“After 25 years of democracy we are still stigmatized and discriminated against…”: Health care experiences of HIV positive older black gay men in a township in South Africa

Authors

  • Thembelani Mange University of the Western Cape
  • Neil Henderson
  • Nomvuyo Lukelelo University of the Western Cape

DOI:

https://doi.org/10.1921/jpts.v19i1-2.1674

Keywords:

healthcare, gay, black, township, training, social work

Abstract

Older gay black men living with HIV and AIDS have been and continue to be an invisible part of the research landscape in South Africa, with the focus being on the younger LGBTQI+ cohort. Furthermore, aging and health care concerns of this population are ‘swept under the carpet’ due to stigmatization and homophobia. This qualitative study explored the aging and health-care experiences of older gay black men in a selected township in the Cape Metropole, with the purpose of finding strategies to deal with their real life concerns. The first author utilized in-depth interviews with 15 participants, 10 of which were a sample of self-identified gay men, aged between 43-77 and drawn from a selected township in the Cape Metropole in South Africa. Five health professionals working at the local clinic were also interviewed. Interviews were audio-recorded in the language of the participants (isiXhosa) and transcribed verbatim. They were then translated from isiXhosa to English before a thematic analysis was undertaken.  One of the key findings of the study was that health-care professionals, particularly nurses at a local clinic, are stigmatizing older black men who are living with HIV and AIDS. This is exacerbated by the rejection by their families and the death of their life partners which leads to isolation, loneliness and depression. Due to comorbidities, COVID-19 has led to some participants passing away. Training of health-care professionals should be prioritized by social workers and workshops should be held in the township to educate families of older LGBTQI+ people on their aging concerns.

References

Almack, K., Seymour, J. and Bellamy, G. (2010) Exploring the impact of sexual orientation on experiences and concerns about end of life care (EOLC) and on bereavement for lesbian, gay and bisexual elders. Sociology, 44, 5, 908-924

Berko, J., Mazonson, P., Short, D., Guttner, C., Karris, M., Huhn, G., Ehui, L. M., Loo, T., Chen, S-M., Spinelli, F. and Zolopa, A. (2021) RCT of an online mental health intervention with PLWH during Covid-19 pandemic. [Accessed on 17 June, 2021 at https://www.natap.org/2021/CROI/croi_107.htm ]

Bhatt, M., Soneja, M. and Gupta, N. (2021) Covid-19 in patients living with human immunodeficiency virus (HIV) infection: Challenges and way-forward. Drug Discoveries and Therapeutics, 15, 1, 42-43

Boehmer, U., Miao, X., Linkletter, C. and Clark, M.A. (2012) Adult health behaviours over the life course by sexual orientation. American Journal of Public Health, 102, 292-300

Bohman, D. M., Van Wyk, N. C. and Ekman, S. L. (2011) ‘South Africans’ experiences of being old and of care and caring in a transitional period. International Journal of Older People Nursing, 6, 3, 187–195

Boone, M. R., Cook, S. H. and Wilson, P. A. (2016) Sexual identity and HIV status influence the relationship between internalized stigma and psychological distress in black gay and bisexual men. AIDS Care. 28, 6, 764-770

Brown, G., Leonard, W., Lyons, A., Power, J., Sander, D., McColl, W., Johnson, R., James, C., Hodson, M., Carman, M. (2017) Gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape. Sex Health, 14, 1, 111-118

Cane, T. (2020) Recognising resilience factors among people living with HIV seeking to adopt. Adoption and Fostering, 44, 2, 173-184

Chen, Y. and Feeley, T. H. (2014) Social support, social strain, loneliness, and well-being among older adults: An analysis of the health and retirement study. Journal of Social and Personal Relationships, 31, 2, 141-161

Creswell, J. W. (2014) Research design (4th edition) Thousand Oaks, CA: Sage

D’Augelli, A. R., Grossman, A. H., Hershberger, S. L. and O’Connell, T. S. (2010) Aspects of mental health among older lesbian, gay, and bisexual adults. Aging and Mental Health, 5, 2, 149-158

De Araujo, L. F, Teva, I., and Quero, J. H. … (2017) Analysis of resilience and sexual behaviour in persons with HIV. Health Psychology Research. [doi: 10.1186/s41155-017-0076-6 ]

Deeks, S. G. (2011) HIV infection, inflammation, immunosenescence, and aging. Annual Review of Medicine, 62, 141

