Canada: When HIV Moves Into Nursing Homes

AIDS experts are increasingly concerned about the prospects of the cohort of gay men who have lived for many years with HIV and now are facing their middle-age or senior years. Many are growing old at a rate 15 or 20 years faster than their uninfected peers and are struggling to cope with age-associated physical and mental ailments. Researchers are studying whether these are the result of the disease itself, the medications used to treat it, or the breakdown of the immune system.

"It's not going to be a pretty picture. Most people are alone and suffering with these complications," said Sean Rourke, executive director of the Ontario HIV Treatment Network. "The health care system and the long-term care system just aren't designed to handle this, not to mention the stigma and other issues that come into play from being gay."

Casey House, Canada's first free-standing HIV/AIDS hospice, is working to help. Representatives have visited nursing homes to educate staffers in the hope of alleviating the stigma and fear confronting residents with HIV. "I think the experience in long-term care is that really strong homophobia exists and [so does] a really strong fear of transmission," said Karen de Prinse, chief nursing executive at Casey House.

Rourke is researching HIV's toll on the brain. About half of longtime survivors experience symptoms like depression and forgetfulness. In rare cases, HIV's attack on the brain breaks down social filters, leading to erratic and inappropriate actions that make it very difficult for patients to live among the general population of nursing care facilities.

"It's not always possible to integrate people with specific needs in with the frail elderly," said Christina Bisanz, CEO of the Ontario Long Term Care Association, which is asking the province for a 2 percent budget increase to cover its current costs.

Casey House, where more than half of residents are over age 50, and 30 percent have HIV-related dementia, has proposed a day-health program and a downtown facility that would serve 200 HIV/AIDS patients, in particular offering programs to help them stay healthy at home for as long as possible.

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