HIV Disease in Older Adults

HIV Disease in Older Adults

The U.S. government must also do better to monitor the conditions that people with HIV experience as HIV progresses with age. With better recognition of these conditions, we can modify standards of care. This will in turn help us better understand how HIV and aging processes interact. Additionally, screening and prevention measures are available to reduce risk for NARCs, such as anal and vaginal pap smears, the hepatitis B vaccine, and reduced alcohol and tobacco intake. These measures should be broadly instituted and available for older adults with HIV.

Up to 91% of older adults with HIV deal with other medical conditions, including high blood pressure, nerve problems, hepatitis, arthritis, and depression. Many older adults receive some type of medical care for these conditions. So a significant portion of potentially affected older adults have a point of contact with a medical provider. This offers a unique opportunity for doctors and service providers to make a large impact on preventing HIV infections and assisting older adults in finding out their HIV status.

Recommendations

GMHC and ACRIA, together with SAGE and GRIOT Circle, recently held a strategy planning meeting on HIV and older adults in Washington, D.C. Hosted by AARP, the meeting included advocates, policy experts, and federal officials. Funded by the MAC AIDS Fund, this was the first wide-ranging conversation among key players in both HIV and aging circles at the federal level, but it will not be the last. A key outcome was the agreement to come together again after the issuance of a policy paper on HIV and older adults in early 2010. Given the significant differences between aging and HIV providers, just understanding how best to approach prevention and services will require the commitment of all parties. A few important recommendations emerged from the meeting.

• Our understanding of older adults with HIV and those at risk is quite limited, making it difficult to know what is needed for prevention or services. A targeted research effort should run the gamut from drug clinical trials to behavioral and psychosocial research to the development of evidence-based prevention initiatives targeted at older adults.
• More training and technical assistance for both HIV and older adults providers is needed to improve services in senior settings for those with HIV or at risk of infection. HIV providers need continuing education on what we know about older adults with HIV. Senior providers need education on HIV basics, stigma, discrimination, and other topics. A key training need is to increase the number of geriatricians generally and to increase the number with knowledge of HIV. We must also increase the number and competence of NPs, PAs, nurses, social workers, case managers, and others with regard to this population.
• There is a need for greater advocacy not only at the federal level, but at the state and local levels as well. This collaborative advocacy should be targeted at key HIV and aging allies among elected officials, as well as with the government agencies charged with funding and overseeing HIV and senior services.

In sum, legislation and funding aimed at older adults and people with HIV should focus on research, education, and collaboration, improving our understanding of this growing population and how best to meet their needs, given the realities and limitations of our existing service networks. As older adults will constitute more than one-half of all persons with HIV in the U.S. in the next ten years, the time to act is now.