Dentato, P., Orwat, J., Spira, M. and Walker, B. (2014) Examining cohort differences and resilience among the aging LGBT community: Implications for education and practice among an expansively diverse population. Journal of Human Behavior in the Social Environment, 24, 316-328

De Vries, B., Gutman, G., Beringer, R., Gill, P. and Daudt, H. (2021) Advance care planning among older Canadians amid the Covid-19 pandemic: A focus on sexual orientation. Palliative Care and Social Practice, 2021, 15, 1-14

Dos Santos, M. M. L., Kruger, P., Mellors, S. E., Wolvaardt, G and van der Rys, E. (2014) An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: The People Living with HIV. Public Health, 14, 80

Emlet, C. A. (2016) Social, economic, and health disparities among LGBT older adults. Generations, 40, 2, 16-22

Figueiredo, A. R., and Abreu, T. (2015) Suicide among LGBT individuals. European Psychiatry, 30, 1815

Fredriksen-Goldsen, K. I., Hoy-Ellis, C. P., Goldsen, J., Emlet, C. A., and Hooyman, N. R. (2014) Creating a vision for the future: Key competencies and strategies for culturally competent practice with lesbian, gay, bisexual, and transgender (LGBT) older adults in the health and human services. Journal of Gerontological Social Work, 57, 80-107

Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Muraco, A. and Hoy-Ellis, C. P. (2013) Health disparities among lesbian, gay, and bisexual older adults: Results from a population based study. American Journal of Public Health, 103, 1802-1809

Fredriksen-Goldsen, K. I., Kim, H. J., Chengshi, S., Goldsen, J. and Emlet, C. (2015) Successful aging among LGBT older adults’ physical and mental health-related quality of life by age group. The Gerontologist, 55, 154-168

Fredricksen-Goldsen, K.I., Kim, H-J., Emlet, C.A., Muraco, A., Erosheva, E.E., Hoy-Ellis, C.P., Goldsen, J. & Petry, H. (2012) The aging and health report: Disparities and resilience among lesbian, gay, bisexual and transgender older adults. Seattle: Institute for Multigenerational Health

Fredricksen-Goldsen, K. I. and Muraco, A. (2010) Ageing and sexual orientation: A 25 year review of the literature [Accessed 11 August 2013 at http://roa.sagepub.com/control/32/3/372]

Fry, S. P. and Keyes, C. L. M. (Eds.) (2010) New frontiers in resilient aging: Life strengths and well-being in late life. New York: Cambridge University Press

Gardner, A.T., De Vries, B. and Mockus, D.S. (2013) Aging out in the desert: Disclosure, acceptance and service use among midlife and older lesbians and gay men [Accessed 8 November 2021 at http://doi.org/10.1080/00918369.2013.835240]

Gay and Lesbian Network (GLEN) (2011) Visible lives: Identifying the experiences and needs of older lesbian, gay, bisexual and transgender people in Ireland. Dublin: GLEN

Han, C., Ssewamala, F. and Wang, J. (2013) Family economic empowerment and mental health among AIDS-affected children living in AIDS-impacted communities: Evidence from a randomised evaluation in southwestern Uganda. Epidemiol Community Health, 67, 225-235

Henderson, N. and Khan, J. (2020) ‘I will die if I have to go to an old age home…’: Afro-centric options for care of older LGBT people in South Africa. Agenda Journal, 34, 1, 94-107

Hennink, M. M., Kaiser, B. N. and Marconi, V. C. (2016) Code saturation versus meaning saturation: How many interviews are enough? Qualitative Health Research, 27, 4, 591-608

Herek, G. M., and Capitanio, J. P. (1999) AIDS stigma and sexual prejudice. American Behavioral Scientist, 42, 7, 1130-1147

Herek, G. M., Capitanio, J. P. and Widaman, K. F. (2003) Stigma, social risk, and health policy: Public attitudes toward HIV surveillance policies and the social construction of illness. Health Psychology, 22, 5, 533-540

Institute of Medicine. (2011) The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press

Jeffries IV, W. L., Gelaude, D. J., Torrone, E. A., Gasiorowicz, M., Oster, A. M., Spikes Jr, P. S., McCree, D. H., and Bertolli, J. (2017) Unhealthy environments, unhealthy consequences: Experienced homo-negativity and HIV infection risk among young men who have sex with men. Global Public Health, 12, 1, 116-129

