HIV and Aging

By Barry Waller, Achieving Together Partner

If you had to guess, which age group would you say was the largest group living with HIV in 2017?

If you said the 45-64-year-old age group you would be correct.

We’ve all seen the headlines about the rapidly growing senior population. What is not quite as well known is the trend in the population living with HIV. HIV was originally thought of as a disease impacting young gay men. Thanks to medical advancements in the last 20 years, people are living much longer with HIV. Based on current trends, a significant number of those with HIV in the 45-64 categories will not only celebrate their 65^th birthday but are projected to live well beyond.

While advances have contributed to this positive trend, we should be aware of and plan for some of the needs of an aging HIV+ population. I would like to start a conversation about the future of HIV+ individuals as they age in Texas – specifically a conversation between those organizations providing services to seniors and those providing services to HIV+ clients. I’ll start this conversation by sharing some of what we know about the population of people who are and will be aging with HIV.

In 2018, over half of the PLWH in Texas were 45 years of age or older.

Primary challenges for the aging HIV+ population include:

• Medical care,
• Medications,
• Housing, and
• Social Isolation.

While these issues are not uncommon among the aging population in general, there may be additional concerns for people living with HIV. Let’s take a closer look at these topics.

Medical Care

A recent study of 180 HIV+ individuals over 50 years-old found that they had an average of 3.4 medical conditions occurring at the same time (comorbidities). People living with HIV also get “age related” diseases at a younger age, including cancers and coronary artery diseases. They may also experience mental impairments earlier than people without HIV.

Additionally, the healthcare system may not be adequately prepared to care for this population. The National Center for Innovation in HIV Care cites a “lack of cultural competency” among providers and an AARP survey found “significant concern” within the LGBT community with regard to healthcare.

Medication

Comorbidities (having two or more conditions at the same time) may result in individuals needing multiple physicians, which increases the risk of medication interactions. Taking multiple medications may also necessitate changes to prescriptions to minimize harmful interactions. In addition, the rising cost of medications is a concern.

Housing

A recent study found that within 10 years more than half of all middle-income seniors won’t be able to afford senior housing. Eighty percent of long-term care is provided by family members; LGBT seniors are twice as likely as heterosexual seniors to be single, three to four times more likely to be without children. Seventy-six percent of LGBT participants in an AARP survey were concerned about having adequate family/social support to rely on as they age. As a result, this population may have a disproportionate dependence on senior services, such as in-home health aides, home-delivered meals, and transportation services.

Every day I worry about where I’m going to be living.

An HIV+ Austinite in his 70s

Social Isolation

Older people living with HIV may face multiple stigmas related to ageism, sexual orientation, HIV+ status, and race. As a result, they may be reluctant to participate in the community or access available services, including medical care.

Strengths

Despite these challenges, the aging HIV+ population has acquired many strengths. Many older adults with HIV exhibit a great deal of resiliency. In addition, they are more likely to adhere to their medications than younger individuals with HIV.

We’ve been here before, we know we can’t assume ‘others’ are going to take care of this.  We also know we can do it – just need to roll up our sleeves and get at it.

LGBT Coalition on Aging focus group participant

It’s great news that people with HIV are living longer, although there are challenges to address. So, what’s the solution? A good start would be for AIDS Service Organizations and senior service providers to begin a dialogue to discuss serving this population.

One of the focus areas of Achieving Together is Collaborate, Cooperate and Coordinate Across Systems. We aspire to strengthen existing relationships and build bridges to work with new partners. Conversations between HIV service providers and those who provide services to seniors offer an opportunity to collaborate and coordinate across systems to improve support for an aging HIV+ population.    

What are the services for seniors in your community?
 How can you use this information to start conversations related to serving an aging population of people living with HIV?

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For over 36 years, Barry Waller has worked in the mental health, intellectual disabilities, physical disabilities, and aging fields at both the community and state agency levels in various administrative and management positions. He has a Master’s Degree in Social Work. As the Texas Legislature combined various state agencies, Barry went to work at the Department of Aging and Disability Services (DADS) as Assistant Commissioner over Provider Services. In this position, he managed directly administered services and various contracts with several thousand providers of disability and/or aging services throughout Texas.

Now retired, Barry spends his time working with different community and volunteer organizations. He served for nine years on the Board of Directors at AIDS Services of Austin, where he still remains as a volunteer. He has also served twice on the Board of Directors for OutYouth Austin and currently serves on the HIV Planning Council, a workgroup at the City of Austin on the City’s Age-Friendly Plan, and the Steering Committee of the LGBT Coalition on Aging.