The aging face of HIV

By DANIEL TIETZ

As we convene from around the world to discuss the future of HIV prevention and treatment here in Washington, we must recognize that AIDS is not confined to young people. Thanks to improved anti-retroviral drugs, HIV is increasingly a chronic, manageable disease for those with access to care and treatment. The CDC has estimated that within the next few years more than half of all Americans with HIV will be age 50 or older. In New York City alone, as of 2010, more than 43 percent of people with HIV are in that age group. The face of HIV is greying, which brings with it its own set of challenges. Here are just a few of the stories of the older adults with which my organization, ACRIA, works.

Douglas says: “I’m dealing with HIV, depression, kidney cancer, high blood pressure, lipodystrophy, and now my doctor tells me my cholesterol is going up.” He acknowledges that he hasn’t always dealt well with his conditions, sometimes refusing to take all his drugs (numbering in the double digits) when he gets tired of doing so. He has yet to tell his doctor about this, and is unable to work due to the side effects of his medications.

David, an African-American man, remained HIV negative at age 50. But, as he says, “I could count on both hands the number of people I wanted to invite to a birthday bash,” most of his past friends and partners having succumbed to AIDS before they turned 30.  He spent his 50th birthday alone at home with his godson. Having been burned out by the loss of most of his gay peers, he has become a “reclusive, mature gay man.” He lives a life of “self-imposed isolation,” suffering from poor eating habits, strange sleeping hours, and incontinence. He chooses not to date because he deems explaining these issues not worth the hassle.

These are just a couple of examples — and each one illustrates a real problem. Douglas, like many older adults with HIV, has not only HIV but also a variety of other medical conditions, some of which may be more challenging now than dealing with HIV. David is HIV-negative, but he faces the same problem of isolation that many of those aging with HIV face. Many older persons, moreover, wrongly assume that AIDS is a young person’s disease, and that their age can somehow protect them.

All of these problems have solutions, but only if health and services providers and policymakers alike work together to solve them. Primary care providers whose patients include older adults with HIV must be trained to ensure that they are prepared to help patients confront their multiple chronic illnesses, and that they adhere to a treatment regimen that will keep them in the best possible health, as difficult as it may be. That includes addressing depression and other mental health issues, which our research has found to be the most consistent predictor of non-adherence to HIV treatment.

It also includes helping patients to discuss risky behaviors in a nonjudgmental space; if patients feel they will be subjected to harsh criticism, rather than advice, for the slightest bit of disclosure, they are less likely to discuss such behavior openly, rendering it all the more difficult to reduce. ACRIA has created an ad campaign based on this non-moralistic approach with the slogan “Have Sex? Age is Not a Condom.” And as David’s story shows, these older adults are more likely to become depressed when they’re isolated and lack social support networks. Without intervention, they’re unlikely to remain in good health. These adults need opportunities to socialize with their peers — and we need to endeavor to ensure they have them.

These are not the only challenges that older adults with HIV face. But these issues, and others, are why this week, at the International AIDS Conference in Washington, D.C., ACRIA, SAGE and GMHC, together with several international partners, will host a satellite conference on HIV and aging, sponsored by the MAC AIDS Fund. At this conference, we will describe and address HIV and aging as a truly global issue. Scientists, health and services providers, activists, policy makers, and older adults with HIV will speak, as will a panel of older adults with HIV. Together, we are working to create a world in which AIDS is universally recognized as a disease that people over 50 get — and in which we unite to ensure that they get the care and services they need.

Daniel Tietz is executive director of AIDS Community Research Initiative of America. Reach him via acria.org.