Karpetis, G. (2017) Social work skills: A narrative review of the literature. British Journal of Social Work, 48, 3 [Accessed 14 June 2021 at https://doi.org/10-1093/bisw/bcx066]

Kessler, R. C., Birnbaum, H., Bromet, E., Hwang, I., Sampson, N. and Shahly, V. (2010) Age difference in age depression: Results from the National Comorbidity Surveys Replication (NCS-R). Psychological Medicine, 40, 2, 225

Kim, J. H. and Richardson, V. E. (2012) The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults. Health and Social Care in the Community, 20, 1, 42-51

King, S. D. and Orel, N. (2012) Midlife and older gay men living with HIV/AIDS: The influence of resiliency and psychosocial stress factors on health needs. Journal of Gay and Lesbian Social Services, 24, 4, 346-370

King, S. D. and Richardson, V. E. (2015) Influence of income, being partnered/married, resilience, and discrimination on mental health distress for mid-life and older gay men. Journal of Gay and Lesbian Mental Health, 20, 2, 127-151

Kirst-Ashman, K. and Hull, G. H. (2012) Generalist practice with organizations and communities. Stamford, CT: Brookes/Cole-Cengage Learning

Löf, J. and Olaison, A. (2020) ‘I don’t want to go back into the closet just because I need care’: Recognition of older LGBTQ adults in relation to future care needs. European Journal of Social Work, 23, 2, 253-264

Mazonson, P., Loo, T., Berko, J., Adeyemi, O., Oglesby, A., Spinelli, F. and Zolopa, A. (2020) Older black gay men living with HIV report higher quality of life than older white gay men despite facing additional burdens. Open Forum Infectious Diseases, 7, 1, 509

McIntosh, M. J. and Morse, J. M. (2015) Situating and constructing diversity in semi-structured interviews. Global Nursing Qualitative Research, 1-12, [Accessed the 25th of June 2021 at https//doi:10.177/2333393615597674]

McLachlan, C., Nel, J., Pillay, S. and Victor, C. J. (2019) The Psychological Society of South Africa’s guidelines for psychology professionals working with sexually and gender-diverse people towards inclusive and affirmative practice. South African Journal of Psychology, 49, 3 314-324

Mirzaei, H., McFarland, W., Karamouzian, M. and Sharifi, H. (2020) Covid-19 among people living with HIV: A systematic review. AIDS and Behaviour, 25, 85-92

Nabunya, P., Padget, D., Ssewamala, F. M., Courtney, M. E., and Neilands, T. (2019) Examining the non-kin support networks of orphaned adolescents participating in a family-based economic strengthening intervention in Uganda. Journal of Community Psychology, 47, 3, 579-593

National Department of Health. (2002) Patients’ Rights Charter. Available: http://capegateway.gov. za/eng/your_gove/595/pubs/public_P3162 [Accessed on 26 August 2010]

Nkoli, S. (1995) ‘Wardrobes, coming out as a black gay activist in South Africa’. In M. Gevisser and E. Cameron (Eds.), Defiant desire: Gay and lesbian lives in South Africa. London: Routledge (pp. 249-257)

Nyasulu, J. and Himani, P. (2020) The effects of coronavirus disease 2019 pandemic on the South African health system: A call to maintain essential health services. African Journal of Primary Healthcare and Family Medicine. 12, 1, 1-5

Opening Doors. (2010) Supporting older lesbian, gay, bisexual and transgender people: A checklist for social care providers. London: Age UK

Parker, R. and Aggleton, P. (2003) HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Social Science and Medicine, 57, 13-24

Queiroz, A. A., Sousa, A. F., Brignol, S., Araújo, T. M. and Reis, R. K. (2019) Vulnerability to HIV among older men who have sex with men users of dating apps in Brazil. The Brazilian Journal of Infectious Diseases, 23, 5, 298-306

Qureshi, R. I., Zha, P., Kim, S., Hindin, P., Naqvi, Z., Holly, C., Dubbs, W. and Ritch, W. (2017) Healthcare needs and care utilization among lesbian, gay, bisexual and transgender populations in New Jersey. Journal of Homosexuality, 65, 2, 167-180

Republic of South Africa. (1996) Constitution Act of 1996. Pretoria: Government Printer

