What Do Social Workers Need to Serve Older People Living with HIV/AIDS?

Most people living with HIV are now ages 50 and older. These older people living with HIV and AIDS (OPLWHA) are living longer and face challenges associated with the natural aging process, in addition to challenges related to living with HIV.

HIV prevention, care and treatment to improve the health and overall well-being of OPLWHA could not happen without social workers and allied professionals. Social workers navigate every system along the HIV care continuum to ensure optimal well-being of persons living with HIV/AIDS. Critical to social work is the understanding that prioritizing the broader social determinants of health—mental health, substance abuse, housing, employment, transportation, etc.—will improve the experiences of OPLWHA.

Often, the systems providing HIV-specific care, older adult care, and those addressing the social determinants of health are siloed. Social workers have a unique opportunity to connect these systems as they often work across multiple areas and promote a person-in-environment, relationship-driven philosophy. Social work practices involve trauma-informed and strength-based approaches, a priority on meeting individuals where they are, and recognizing the unique and positive attributes that individual and community assets can play in ensuring positive changes throughout the care continuum for OPLWHA.

The Professional Association of Social Workers in HIV & AIDS (PASWHA) is a national nonprofit membership organization created in 2010 to support social workers and other professionals working in the field of HIV and AIDS. PASWHA’s mission is to serve as the lead organization that supports the professional growth and development of HIV social workers and allied professionals, promote evidence-informed practice, and advance equitable and just policies to end the HIV & AIDS epidemic.

As leaders in the field of HIV Social Work, PASWHA strives to end the HIV and AIDS epidemic by promoting social justice and equity through all forms of social work practice. PASWHA is the only national association solely representing the critical role of social work practitioners, researchers and policy makers in ending the HIV epidemic in America.

Guided by the Association’s National Social Work Strategy to End HIV and AIDS, PASWHA strives to strengthen the social work profession in its role in ending the HIV epidemic and in meeting the emerging needs of individuals and families living with and affected by HIV/AIDS. PASWHA provides ongoing professional development opportunities, advances research- and evidence-based practices, and supports advocacy efforts at national, regional and local levels, especially in areas disproportionately impacted by HIV/AIDS.

As part of its professional development and education strategy, PASWHA developed an HIV and Aging Task Force to help guide the work and develop an evaluation to determine the professional development needs for social workers working with OPLWHA. This work informed the exciting new curriculum for the Social Work Certification in HIV and Aging.

So, what do social workers need to work with OPLWHA? This article will get to the heart of this matter by answering the following questions:

1. What are the professional development needs of social workers working with OPLWHA?
2. What gaps exist for social workers working with OPLWHA?
3. What are the professional development preferences for social workers working with OPLWHA?

To help assess what social workers need to effectively be of service to OPLWHA, we emailed PASWHA members extracted from the PASWHA database. At least 177 participants enrolled in the study and met the eligibility criteria of having a social work degree (BSW, MSW, PhD or DSW) and practicing social work with OPLWHA in the United States. More than 60% (n=106) worked in nonprofit agencies, more than 70% (n=124) were female. Most participants identified as White (64%, n=113 ), followed by Black (24%, n=43 ), Hispanic/Latino (10%, n=18 ), and other (2%, n=4).

More than half (58%; n=103) had graduate degrees in social work. At least 30% (n=53) of participants have been working with older clients living with HIV for more than 16 years.

Geographically, 29% (n=51) of survey respondents are located in the Midwest, 17% (n=30) in the Northeast, 17% (n=30) in the Southeast, 12% (n=21) on the West Coast, and the remainder throughout the country with a handful also located outside of the United States.

Among participants, 41% (n=73) are married, 22% (n=39) are single (never married), 17% (n=30) are divorced, 14% (n=25) are in a domestic partnership, and the remainder are either separated or widowed.

About 60% (n=106) of respondents have a graduate degree, 32% (n=57) have a college or university degree, 6% (n=11) have some college or university, and 3% (n=5) have an MD or PhD.

