Academic journal article Health and Social Work

Unserved, Unseen, and Unheard: Integrating Programs for HIV-Infected and HIV-Affected Older Adults

Academic journal article Health and Social Work

Unserved, Unseen, and Unheard: Integrating Programs for HIV-Infected and HIV-Affected Older Adults

Article excerpt

A fundamental reason for social workers to be able to access services through both the Older Americans Act (OAA) of 1965 (EL. 89-73) and the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 (P.L. 101-381) is social works ecological and family-centered practice models. We argue that social workers should know the rudimentary provisions of these two important pieces of federal legislation. No matter the setting or primary population, practitioners will likely meet and work with older adults who are either infected with or affected by HIV disease. Because aging and AIDS are ubiquitous in social work practice, social workers need to be more prepared to provide case management and referrals in those areas.

Another compelling reason for social workers to know something about both the aging and HIV networks is that older adults living with HIV or taking care of someone with HIV often are unseen and unheard by practitioners and policy makers. HIV case managers and counselors tend to not know about services for older Americans; similarly, gerontological workers have insufficiently explored HIV services (Anderson, 1998). Programs under the OAA and Ryan White CARE Act constitute separate systems of care. Few social workers understand the resources available in both programs and may not use the full range of options with their older clients.

Older adults with HIV can fall between the cracks of the aging and HIV services systems, which do not communicate or coordinate as effectively as they could or should. The HIV and aging networks have interfaced in some areas for two decades. Some local Councils on Aging took it upon themselves to offer home-delivered meals to people disabled because of HIV. Some AIDS services organizations have reached out to older people, and some Medicaid waiver programs have taken on programs for elderly and disabled people along with services for people with HIV. In general, however, the two networks have not often or easily intersected, resulting in a benign neglect of elderly people who are infected with HW or affected by HIV.

Specialized practitioners maybe uncomfortable in either the aging or the HW arenas for several reasons. First, social workers are not immune to ageist beliefs and stigmatizitation of HIV and may consciously or unconsciously avoid learning about another field. Second, social workers tend to be stressed and stretched thin and often can study only a limited number of issues and service systems. HIV advocates may feel that they do not have time to seek knowledge on aging, and gerontologists may not be able to keep up with the complexities of the HIV field. Third, professional and on-the-job learning tend to be narrowly focused because there is much to learn about every topic and population, and social workers are not routinely cross-trained. This article is intended to be a first step to closing this gap.


Although HIV disease has been viewed as affecting young adults and people in early middle age (Riley, 1989), individuals over age 50 with AIDS have been reported over the course of the pandemic (Ory & Mack, 1998). Throughout the tracking of HIV infection by the Centers for Disease Control and Prevention (CDC), 10 percent to 12 percent of U.S. residents diagnosed with AIDS have been age 50 and over (CDC, 2002), which translates to 90,513 AIDS cases as of December 2001 (CDC, 2002) (Table 1). This figure does not include older adults diagnosed with HIV (not yet AIDS) or those who received an AIDS diagnosis before age 50 and have "aged in" with the disease. Ory and Mack suggested that when these figures are adjusted for estimates of actual age rather than age at diagnosis, the proportion of cases 50 years and older is closer to 15 percent. (Although age 50 is not considered old, until recently CDC did not stratify AIDS surveillance numbers past that age, which is why discussions of HIV and aging in the United States must consider people age 50 and older. …

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