Republic of South Africa. (1997) White Paper of Transforming Public Service Delivery (Batho Pele White Paper) (No. 1459 of 1997) Pretoria: Government Printer

Republic of South Africa. (2006a) Civil Unions Act 17 of 2006. Pretoria: Government Printer

Republic of South Africa. (2006b) Older Persons Act 13 of 2006. Pretoria: Government Printer

Reygan, F. and D’Alton, P. (2013) A pilot training programme for health and social care professionals providing oncological and palliative care to lesbian, gay and bisexual patients in Ireland. Psycho-Oncology, 22, 1050-1054

Reygan, F. and Henderson, N. (2019) All bad? Experiences of ageing among LGBT elders in South Africa. International Journal of Ageing and Human Development, 88, 4, 405-41

Reygan, F., Henderson, N. and Khan, J. (2020) ‘I’m black, a woman, disabled and lesbian’: LGBT ageing and care services at the intersections in South Africa. Sexualities, UK

Rosenfeld, D., Bartlam, B. and Smith, R. B. (2012) Out of the closet and into the trenches: Gay male baby boomers, ageing, and HIV/AIDS. The Gerontologist, 52, 2, 255-264

Rossman, G. B. and Rallis, S. E. (2012) Learning in the field: An introduction to qualitative research (3rd edition) Thousand Oaks, CA: Sage Publications

Shang, X. (2009) Supporting HIV/AIDS affected families and children: The case of four Chinese counties. International Journal of Social Welfare, 18, 202-212

Slater, L. Z., Moneyham, L., Vance, D. E., Raper, J. L., Mugavero, M. J. and Childs, G. (2015) The multiple stigma experience and quality of life in older gay men with HIV. Journal of Assoc. Nurses, AIDS Care, 26,1, 24-35

South African Police Service. (2021) Police recorded crime statistics Republic of South Africa: First quarter of 2021/2022 financial year (April to June 2021) [Accessed 28 October 2021 at https://www.saps.gov.za/services/downloads/april_june_2021_22_quarter1_presentation.pdf]

Statistics South Africa. (2020) Mid-year population estimates (2020). [Accessed 15 September 2020 at http://www.statssa.gov.za/publications/P0302/P03022020.pdf]

Stonewall Report. (2011) LGB people living in later life. [Accessed 29 September 2015 at http://www.stonewall.org.uk/sites/default/files/LGB_people_in_Later_Life__2011_.pdf]

Swarr, A. L. (2012) Sexual transition: Remaking gender and race in South Africa. State University of New York: New York Press

Thomas, G. (2017) How to do your research project: A guide for students (3rd edition) London: Sage

Tronto, J. (2013) Caring democracy: Markets, equality and justice. New York: New York University Press

Turan, B., Budhwani, H., Fazeli, P. L., Browning, W. R., Raper, J. L., Mugavero, M. J. and Turan, J. M. (2017) How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS and Behavior, 21(1), 283-291. [https://doi.org/10.1007/s10461-016-1451-5]

UNAIDS. (2019) UNAIDS Data 2019. [Accessed 15 September 2020 at https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_en.pdf]

UNAIDS. (2015) UNAIDS Terminology Guidelines [Accesses 25 October 2021 at [https://www.unaids.org/sites/default/files/media_asset/2015_terminology_guidelines_en.pdf ]

Van Breda, A. (2018) A critical review of resilience theory and its relevance to social work. Social Work/Maatskaplike Werk Journal, 54, 1, 1-18

Westwood, S., King, A., Almack, K., Yui-Suen, T. and Bailey, L. (2015) Good practice in health and social care provision for older LGBT people. In J. Fish and K. Karban (Eds.), Social work and lesbian, gay, bisexual and transgender health inequalities: International perspectives. University of Bristol: Policy Press (pp. 145-159)

Westwood, S. (2017) Religion, sexuality, and (in)equality in the lives of older lesbian, gay and bisexual people in the United Kingdom. Journal of Religion, Spirituality and Aging, 29, 1, 47-69.

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Published

2022-04-13

How to Cite

Mange, T., Henderson, N., & Lukelelo, N. (2022). “After 25 years of democracy we are still stigmatized and discriminated against…”: Health care experiences of HIV positive older black gay men in a township in South Africa. The Journal of Practice Teaching and Learning, 19(1-2). https://doi.org/10.1921/jpts.v19i1-2.1674