Age groups (ref=<40) age group 40 to 45.881.05 age group 46 to 491.431.15 age group 50 to 55-.451.16 age group 56 or older-2.831.20 * Gender (ref = man)3.011.13 ** Sexual Orientation Regardless of Gender (ref= Homosexual) Heterosexual4.25.98 *** Bisexual6.291.39 *** Gross Personal Income (ref=>$30,000/year).23.71 Race (ref=white) Asian.631.74 Other/mixed race.04.99 Black2.121.11 + Time since HIV+ (years)-.14.06 * Depression Level4.06.79 *** Maladaptive Coping.45.06 *** Tangible Social Support-.47.07 *** *p<.05 **p<.01 ***p<.001 +p<.06 Table 1. Description of the Analytic Sample of Adults Living with HIV from the OHTN Cohort Study by Age Group (N=960) Characteristic<4040-4546-4950-55>55 Total n (%) (n=198)(n=212)(n=176)(n=191)(n=183)(n=960) Gender Woman Man 77 (38.9) 121 (61.6) 38 (17.9) 174 (82.1) 20 (11.4) 156 (88.6) 17 (8.9) 174 (91.1) 22 (12.0) 161 (88.0) 174 (18.1) 768 (81.9) Sexual Orientation Regardless of Gender Homosexual Heterosexual Bisexual 86 (43.3) 101 (51.0) 11 (5.6) 127 (59.9) 72 (34.9) 11 (5.2) 110 (62.5) 53 (30.1) 13 (7.4) 144 (75.4) 35 (18.3) 12 (6.3) 123 (67.2) 47 (25.7) 13 (7.1) 590 (61.5) 310 (32.3) 60 (6.2) Income < $30,000 $30,000 132 (66.7) 66 (33.3) 119 (56.1) 93 (43.9) 80 (45.5) 96 (54.5) 96 (50.3) 95 (49.7) 97 (53.0) 86 (47.0) 524 (54.6) 436 (45.4) Race Other/ mixed race 46 (23.2)44 (20.7)35 (19.9)28 (14.7)22 (12.0)175 (18.2) African or black 74 (37.4)42 (19.8)22 (12.5)16 (8.4)16 (8.7)170 (17.7) White 78 (39.4)126 (59.4)119 (67.6)147 (77.0)145 (79.2)615 (64.1) Depression (CES-D) Yes (Score 16) 89 (26.6)83 (39.2)53 (30.1)61 (31.9)48 (26.2)334 (34.8) No (Score < 16) 109 (55.1)129 (60.8)123 (69.9)130 (68.1)135 (73.8)626 (65.2) Time Since HIV+ Diagnosis (mean, SD) 6.71 (5.2)11.20 (6.1)13.08 (6.6)14.79 (6.3)15.92 (5.6)12.23 (6.82) Total Stigma,a,b,c,d (mean, SD) 53.86 (12.1)51.49 (12.4)50.47 (11.1)47.42 (12.2)44.52 (12.0)49.65 (12.4) Enacted Stigma,a,b,c,d (mean, SD) 11.4 (4.4)11.31 (4.7)11.05 (4.1)10.4 (4.5)9.47 (3.9)10.75 (4.4) Anticipated Stigma,a,b,c,d ( mean, SD) 29.63 (5.9)28.37 (6.0)28.3 (25.8)26.18 (6.2)25.29 (6.6)27.6 (6.3) Internalized Stigma,a,b,c,d (mean, SD) 12.83 (4.1)11.81 (4.2)11.1 (3.9)10.84 (4.1)9.76 (3.8)11.31 (4.2) Maladaptive Coping,a,b,c,d (mean, SD) 23.40 (6.1)22.71 (5.8)21.66 (5.8)21.51 (5.6)20.92 (5.5)22.08 (5.8) Tangible Social Support,a,b,c,d (mean, SD) 13.21 (5.2)13.95 (5.6)14.01 (5.3)14.39 (5.2)15.12 (4.9)14.12 (5.3) F test significant a >55 significantly different from 55 b 50 significantly different from <50 c 46 significantly different from <46 d 40 significantly different from <40 Table 3. Unstandardized Coefficients for Regression of HIV Stigma Sub-Scales on Age in a Sample of Adults Living with HIV from the OHTN Cohort Study (n=960). Enacted Stigma Anticipated Stigma Internalized Stigma Final Model bS.E b b Age groups (ref=<40) age group 40 to 45.49.41.54.56-.14.37 age group 46 to 49.61.441.19.61-.36.40 age group 50 to 55.06.45-.19.62-.33.41 age group 56 or older -.75.46-.93.64-1.15.42** Gender (ref = man).44 1.66.61**.91.40* Sexual Orientation Regardless of Gender (ref= Homosexual) Heterosexual.74.38+2.82.52***.69.35* Bisexual 1.05.54+3.97.74***1.28.49** Gross Personal Income (ref=>$30,000/year) 1.01.27***-.36.38-.41.25 Race (ref=white) Asian.11.67.35.93.17.61 Other/mixed race.15.38.15.53-.26.35 Black.80.43+.98.59.35.39 Time since HIV+ (years).04.02-.12.03***-.06.02** Depression Level 1.43.31***1.03.43*1.60.28*** Maladaptive Coping.10.02***.17.03***.18.02*** Tangible Social Support -.17.03***-.19.04***-.12.02*** *p<.05 **p<.01 ***p<.001 +p<.06 HIV stigma continues to be a major social problem in the lives of persons living with HIV disease (Logie & Gadalla, 2009). HIV stigma has been well documented in older populations (Emlet, 2006a; Emlet, 2006b; Foster & Gaskins, 2009; Haile, Padilla & Parker, 2011; Sankar, Nevedal, Neufeld, Berry, & Luborsky, 2011;) and is associated with negative psychosocial and health outcomes, including depression, poor health-related quality of life, lack of disclosure and