An excerpt from this editorial was published on the HIV-Age.org website. Here is the full article:
Making meaning in middle age: The challenge of living longer than expected
It is easy to feel stuck at middle age. Looking back can stir regret for missed opportunities; ahead, the prospects of aging and mortality. Even satisfaction with our present lives involves reckoning with the reality that things are not quite what we anticipated. Unless we see the value in relationships with friends and family, work and social involvement, we can sink into stagnation at midlife.
This challenge can be even more profound for people with HIV who never imagined living to age fifty or beyond. Having spent decades caring for themselves and others AIDS has knocked them off their life course. A magnitude of loss has decimated their social networks, removing the very people with whom they expected to grow old. And, subtle adjustments to physical challenges, financial limitations, and changing priorities have further diminished circles of social involvement.1
Stagnation: “What am I doing it for?”
Stagnation was a significant theme in my study of aging with HIV. Hector, age fifty,2 said he “got into t.v.” rather than pursue work opportunities. Jamie, 57, acknowledged he, “doesn’t get out much.” Joe, age 64, spoke of the losses that accompanied aging with HIV. Not only had all of his close friends died of AIDS, but physical challenges, leaving work to care for his health and the financial limitations that followed all coalesced to create what he called, “a shrinking kind of life.”:
“Then, the other question comes into point, what for? Why should I eat properly, exercise, stay active, not just lay back and wait to die, and go without medication and all those other things?”
For Joe the threat of stagnation at middle age had serious implications.
Generativity: “Mature man needs to be needed”3
The antidote to stagnation is generativity. In middle age we can stagnate into self-absorption or we can give our lives meaning by passing on our experience to the next generation. When we are generative we use our strengths creatively to engage with others through teaching, mentoring, volunteering, or leading.
There were examples of generativity throughout the narratives of the men I interviewed. Arthur, age 64, talked about his writing as a way to “leave something behind”, Luis, 51 volunteered at an AIDS service organization in order to “make a difference.” Tim, at 50, described his activism as honoring friends who died of AIDS:
For my friends that are dead… but it’s not for me, it’s for the future as my friends did it for me, I want to do it for them. I want to make the future better for the people, whether they’re related to me or not that follow me.
I met with Joe several times over the eight months of my study and during that period he made significant changes to his life. He continued his rigorous health care regimen. He got into therapy and rejoined a support group for older people living with HIV. He even attended a family reunion and was surprised that rather than feel ostracized for his HIV-status, he felt included and involved. What motivated Joe to emerge from stagnation? He attributed his adaptation to aging with HIV to concern for others and desire to stay engaged:
“You have to care about other people, and try to integrate your life with other people.”
Generativity vs. Stagnation
In adulthood we continue our psychological development through mastering the challenge of generatively vs. stagnation. For Luis the solution was obvious: “I refuse to be stagnated.” Sometimes the decision to be generative involves more subtle choices regarding how and with whom we spend our time. This challenge was evident as Patrick, age 55, expressed his ambivalence about reconstructing a career at middle age:
“There are those things about 55 that make you want to say, oh just relax…But on the other hand, because that was snatched out of my life in my late 30s and throughout my 40s, I’m scrambling to have those experiences that I should have had when I was younger. You know?. . . so I’m conflicted between being 55 and going, “Well, you’re 55, you know, it’s hard to get out of bed, just relax! Enjoy your life, you know? Don’t . . . don’t work so hard.” And then this other part that’s still hungry.”
Generativity has additional psychological benefits. Generative activities can help people living with HIV rebuild social relationships, reclaim goals relinquished to HIV/AIDS, and remind middle aged and older people of what they have to offer.
Here are a few strategies for generativity that emerged from my study of aging with HIV4:
Teach a class or workshop
Lead a social group
Tutor a child
Provide companionship to a homebound person
Become politically active
Be an HIV peer educator
Serve on a community advisory board
Join a chorus
Create an inter-generational art project
Mentor gay teens
Join a professional organization
Start a blog
Write an editorial on aging with HIV
It’s never too late to pursue a goal, find new interests or impact someone’s life in a positive way. You have a great deal to offer the world, but you are of no service to anyone, including yourself, if you don’t put yourself out there.
Masten, J.E. (2014) A Shrinking Kind of Life: Gay Men’s Experience of Aging with HIV, Journal of Gerontological Social Work. 58(4):319-37.
All names changed
Erikson, E. H. (1963). Childhood and society. New York, NY: W.W. Norton and Company.
Excerpt from: Masten, J.E. (2011) Aging with HIV: A Gay Man’s Guide. Oxford University Press: New York.
The Journal of Gerontological Social Work is publishing an article I’ve written entitled “A Shrinking Kind of Life: Gay Men’s Experience of Aging with HIV.”
