Giving Back: The Role of Generativity in Successful Aging Among HIV-positive Older Adults Charles A. Emlet, Lesley Harris, Charles Furlotte, Christina M. Pierpaoli & David J. Brennan

I have no relevant commercial relationships to disclose. DISCLOSURE I have no relevant commercial relationships to disclose.

This research was supported by grants to Acknowledgements This research was supported by grants to Charles A. Emlet by Fulbright Canada and the University of Washington – Tacoma while he was a Fulbright Scholar at McMaster University 2012-13 We greatly appreciate the 30 older adults living with HIV who graciously shared their lives and stories with us

Background Older adults constitute an increasing proportion of those living with HIV disease in North America. Projections suggest by the year 2020, nearly 70% of people living with HIV in the U. S. will be age 50 or older (Senate Special Committee on Aging). The NIH Working Group on Aging and HIV have identified the importance of understanding components of successful aging in this population (High et al, 2012)

Late Life Resilience Smith & Hayslip (2012) acknowledge individual characteristics, intrapersonal relationships and environmental support as elements supporting late-life resilience Protective Factors Individual Attributes Interpersonal Relationships Environmental Supports Social Networks

Generativity Theory Based upon an investment in a larger community “Dividuality” or the placing a part of the self with others (Sahlins, 2013) Generative expression moves beyond skill transfer to include helping other to discover self and meaning Rubinstein et al (2015) identified four foci that embrace “a new way of culturally thinking about generativity” -People -Groups -Things -Activities

Research Question Does generativity have a role in successful aging among older adults living with HIV? If so, how does it manifest?

Methods Framed by Late Life Resilience Model (Smith & Hayslip Jr., 2012) and generativity theory (Rubinstein et al.,2015) Qualitative Methodology: emergent nature of this work allowed for new ideas to come forward in the interview process and analysis In-depth interviews conducted with adults 50+ living with HIV infection in Ontario, Canada Recruited through AIDS Service Organizations, clinics, HIV service providers in Toronto and Hamilton All interviews conduced between February and May of 2013 Study procedures approved by McMaster University REB (Emlet, PI)

Methods Inclusion criteria: Age 50 and over HIV-positive Self perception of “aging well with HIV” Living in Ontario, Canada - Incentive included $25 CAD gift card for participation

Methods Procedures -Initial phone screening -In-depth, face-to face, semi-structured interviews - Location of choice for participants (their home, HIV hospital, other) - Nine semi-structured questions with additional probes • Three specific questions on support (people, organizations, environment) • Approximately 45-90 minutes each interview -Digitally recorded and professionally transcribed using encrypted files

Analysis All transcripts read by all five researchers - Transcripts were entered into QDA (Nvivo 10) Open coding and focus coding (Charmaz, 2014) used for the development of the central tactics and process of “generativity” - Peer debriefing and consensus-building around the process of “generativity” (Corbin & Strauss, 2007; Charmaz, 2014)

Results

Results - Themes Pioneers Yesterday one of our little 18 year olds came up and gave me this great big hug, and I heard the staff all go, aww. And, I said, what’s the aww all about? And, they said, that you take time to nurture an 18-year-old boy. And, I said, well, bless their hearts, that was us 40 years ago, and we must never forget that. Pioneers First cohort living into older age with HIV infection. Participants felt they represented pioneers paving the way for younger individuals who can now live into older age with HIV But, that’s why explaining to the young people today the history of the HIV walk, to what we’re enjoying today, with the cocktail meds and, of course, all the information that we have currently,

Results - Themes Giving Back Participants spoke extensively about giving back to others manifesting the concept of dividuality or the placing something of the self with other. The HIV community, in general, have been very supportive of me. And, it’s the reason why, as I said, I give back, by volunteering with three or four ASOs. You feel better about yourself, and you feel like you’re contributing, rather than you’ve been put on a shelf, you’re retired now, you’ve done your bit. Well, no, you haven’t, you can still contribute in a positive way, make a difference. My mind is clear. My heart is clear. I want helping the people [sic].

Results - Themes Mentoring Coming back to the earlier concept of being a teacher as an older gay person, and trying to play that role. Not play it, but be that role for people in the community as a whole. Mentoring Participants talked about the role of teacher, mentor, keeper of history of HIV in their work with HIV organizations and younger people living with HIV. I’m a mentor for young, gay, black men. And, basically, what it is, is that they have a program where they mentor young, gay, black men, whether you’re HIV positive or not. So, in my giving back in that area, that has been … in a way, it’s kind of providing support to me, because it keeps me busy. A positive aspects of living well with HIV is that I can take my experiences, and volunteer and teach other PHAs about my successes in living with HIV.

Discussion Findings are consistent with the importance of intrapersonal and environmental elements of resilience in aging well among long term survivors. Themes of pioneers, giving back and mentoring are elements of social support, emphasizing the importance of reciprocity, social exchange and sense of community.

Discussion Our findings support the four foci of generativity posited by Rubinstein and colleagues (2015). People – Others were at the heart of the interaction through giving, mentoring and teaching. Participants noted however the personal benefit derived from giving Groups – Groups and organizations often benefited from these generative efforts, particularly AIDS Service Organizations and other HIV oriented services Things – Connection to historic places such as Casey House (first AIDS hospice in North America) Activities – defined roles within social programs such as the mentoring for young, gay black men and giving back through structured activity.

Limitations Purposive sampling Limited geographical recruitment Short term engagement Information connected to engagement with medical and social services Analysis continues

For More information please contact For Information For More information please contact Charles Emlet caemlet@uw.edu (253) 692-5827