loneliness (Emlet, 2007; Grov, Golub, Parsons, Brennan, & Karpiak, 2010; Haile, Padilla & Parker, 2011; Karpiak, Shippy, & Cantor, 2006). While the literature suggests that older adults are at significant risk for experiencing HIV stigma (GMAC, 2010; LeBlanc, 2011; Sankar et al, 2011), it is not known if older adults living with HIV disease experience HIV stigma to a greater or lesser degree than their younger counterparts. Findings from numerous HIV studies are unclear about this question. For example, Wagner et al (2010) found no association between age and stigma among HIV+ women; however, there were very few older individuals in the sample used. Other studies have also found no association between age and stigma (Vanable et al., 2006; Wolitski et al., 2009). The purpose of this study was to compare HIV stigma across age groups in a large sample of persons living with HIV/AIDS (PHAs). Cross-sectional data were used from the OHTN Cohort Study (OCS), an ongoing survey that collects information on the clinical profile and social determinants of health of people with HIV in Ontario. Participants are eligible for the OCS if they are an adult (18+) resident of Ontario diagnosed with HIV and can provide informed consent. This study was approved by the Research Ethics Board of the University of Toronto. A sub-sample of the OCS dataset was selected of adults aged 21 years or older at their most recent interview that had complete data on stigma and all independent variables selected for the study (n= 960). Measures Dependent Variable: A modified version of the HIV Stigma Scale was used to measure overall HIV- related stigma (Berger, 2001; Bunn, 2007; Wright, 2007) and three stigma subscales: Enacted Stigma, Anticipated Stigma and Internalized Stigma. Focal Independent Variable: The multivariate analysis was centered on age represented in quintiles (i.e., 22-39, 40-45, 45-49, 50-55, 56 and older). Covariates: Selection of covariates for multivariate modelling was determined by bivariate screening. Relevant variables were selected for inclusion in the modelling if they were associated with stigma and age at the p<.10 level. The following variables were selected for the analysis: Sociodemographic variables: sexual orientation (heterosexual, homosexual, bisexual), gender (men and women), race (white, black, other/mixed), income (> or < $30,000), and time since HIV diagnosis. Psychosocial measures: depression (CES-D; Radloff, 1977), Maladaptive Coping (Brief COPE, Carver, 1997), Tangible Social Support (MOS-HIV Social Support Survey; Sherbourne & Stewart, 1991). Bivariate associations between the age groups and stigma were investigated using ANOVA and orthogonal contrasts. Multiple linear regression was used to assess the relationship between age and stigma, while taking into account sociodemographic and psychosocial covariates. A hierarchical modeling strategy was used, such that age was entered into the model first, followed by the sociodemographic variables. The psychosocial variables were entered into the model last. This procedure was repeated four times: once predicting overall stigma and once for each of the three stigma subscales. All analyses were undertaken using SPSS 20. Results Summary Older age groups have significantly lower stigma scores. Those older than 55 have significantly lower overall and internalized stigma than those younger than 40, even when accounting for gender, sexual orientation, income, time since diagnosis, depression, maladaptive coping and social support. Age does not predict enacted or anticipated stigma when accounting for the demographic and psychosocial variables. Age does matter when it comes to understanding stigma among adults living with HIV/AIDS. Age is most important for understanding overall stigma and internalized stigma. The relationship between age and enacted stigma, and age and anticipated stigma, may be explained by other demographic and psychosocial variables. Conclusions Contact: Charles Emlet caemlet@u.washington.edu