Today is World Aids Day. A day we remember all the lives lost and affected by the pandemic of the 1980s. Forty years on, many people are still living with the memories of the 80s, many still living with AIDS. But what does this mean for social care?

Many people accessing social care now lived through the AIDs pandemic and experienced the  systematic oppression of LGBTQ community. As a result, many LGBTQ people have Minority Stress conditions. Minority Stress Theory relates to the idea that people from disadvantaged or marginalised backgrounds experience long-term stress because of factors associated with such an identity. In the context of LGBT ageing, the idea is that poorer health outcomes stem from the hostile social climate that LGBTQ people have experienced in the past. In other words, the consequences of prejudice and stigma impact that manifests in worse physical and mental health. Considering 40 years on from the AIDs epidemic, many young individuals at the time are now or soon may be seeking care. Let’s consider the facts…

• The AIDS epidemic’s impacts on a generation of gay men, now aged 54-72. High mortality within tight gay networks has inspired the term ‘multiple loss syndrome’ to capture a psychological death toll in one’s life. But these deaths’ impact varies by, for example, gay men’s degree of connectedness to urban gay communities and when they entered gay life.
• Gay men diagnosed with HIV pre-1996 lived through often-lengthy periods of ill health, with life-long consequences, and of expectations of imminent and/or premature death from AIDS. Creating The ‘Lazarus effect‘.
• Transgender women in specific communities have 49 times the odds of living with HIV than the general population.
• 83 out of every 1,000 men who have sex with men (aged 15 to 74) live with HIV.

Sources:

• Rosenfield, D. (20180) The AIDs epidemics last affect on gay men https://www.thebritishacademy.ac.uk/blog/aids-epidemic-lasting-impact-gay-men/
• UnAIDS Prevention gap report https://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf

AIDs is not going away; it has become a manageable one. Social care providers need to take extra care and consideration when working with Gay men and Transgender women. By responding to the daily medication, they receive for AIDs, the stigma they face and the great oppression they have lived through during this time. It is about being compassionate to the lives lost; many have been partners, friends, and family. Friends who are family, considering many gay people in 1980, were stigmatised. Families rejected many people; thus, friends became the new family. Conversations in social care around friends and family need to be inclusive of the fact not many people include only “blood ties” as their immediate family. Many gay men and transgender women will not have family or traditional family types and are more likely to require support and reside in care homes more so than heterosexual couples (as they are more likely to be single, live alone and not have children). Social are providers should consider the importance of education and need to understand that…

• Older LGBT people are more likely to engage in harmful behaviours like drug use, frequent alcohol consumption, or smoking. 
• One study found that 18% of older LGBT people would feel uncomfortable disclosing their sexual orientation to their GP and healthcare professionals. 
• Older LGBT people’s past experiences of negative interactions with health care providers shape how they engage with and access health services later in life.
• Reminiscence activities with LGBTQ people may take them back to a place in which they do not want to revisit. It may be a place that is very hurtful for them. Probing too deeply could result in worsening of mental health and potentially furthering problematic behaviour.

Source: National LGBT Survey (2018) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/722314/GEO-LGBT-Survey-Report.pdf

Remember that the interactions that social care providers have with gay men and transgender women are very much affected by the social care they may have received around the AIDs epidemic. Their trust for care providers resides in your ability to reassure them of how times have changed. How you respond to potentially harmful situations could be the realisation for many LGBTQ that they are safe, valued, and worthy of care.

Stigma can be a killer.

End Inequalities, End AIDs, End Pandemics.