Social workers, gerontologists, and public health officials are beginning to recognize the impact of HIV/AIDS on older adults. Because HIV/AIDS is seen primarily as a disease of younger people, older adults with HIV disease have been referred to as a hidden population (Emlet, 1997) and as the "invisible ten percent" (Genke, 2000), the latter referring to the fact that adults age 50 years and older have traditionally represented approximately 10 percent of adult AIDS cases in the United States. The advent of highly active antiretroviral therapies (HAART) in the 1990s, however, has extended life for many people with HIV disease and will allow, as never before, individuals who were infected in midlife to live into old age. The number of older adults diagnosed with HIV before age 50 has increased consistently during the 21st century and will continue to increase in numbers as treatments for HIV improve (Mack & Ory, 2003). Surveillance data from the Centers for Disease Control and Prevention (CDC, 2005) have illustrated this phenomenon: The estimated number of people 50 years and older living with HIV/AIDS increased from 65,655 in 2001 to 104,260 in 2004. This represents a 59 percent increase in four years. This pattern appears to hold true for adults on the older end of the spectrum as well. During that same time period, the estimated number of adults 65 years and older living with HIV/AIDS rose from 6,674 to 10,861 (an increase of more than 60 percent) (CDC). Although cases of HIV/AIDS are increasing among older adults, deaths continue to increase as well. According to CDC data, deaths from AIDS decreased by 8 percent overall between 2000 and 2004; however, they increased in all age categories 50 years and older (CDC). Because older adults continue to be diagnosed with HIV/AIDS in increasing numbers, it is imperative that we continue to improve our knowledge of issues that positively and negatively affect these individuals.
This article explores the social networks of older adults living with HIV disease and compares those networks with those of their younger counterparts. This information should add to the knowledge base concerning this population, as well as elucidate for practitioners sociodemographic characteristics that may increase vulnerability for social isolation.
THE IMPORTANCE OF SOCIAL NETWORKS AND SUPPORT
Social support networks have been consistently acknowledged as an important element in the lives of people with HIV/AIDS. Adequate social support has been associated with physiological and treatment aspects of HIV. For example, inadequate social support has been associated with lower physical functioning (Collins, 1994; Gielen, McDonnell, Wu, O'Campo, & Faden, 2001), and adequate emotional support has been found to improve compliance with HIV medications (Cox, 2002). Social support has been repeatedly associated with psychological functioning, such as psychological well-being and mental health (Catz, Gore-Felton, & McClure, 2002; Collins; Cowdery & Pesa, 2002), positive states of mind (Turner-Cobb et al., 2002), coping with the stress of the disease (Crystal & Kersting, 1998), and quality of life (Gielen et al.). Although the importance of social support to adults with HIV disease has received considerable attention, Shippy and Karpiak (2005) pointed out that most studies have focused on younger gay white men. In fact, many studies that have examined social support in HIV-infected populations did not collect data on age or neglected age as a variable in their analysis (Catz et al.; Cox; Crystal & Kersting, 1998; Gielen et al.; Pakenham, 1998; Turner-Cobb et al.).
A small number of studies have examined various elements of social support among midlife or older adults living with HIV/AIDS. Although not focusing on older adults specifically, Cowdery and Pesa's (2002) study included both older and younger adults who had HIV and analyzed age as an independent variable. …