HIV and Aging: Challenges for the Fourth Decade of HIV

By Nathan L. Linsk

HIV & Aging Blog Series

Click below to read additional articles in this series from the LGBT Aging Issues Network.

Success with HIV Provides an Opportunity for Leadership
By Stephen E. Karpiak

Identifying Challenges in HIV/AIDS Prevention and Management at the Sixth Annual National Conference on HIV/AIDS and Aging
By James P. Campbell

Research Note: Health Disparities Among LGBT Older Adults Living With HIV 
By Karen I. Fredriksen-Goldsen and Charles A. Emlet

Research Note: Older Adults Living With HIV/AIDS in Ontario, Canada
By David J. Brennan and Charles A. Emlet

Research Note: New Boston Study on HIV/AIDS Packed with Over-50 Info
By James Campbell

Advocacy in Action: LGBT Elders Take Pride!
By James P. Campbell

Aging and HIV: An Overview of Neurocognitive Concerns
By Kevin J. Kukoleck

HIV and Aging Resources 
By Ken South, Hope Barrett, Katja Heinemann and Naomi Schegloff

One unrecognized challenge in the fields of aging and HIV is the confluence of the two: the emergence of older adults as a significant and quickly growing part of the HIV population. Recent Centers for Disease Control (CDC) data indicates that one in every six HIV infections occurs in those older than 50, and that by 2015, half of all people living with HIV in the United States will be older than 50.

These statistics only outline the story, however. The impact of HIV on the older LGBT community has been critical in the past 30 years of the epidemic. Today’s LGBT elders were in the center of the storm of fear, stigma and death that decimated the gay men’s population in the 1980s and early 1990s. Many were caregivers, became widowed, lost lovers or had their own health decline. All had to confront HIV prevention and a change in sexual patterns.

But the percentage of those with HIV who were older than 50 varied dependent upon location, hovering for many years around 10 to 11 percent of the overall epidemic. Consistently more than half of the new reports of HIV have been among “men who have sex with men,” a construct configured by the CDC to describe a population that doesn’t always identify as gay, where disclosure issues and stigma have remained challenging.

In short, HIV has been accompanied by fear, health disparities, loss and more recently successful life extension with effective therapies. Now the issue has become: What does it mean to live for upward of 30 years with an infectious and stigmatized illness, often detached from a supportive community?
In the related AgeBlog articles, we review current information, research, advocacy and educational efforts related to the HIV epidemic as it enters its fourth decade. Once thought to be a terminal disease of the young, HIV risk and the need for care, support and prevention now co-exist with other chronic illnesses of aging.

As Stephen Karpiak points out, lessons from the recent ROAH (Research of Older Adults with HIV) and other studies demonstrate that we have opportunities to lead by example during the coming years of the burgeoning elder population as we find ways to care for elders who are HIV-infected and have fragile social networks. James Campbell, who has been active in education and advocacy through the New England Association on HIV over Fifty and its national counterparts, provides a summary of the recent national meeting on HIV and Aging in Boston, and addresses advocacy efforts and a recently released study on LGBT issues in the Northeast.

Other research highlights how the issues of older adults and HIV are getting attention in the United States and Canada. Karen Fredriksen-Goldsen and Charles Emlet describe Caring and Aging with Pride, the first national project to examine LGBT aging and health. It identifies significant health disparities among LGBT older adults living with HIV. Among this sample of LGBT older adults, 9 percent disclosed their HIV status, and that cohort tended to be racial and ethnic minorities with lower income and less education compared with those identified as HIV-negative. They report poorer health, greater challenges obtaining healthcare and more social isolation. Almost two thirds are sexually active, and more likely to smoke tobacco or use recreational drugs. In short they are more at risk for health and social problems. The Boston study echoes these findings.

Brennan and Emlet studied HIV-positive older adults in Ontario, examining mental health and stigma issues. They found protective factors related to stigma, such as feelings of mastery and informational support, while stigma was higher when the diagnosis was more recent or the patient was less able to cope. Gay and bisexual men in their sample reported higher mental health resiliency than women, which was increased when they were well-informed about treatment and supported emotionally.

In short, while we are beginning to have some insight into the physical, social and emotional aspects of living with HIV in later years, studies are few about LGBT-related issues, and what we do know if of great concern. A clinical note by Kevin Kukoleck, who highlights how Minor Cognitive Motor Disorder and HIV Associated Dementia are particularly challenging in elders, parallels these studies.

There is also a resource list on AgeBlog. Recently the American Academy of HIV Medicine (AAHIVM), the American Geriatrics Society (AGS) and the AIDS Community Research Initiative of America (ACRIA) released the first clinical treatment strategies for managing older HIV patients: The HIV and Aging Consensus Project: Recommended Treatment Strategies for Clinicians Managing Older Patients with HIV. These are mostly consensus guidelines based on expert clinical knowledge by geriatricians and HIV specialists, and may help fill the gap in addressing how to provide clinical care to older HIV-infected adults.

Two media projects are also presented in this list, Aging POZitively, a short video suitable for broadcast and teaching that shows the lives of three HIV-positive older adults, as well as a media project, The Graying of AIDS—Stories from an Aging Epidemic, which is an ongoing web-based resource compiling personal narratives that explore the challenges and resilience experienced by older adults confronted with HIV.

Nathan L. Linsk, Ph.D., is professor of social work, Midwest AIDS Training and Education Center, Emeritus, Jane Addams College of Social Work, University of Illinois at Chicago.

This article is brought to you by the editorial board of ASA’s LGBT Aging Issues Network (LAIN).