Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Jeffrey A. Burr

Second Advisor

Elizabeth Dugan

Third Advisor

Mark Brennan-Ing


Almost half of all people with HIV/AIDS in the U.S. are aged 50 or older. The National Institutes of Health has called for research that explores what it means to age optimally with HIV/AIDS. This study applied the stress process framework to examine (1) the association between HIV-stigma and psychological well-being; (2) the role of mediating resources (e.g., spirituality and complementary and alternative medicine [CAM]); and (3) the role of moderated mediation by minority group status (e.g., race/ethnicity and sexual orientation).

Using data from the Research on Older Adults with HIV (ROAH) study, structural equation model (SEM) analyses were used to estimate the hypothesized relationships within a latent variable model. A series of ordinary least squares linear regression analyses examined the relationship of demographic and control variables with six well-being outcomes. A multiple-group correlational design and chi-square difference tests were used to evaluate a moderated mediation model.

Overall, the analyses showed that the model fit the data well. All of the observed variables significantly loaded on their latent factor and all paths were significant. Results indicated that spirituality and CAM use partially mediated the negative association of HIV-stigma on psychological well-being. A moderated mediation hypothesis by sexual orientation was supported, but not by race/ethnicity. Findings suggest that sexual minorities exhibit a crisis competence, a form of resilience in which they showed greater psychological well-being despite HIV-stigma, and a stronger mediation effect of spirituality, than their heterosexual counterparts.

Findings from this study suggest several methodological, practice, and policy implications. Recommendations based upon this study's findings are presented at the societal, community, and individual levels. Researchers, clinicians, and service providers are encouraged to develop interventions, and individuals aging with HIV/AIDS are encouraged to incorporate, spirituality and CAM as part of a comprehensive biopsychosocialspiritual approach to aging with HIV/AIDS.


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