by Mark Brennan-Ing, Director for Research and Evaluation at ACRIA and the ACRIA Center for HIV and Aging.
The year 2015 marks a watershed moment in the HIV epidemic.
The Centers for Disease Control and Prevention (CDC) estimates that this year, fully half of those aging with HIV will be over the age of 50. As we reach this benchmark, preparations are underway for the 2015 White House Conference on Aging (WHCOA), which may represent the first WHCOA where the issue of HIV and aging will be addressed.
Two of this year’s WHCOA themes, healthy aging and long-term services/supports, are particularly germane to those aging with HIV, the virus that causes AIDS. The aging of this epidemic is largely due to successful anti-retroviral treatments that have extended life expectancy to those infected, including older adults, to near normal levels. However, many aging with the virus experience multiple age-related comorbidities earlier than those not infected with HIV. Managing multimorbidity and its implications (multiple prescriptions with the risk of polypharmacy, screening and treatment for multiple disease conditions, etc.) represents a challenge to healthy aging in this population.
Multimorbidity also has implications for long-term services and supports as many aging with HIV lack the informal social network resources that provide caregiving support. It is also important to remember that those aging with HIV face myriad issues that can impact healthy aging and long-term supports/supports, including stigma, discrimination, poverty, racism, and homophobia.
The disproportionate impact of HIV on persons of color is evident among older adults. According to the CDC, in 2010 Blacks/African Americans accounted for 46% of HIV infections among those over the age of 50 although they account for approximately 13% of the U.S. population. Older Blacks/African Americans had the highest rates of HIV in the U.S. population (41.6), followed by Hispanics (15.4), as compared to a rate of 3.9 among older Whites in 2010. Sexual minorities, namely gay, bisexual and other men who have sex with men, accounted for 59% of those living with HIV among older adults, yet they represent only 2-3% of the population. When these often stigmatized and marginalized identities intersect, such as among older gay African American men, the challenges of aging with HIV are magnified.
ACRIA, along with our colleagues at SAGE and the Government Relations Office of the American Psychological Association, have been meeting and providing input to WHCOA 2015 in order to insure the voices of those aging with HIV are heard. Given the state of gridlock in Congress, it is unlikely that new legislation will emerge any time soon to address WHCOA 2015 issues, including the needs of those aging with HIV. For example, we are still waiting for reauthorization of the Older Americans Act which provides vital funding for programs assisting older adults such as senior centers or nutrition programs. Consequently, our advocacy on the issues of HIV and aging have focused on non-legislative remedies to address healthy aging and long-term services and supports for this population. These include the establishment of clinical guidelines for the medical care of those aging with HIV from the Department of Health and Human Services (HHS), and asking that the HHS Office of HIV/AIDS and Infectious Disease Prevention (OHAIDP) convene a meeting with the Substance Abuse and Mental Health Services Administration (SAMHSA) to address the behavioral health issues, like depression, that affect older adults with HIV at three to five times what is observed in the general population.
Despite the legislative headwinds it is imperative that we continue to advance the cause of optimal aging for older adults including those with HIV. Since the theme of this year’s Older Americans Month is, “Get into the Act,” I’d encourage anyone reading this to get involved, advocate, and effect positive change to better address the needs of our growing and aging HIV-positive populations.
The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.