HIV and Aging — A Report on NYC

The U.S. Centers for Disease Control and Prevention (CDC) estimates that more than a million adults and adolescents are living with HIV in the United States. New York City, the epicenter of HIV, has the largest amount of diagnosed persons in the United States. The HIV/AIDS time line began in July 1981, when The New York Times reported an outbreak of a rare form of cancer among gay men in New York City. This ‘cancer’ was identified as Kaposi’s sarcoma, a disease that later became known as HIV/AIDS. Emergency rooms in NYC began to see more and more seemingly healthy young men with flu-like symptoms and a rare form of pneumonia. This began what today is one of the biggest health concerns in modern history.

According to a study made by AIDS Community Research Initiative of America (ACRIA), almost 27 percent of all people living with AIDS in the United States are over 50 years old. In New York City this number goes up to 35 percent. Thanks to research and the introduction of highly effective antiretroviral therapy (HAART), mortality rates and increased life expectancy for people living with HIV and AIDS is higher than ever. Soon we will see a large number of senior citizens with HIV and AIDS. There are three groups of older adults with HIV, the newly infected, the newly diagnosed and the aging individual/longtime survivor. These groups have different but overlapping medical and psycho-social needs.

Research has demonstrated that older adults and seniors with HIV or AIDS face multiple forms of discrimination. Not only do they face the everyday discrimination everyone with HIV and AIDS confronts, but they also have to deal with discrimination related to their age and their health care. For example, a lot of physicians do not perceive older adults to be at risk for HIV infection; and therefore they are less likely to be tested for the virus. In fact, a study of people between the age of 60 and 79 years old who had died in a long-term healthcare facility found that five percent were HIV antibody positive although none had been diagnosed with HIV.

Seniors in the context of HIV and AIDS have somewhat become invisible. They are rarely targeted in HIV prevention campaigns and therefore, they may not realize that their behaviors can put them at risk for HIV infection.

Some two out of three HIV infected older adults in NYC suffers from depression. Depression for older people can be particularly destructive. Caregivers often fail to recognize the symptoms of depression in the elderly; it is often seen as a characteristic of aging rather than an illness. Loneliness and HIV related stigma are two major reasons for the high numbers of depression among HIV positive older adults.

Even though nations and individuals have made progress in treating this condition, HIV and Aids is still highly stigmatized. A lot of older adults feel ashamed and guilty about their condition and don’t feel comfortable telling their family and friends. We can speculate that HIV and AIDS are often related to sex and drugs which may make some people uncomfortable and they would prefer not being associated with it. The study made by ACRIA showed that fewer than half told all their family members and only one-third told their friends that they were HIV positive. Older adults and seniors grew up during a time when discussions about sexuality were considered improper or vulgar; one simply did not talk about sex in the same way that we do today. Some individuals who chose to tell friends and family felt that the ignorance about how HIV is spread still is a problem. After they revealed their illness some felt that people around them would for instance stop touching them and reject them. For example, one person said that after revealing his illness to his family, they would give him plastic plates, knives and forks. Some of these problems even occur within health clinics.

What can be Done?
It is essential that researchers start conducting more research targeting the older population. Many people with HIV infection are now living long enough to experience HIV as a chronic illness. More research is needed on HIV/AIDS and aging, so that we can understand the interaction and overlapping with age-related symptoms and HIV. We need to change the knowledge level and attitudes towards HIV and aging. To prevent new infected cases, we need to start campaigns that specifically targets older adults. Physicians must challenge the myths and start asking older patients about their sexual activity. Doctors must not overlook the possibility that older people are at risk for HIV. If we can do this, I think we come a long way.

S.Klemetti@globalaging.org

Copyright © 2011 Global Aging