Hiv/aids and Older Adults: A New Lease on Longevity

Article excerpt

HIV HITS 100,000, AGES 50-PLUS

By DAVID E. VANCE and DAVID W. COON

The test has come back: "You are positive." These frightful words weren't even conceivable by many Americans who are now infected with HIV. Imagine hearing' this message for yourself. What would you do? How would you respond? A flood of concerns would undoubtedly race through your head: How long do I have? How do I handle my insurance (or lack thereof)? Where do I get my medications? Will I experience side effects from them? Do I tell my family and friends? If not, how do I keep this a secret but keep my sanity? Will I be able to be intimate with someone again? Do I deserve this? Does anyone deserve this?

Now imagine going through this scenario at age 50,60,70. This fact may be hard to believe, but HIV is affecting more older adults than ever before. The United States is at the point in the HIV/AIDS epidemic that HTV studies and gerontology are crossing paths, a trend expected only to continue.

FACTORS DRIVING GROWTH

According to the Centers for Disease Control and Prevention, the number of adults ages so-plus with HIV/AIDS rose from 65,655 cases in 2001 to 104,260 cases in 2004-an increase of 59% in only three years. Several factors are driving this growth. As the U.S. population ages, the sheer number of midlife and older adults with HIV will increase. In addition, as HIV-positive younger adults age, the proportion of midlife and older adults living with HIV/AIDS will expand. Moreover, midlife and older adults also are becoming infected in later life. Unfortunately, very little HIV prevention education is targeted to older adults. Why? Culturally, many still consider HTV to be a disease of the young gay or bisexual male or IV-drug user. Consequently, older adults may be more at risk for infection because they are not normally considered to be a vulnerable population.

In addition, because people in midlife or older are past their reproductive years, many sexually active older adults may be less inclined to use condoms. Furthermore, due to the thinning of vaginal and anal membranes that accompanies the aging process, older adults may experience more tearing during sexual contact, making them even more susceptible to infection.

Thanks to the introduction of protease inhibitors in 1996, the mortality rate from HIV has sharply declined, transforming the disease into a chronic, more manageable condition. Protease inhibitors, in combination with other antiretroviral medications, have often proved to be a strong defense against viral production and mutation. These newer drug combinations allow the body to reconstitute the immune system, restoring the individual to health. Although more research is needed to understand the role protease inhibitors play in the lives of HIV-positive older people, these drugs have clearly allowed growing numbers of men and women to continue to age with HIV.

SUCCESSFUL AGING POSSIBLE

The growing wave of older HIV-positive people calls for gerontologists, healthcare professionals and policymakers to help promote successful aging for adults living with HIV as a research, practice and policy priority. Though limited, the available research on those ages 50-plus with HIV makes clear that successful aging is possible for individuals who are infected. Equally clear, however, are the notable challenges and unknowns along the way. As people age, complications may occur due to HIV. Likewise, for those living with HTV, complications will arise due to the processes of aging. The synergistic effects of aging with HIV are novel and require additional study, insight and planning to help meet the needs of midlife and older adults with HIV and the concerns of their loved ones.

The forthcoming spring-summer 2007 issue of OutWord, the newsletter of the American Society on Aging's Lesbian and Gay Aging Issues Network, will focus on HIV among a specific population of older adults-men who have sex with men (MSM). …