Prepare for More Seniors with HIV

By the end of 2010, more than 630,000 people in the United States had died from AIDS, according to the Centers for Disease Control and Prevention (CDC). At the end of 2009, more than 1.1 million people in the U.S. ages 13 and older were living with HIV. Some 80,000 of these people have been living with the disease for decades, and they are known as long-term survivors. Thursday, June 5, is National HIV/AIDS Long-Term Survivors Awareness Day.

Young people may not remember the deadly virus that ravaged communities around the world in the 1980s. Today, HIV is a manageable disease. In fact, a 20-year-old white gay man in the U.S. diagnosed with HIV today can expect to live as long as any other American man.

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By next year, experts expect that half of all Americans living with HIV will be 50 or older. By 2020, that number will rise to 70 percent. Indeed, the median age for someone with HIV in the U.S. today is 58.

A report released this week by three HIV and elder care advocacy groups has called on the U.S. government to prepare for and adapt to this new population of seniors living with HIV/AIDS. They want this topic addressed next year at the White House Conference on Aging, and they offer eight recommendations for improving the health and well-being of older adults with HIV.

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1. Put HIV on the Agenda

Topping the list compiled by the Diverse Elders Coalition (DEC), the AIDS Community Research Initiative of America (ACRIA), and Services and Advocacy for GLBT Elders (SAGE) is a request that the White House put the issue of HIV and aging on the agenda for its once-in-a-decade aging conference, scheduled for 2015. The discussion needs to center on how to reach this population and identify their needs.

Robert Espinoza, senior director of public policy and communications for SAGE, told Healthline that older people at risk for HIV often have a different set of circumstances than other at-risk or infected groups.

“Some older people become sexually active later in life after a partner or spouse passes away,” he said. So they are less likely to have tools and coping skills for safer sex.

2. Identify Those with Special Needs

The report also says that seniors with HIV need to be designated a population of “Greatest Social Need” if and when the U.S. Congress reauthorizes the Older Americans Act of 1965.

Many older gay men, in particular, grew up in a bygone era of extreme discrimination and stigma. As a result, they may not disclose their sexuality to their doctors, so the doctors won't know they are at risk.

In the end, these men are often diagnosed with HIV and AIDS concurrently because they don’t get tested until symptoms appear, Espinoza said. This can be further complicated by the fact that some symptoms of HIV resemble symptoms of aging and so go unchecked.

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3. Test, Test, Test

Advocacy groups urge Congress to allocate more funds to the CDC so that the agency can devise campaigns aimed at the elderly that encourage them to get tested for HIV.

There is a myth that older people don’t have sex, Espinoza said, but they do. Even though the CDC recommends annual HIV testing through the age of 65, many doctors don’t adhere to this guideline.

Getting older people tested and into treatment would not only save the healthcare system money in the long run, Espinoza said, but also help avoid a public health crisis.

4. Track HIV Data

The CDC and other government agencies should focus on tracking HIV (called disease surveillance) among people ages 50 and older. 

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5. Expand Medicaid Coverage

The report also suggests expanding Medicaid coverage as outlined in the Affordable Care Act (ACA) so that people younger than 65, who don’t yet qualify for Medicare, can get treatment regardless of their ability to pay.

6. Increase Funding for the Ryan White Program

Advocates are pushing for more money for the federal Ryan White program, which “has been essentially flat-funded for the last decade despite the ongoing severity of the epidemic, especially among older people,” according to the report.

This is particularly important, the report argues, in states where Medicaid has not been expanded. Those states include Louisiana, Florida, Georgia, Mississippi, and Texas, where HIV infection rates are on the rise.

7. Fund NIH Research on HIV

The report calls for increasing support to the National Institutes of Health (NIH), to fund more research on HIV and aging among diverse populations.

“On average, adults age 60 and older have more than two chronic diseases,” the report states. One ACRIA study found that the most common conditions among people 50 and older with HIV include depression, arthritis, hepatitis, neuropathy, and high blood pressure.

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8. Create Better Clinical Guidelines

Lastly, the advocacy groups say the U.S. Department of Health and Human Services must develop treatment guidelines specifically for the care of older people with HIV.

More resources on HIV and aging can be found online at the National Resource Center on LGBT Aging.