All but two respondents (98%, n=173) were employed at the time they took the survey, and 95% (n=168) work full-time (more than 30 hours/week.) Almost half of respondents (46%, n=81) have a household income between $51,000–100,000, while about a quarter have a household income of $10,000–50,000 and another 20% (n=35) have a household income between $101,000–150,000.

Participants worked in several workplace settings, including nonprofit AIDS service organizations (35%, n= 62), nonprofit community-based organizations (36%, n= 64), governmental organizations (20%, n= 35), and private practice (1%, n= 2).

1. What are the professional development needs of social workers who work with OPLWHA?

Figure 1. shows the types of tasks social workers are performing in their work with OPLWHA. Most social workers are doing case management, medical social work and administrative tasks. Few social workers are performing activities in long-term care facilities, substance abuse counseling and policy/advocacy work.

Figure 1. Types of Social Work (n=173)

Table 1. shows the professional development social workers have already acquired. Most have received professional development in care and case management, assessing social support, and housing. Fewer social workers received professional development in assessing religion/spirituality, caregiving, dementia or delusion assessment. This is an important gap in existing professional development efforts.

Table 1. Professional Development Topics Already Acquired

Figure 2. shows where social workers are acquiring knowledge about OPLWHA. Conferences seem to be the most popular setting for knowledge development, with about half of the participants attending PASWHA’s National HIV & AIDS and Social Work Conference.

Figure 2. Location Where Acquired Knowledge About OPLWHA (n=168)

2. What gaps exist for social workers working with OPLWH?

To identify gaps in education, we compared social work interests with types of professional development received.

Table 2. shows that areas of high interest and low knowledge acquisition include: dementia(s) vs. delusion assessment, long-term care planning, and linking clients with meaningful work or “encore careers.” According to Marc Freedman, an encore career refers to beginning a new vocation at a later age, typically after regular retirement from a prior career. Although 82% of social workers acquired knowledge on case management, the least number of social workers were interested in the topic (20%).

Table 2. Comparing Interest in and Already Acquired Professional Development Topics

3. What are the professional development preferences for social workers working with OPLWH?

Most social workers prefer a healthy mix of in-person and technology-based professional development. Regarding online professional development, social workers preferred an equal mix of synchronous and asynchronous learning opportunities. The fewest number of social workers (60%) preferred all in-person–only learning opportunities. Figure 3 shows social workers’ learning preferences.

Figure 3. Learning Mode Preferences

Conclusion

Social workers are often the first line of help for OPLWHA. These results show that even though most social workers are performing case management, few social workers are performing activities in long-term care facilities, substance abuse counseling, and policy/advocacy work.

With the rise of OPLWHA through 2050, more social workers will be needed in these areas. Furthermore, future professional development opportunities can meet social work interests and the gaps in their current learning opportunities by including: dementia/delusion assessment, long-term care planning, and linking clients with meaningful work or “encore careers.”

Finally, these results have informed the development of the Social Work Certification in HIV and Aging. Meeting the social work preference by developing online and in-person sessions, PASHWA is using these findings to refine this exciting new certification opportunity. Social Workers can find out more about this opportunity by attending the National Conference on Social Work in HIV/AIDS in Orlando, Fla., in May 2024 or by contacting PASHWA directly at https://www.paswha.org.

Russell L. Bennett, LMSW, PhD, is executive director with the Professional Association of Social Workers in HIV & AIDS (PASWHA) and CEO of Collaborative Solutions, Inc., in Birmingham, Ala. K. Littlewood, MSW, PhD, is president with AAJ Research & Evaluation, Inc., in Seminole and a consultant with the Center for Social Innovation and Health Equity Research, Collaborative Solutions, Inc., in Birmingham, Ala. C. Spadola, LMHC, PhD, is an assistant professor at the University of Texas Arlington in Arlington, Texas.

Photo credit: BearFotos