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The frequency of HIV infection is increasing in men who have sex with men (MSM) aged 40 and older yet little is known about factors that influence their risky sexual behavior, such as sexual positioning. The goal of this study was to examine multi-level factors associated with unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI) in MSM aged 40 and older. A community-based sample of 802 self-identified MSM aged 40-94 years was recruited through targeted outreach from community venues (e.g., bars, social events) in South Florida and completed an anonymous pen-and-paper questionnaire. Logistic regression showed that younger age (i.e., aged 40-59; odds ratio [OR]=0.6; 95% confidence interval [CI]: 0.4, 0.9), HIV-positive status (OR=2.8; 95% CI: 1.9, 4.0), drug use (OR=2.6; 95% CI: 1.7, 3.7), a larger number of male sexual partners (OR=1.7; 95% CI: 1.3, 2.3), and lower scores on internalized homonegativity (OR=0.9; 95% CI: 1.0, 1.0) were associated with higher risk for URAI. Younger age (OR=0.4; 95% CI: 0.3, 0.6), HIV-positive status (OR=1.5; 95% CI: 1.0, 2.1), drug use (OR=1.6; 95% CI: 1.1, 22.3), Viagra use (OR=1.7; 95% CI: 1.2, 2.4), larger number of sexual partners (OR=2.1; 95% CI: 1.6, 2.9), and holding views more characterized by high optimism concerning the future (OR=1.1; 95% CI: 1.0, 1.1) were associated with higher risk for UIAI. These results provide useful information that may guide the development of tailored prevention interventions to reduce the growing rates of HIV among MSM aged 40 and older.

The Cambridge Mental Disorders of the Elderly Examination (CAMDEX) was developed by Roth, et al (1986) to assist in the early diagnosis and measurement of dementia in the elderly. In this study the CAMDEX was administered to a mixed group of independently diagnosed elderly psychiatric patients and control subjects in the United States. The CAMDEX was found to have a high interrater reliability with a mixed group of clinicians of varying backgrounds. The diagnostic scales and the cognitive section of the CAMDEX demonstrated considerable promise in distinguishing between independently diagnosed populations of depressed, demented, and normal subjects. The results suggest comparability between samples of subjects in England and the US, and that the CAMDEX is a promising instrument for use in both research and clinical settings.

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HIV-related stigma has been identified as a barrier to HIV testing and prevention efforts internationally and nationally. Although the prevalence of HIV/AIDS is rapidly increasing in women aged 50 and older, little is known about the HIV-stigmatizing behaviors in this underserved population. In this exploratory analysis we investigated the influence of self esteem, sensation seeking, self silencing, and sexual assertiveness on the HIV-stigmatizing behaviors in 572 women aged 50 to 93. The variables considered in this analysis included subscales for the variables self silencing (Externalized Self Perception, Care as Self Sacrifice, Silencing the Self, Divided Self) and sexual assertiveness (Information Communication, Initiation, Refusal). Contributing predictive variables in the final model included: Self esteem (beta = -.190, t = -4.487, p = .000), Care as Self-Sacrifice (beta = .125, t = 2.714, p = .007), and Silencing the Self (beta = .164, t = 3.290, p = .001). Initiation (beta = .108, t = -2.619, p = .009) and Refusal (beta = -.091, t = -2.154, p = .032). Implications for social work and health perception regarding HIV prevention in midlife and older women are considered. Development of age- and gender-appropriate strategies assisting women in addressing HIV-stigma and related influences are addressed.

This study examined the correlates of psychosocial and behavioral factors on loneliness in midlife and older gay and bisexual men in South Florida. A community-based sample of 802 self-identified gay and bisexual men ages 40 to 94 years completed standardized measures of life orientation (optimism versus pessimism), internalized homonegativity, coping self-efficacy, and loneliness. Multivariate modeling successfully explained 45% of the variance in loneliness, which was significantly related to life orientation, coping self-efficacy, internalized homonegativity, and finding partners on the Internet (F = 96.140, df = 6, p < .001). The emphasis on skills building to increase coping self-efficacy and optimism and addressing the effects of internalized homonegativity may have lasting effects in reducing loneliness in older gay and bisexual men and thus improving their mental and physical well-being.

This article focuses on the importance of a practitioner's awareness of ageism, motivation, and countertransference in working with elders with dementia. These factors have the capacity to significantly affect a professional's performance. Additionally, they may also affect the type and quality of services a memory-impaired client receives. Ageism is discussed at the micro, mezzo, and macro level, and practitioners are urged to develop an increased awareness of the effects of ageism on client/service options and as well as practitioner's beliefs. Monitoring professional motivation and being aware of countertransference are important considerations in practitioner-client relationships. Professionals are encouraged to incorporate personal introspection and consultation or supervision to ensure that clients receive the most appropriate service available. Case examples are provided to illustrate concepts.

Alzheimer's disease (AD) does not respect the boundaries of ethnicity or culture. Diverse ethnocultural groups adapt to the stresses of AD in their own unique fashion. As the attitudes, values, help-seeking and coping behaviors vary from one individual to another, so also does variation exist among the diverse ethnocultural groups. This paper will review current literature regarding several ethnocultural groups, as well as common attitudes, values, helpseeking and coping behaviors. Skills, values, and knowledge for the ethnoculturally-sensitive practitioner are discussed. Finally, case examples are cited.