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The number of people ages 50 or older living with HIV in the United States is increasing. Yet, few older adults see themselves at risk of infection. This study examines the heuristic reasoning that low income, minority adults, ages 50 or older use in calculating the likelihood of infection. The data are drawn from face-to-face interviews with a sample of 134 African American and Latino residents, ages 50 to 86, living in low-income housing in Chicago, Illinois, and Hartford, Connecticut. Results show that nearly half of the study's participants thought themselves to be at some level of risk for HIV. In self-assessing their risk, they relied on seven heuristic categories: self-imperilment, social imperilment, fate, incidental contact, situational safety, medical iatrogenesis, and self-protection. These findings extend our understanding of how individuals make sense of their likelihood of experiencing a major health threat and provide insight into more effective HIV prevention programming for older adults.

Hospice organizations are assailed by stiff competition, ever-rising costs, limited funding, and policy changes. Do such pressures stifle the high quality of care these organizations strive to provide? As a case-in-point, we draw from the mid-1990s accounts of caregivers at a nonprofit hospice in a Midwestern city in the United States. We maintain that economic pressures drive organizational restructuring, which then weakens working conditions and, thereby, weakens the staff-client relationship. We discuss effects upon worker behaviors, the worker-client relationship, and client care. This ethnographic case study signals the need to closely examine the threats that current economic and organizational pressures in the United States may pose to the quality of hospice care.

Despite the rising number of cases of HIV in adults over age 50, older persons rarely are considered to be at risk for HIV/AIDS, and even though they may be involved in risky behavior, such as unprotected penetrative sex, they may not consider themselves vulnerable to becoming infected. Informed awareness of risk is essential to making positive decisions about adopting preventive measures. We examined demographic, sociobehavioral, and contextual factors that predict urban, low–income older adults’ perception of HIV/AIDS risk. Logistic regression results from 398 residents aged 50–93 living in six buildings in two American cities found that males, younger participants (aged 50–61), those living in higher risk buildings, and those who worried more about contracting HIV/AIDS were more likely to perceive themselves to be at HIV/AIDS risk. Findings accounted for 32% of the variance and the prediction success rate was 72%. Results point to the importance of considering sociodemographic characteristics and environmental (contextual) factors as they influence heuristic decision making in understanding HIV/AIDS risk perception among low–income urban older adults and when designing HIV/AIDS education and intervention strategies targeting this population. Perception of risk for HIV/AIDS, defined for the purposes of this article as individuals’ subjective perceptions of their own likelihood of contracting the virus, has interested both researchers and interventionists because of the centrality of risk perception to health beliefs, and cognitive–behavioral and social learning models of health behavior (Ajzen & Fishbein, 1980; Bandura, 2001; Prochaska & DiClemente, 1986; Rogers, 1983). These models presume that the individual’s perception of risk is a necessary antecedent to self–protective changes in behavior. According to these models, increased knowledge and awareness of the dangers of HIV infection through personal behavior motivates individuals to select self–protective or less risky actions (e.g., Catania