Here is the abstract:
More people are living with HIV into midlife and older age. Although increased longevity brings new hope, it also raises unanticipated challenges—especially for gay men who never thought they would live into middle and older age. Middle-aged and older people are more likely to face multiple comorbidities, yet many lack the necessary supports to help them adapt to the challenges of aging with HIV. This article presents the findings of a qualitative study developed to explore gay men’s experience of aging with HIV. Multiple in-depth exploratory interviews were conducted with 15 gay-identified men living with HIV/AIDS over an 18-month period. A systematic strategy data analysis consistent with grounded theory revealed a pattern of subtle adjustments to living with HIV that resulted in diminishing circles of social support and social involvement. This dynamic is referred to as “a shrinking kind of life,” an in-vivo code built from the participant’s own words. Four themes from the research (physical challenges, a magnitude of loss, internal changes, & stigma) are discussed. Conclusions include recommendations for future research and implications for practice in the field. Practitioners knowledgeable of the factors that impact their social involvement can empower gay men through individual and group interventions to confront a shrinking kind of life and define for themselves what it means to optimally age with HIV.
Taylor and Francis has given me 50 free downloads. Just click on the link above to access the full article.
I will be speaking at a conference sponsored by ACRIA on Friday April 7th in Manhattan — The End of AIDS: Implications for Care and Treatment of an Aging Population. Click the link to learn more about this event.
HIV and Aging Group
Living longer than you ever expected offers new hope and possibilities, yet growing older with HIV also comes with unique challenges. This short term working group is designed to help gay men over age forty adapt to the changes that accompany aging with HIV. Through group discussion, exercises and mutual aid you will reassess where you are in life and reevaluate your goals for the future.
Aging with HIV is new territory. Get support from other gay men to help you define for yourself what optimal aging with HIV means to you.
- 12 week group beginning spring 2014
- Date/Time to be determined
- 6-8 participants
- $50 per 90 minute session
- Psychotherapist led/ Confidential
- Financial District Manhattan location
For a free consultation call, please don’t hesitate to call.
The AHA Project website is up and running. It’s still in development, so please share your feedback and referrals.
As part of my New Year’s resolution I have been reading one poem from Walt Whitman’s Leaves of Grass every day. This one resonated with me as an author and psychotherapist interested in themes of identity:
When I Read The Book
When I read the book, the biography famous,
And is this then (said I) what the author calls a man’s life?
And so will some one when I am dead and gone write my life?
(As if any man really knew aught of my life,
Why even I myself I often think know little or nothing of my real life,
Only a few hints, a few diffused faint clews and indirections
I seek for my own use to trace out here.)
The 2011 HIV/AIDS and Aging Symposium held in Austin, TX last week was an inspiring event. I was proud to be a participant in a true community-based, grass-roots initiative to address the concerns of this often invisible, yet growing population. It was informative. – I learned a few things that I didn’t know about HIV/AIDS and Aging. But, even more importantly, the symposium brought together people from diverse backgrounds to discuss how the issue is impacting their community. The symposium was a great model for how communities across America can respond to the issue of Aging with HIV.
After registration and a light breakfast (that I truly appreciated at 8AM) the 90 plus participants gathered for the opening remarks. The first speaker, Justin Irving, from the Austin/Travis County Health and Human Services presented the HIV/AIDS demographics and emerging population trends. This was a good grounding for the event offering a local and national context for the discussion.
The group divided into two “breakout sessions” – Aging 101 and HIV/AIDS. I attended the HIV/AIDS seminar presented by Jennifer Herrera from AIDS services of Austin. It was a great overview of the illness in which I learned a few things about HIV transmission. She also focused on how HIV is affecting folks in Austin, and emphasized the need for prevention geared toward older people. I walked away with some ideas on how to help social workers talk about sex and HIV education. I am sure that the concurrent session offered by Annette Juba from AGE was as informative and community building as the one I attended.
We broke for lunch, and I attended a “leadership luncheon” with the executive directors from area agencies servicing seniors and people living with HIV. I left the lunch feeling hopeful that there was a forum in this community for leaders from both fields to come together and problem solve to address this issue.
It was then my turn to bring everyone together. My talk was entitled, “Aging with HIV: The challenges of living longer than expected.” I gave an overview of the demographics nationwide on HIV over fifty and talked about why Aging will be “the issue” in HIV in the coming years. By 2015 the majority of people living with HIV will be over fifty. While this is a hopeful statistic, it is also a troubling one, since we currently know very little about what it means with HIV. I presented the public health challenges this trend creates. I talked about the issue of mortality and medical challenges that midlife and older people face as they live longer with HIV. And, I presented the complex psycho-social challenges that accompany aging with HIV. We concluded the session with a discussion of the unique constellation of issues faced by people living with HIV over age fifty, the similarities and differences with younger folks living with HIV, as well as their HIV-negative peers. Experts in the fields of aging and HIV were able to share their experience to help each other find solutions for the challenges of living longer than expected.
The final panel was made up of midlife and older people living with HIV and local agency workers servicing this population. They offered their experience and gave real faces to the concerns of people living with HIV in the Austin community.
The HIV/AIDS and Aging Symposium Committee created an effective model for sharing of information and ideas that can be replicated in communities throughout the country.
I will be presenting at the 2011 HIV/AIDS and Aging Symposium in Austin Texas next Friday November 4th. If you are in the area there is still time to register for this full day event.
For more information go to their website (with a very familiar sounding name): hivandaging.wordpress.com.