Priority Policy Recommendations
Decisive, immediate, and simultaneous policy adaptations are required across multiple fronts:
Medical and Behavioral Research
The National Institutes of Health (NIH) should make HIV and aging a top research priority, utilizing new and existing resources to understand this population better. In so doing, the Office of AIDS Research should actively plan, budget, and guide trans-NIH efforts to focus efficiently and effectively on older adults with HIV, most notably (but not exclusively) with the National Institute of Allergy and Infectious Diseases, National Institute on Aging, National Institute on Drug Abuse, National Cancer Institute, National Institute of Neurological Diseases and Stroke, National Institute of Mental Health, and the Center for Scientific Review.
NIH should promote and fund research to:
- Investigate the extent to which the onset and course of age-related morbidities differs between HIV-positive and -negative older adults.
- Determine the association between barriers to access and health outcomes.
- Understand better the unique biological and psychosocial characteristics of older adults with HIV and determine how they affect health outcomes.
- Understand better how HAART interacts with aging bodies and treatments for other conditions.
- Determine the association among and between mental health disorders, substance use, low-functioning social networks, and unprotected sex among older adults.
- Determine whether the factors precipitating depression differ between HIV-positive and HIV-negative older adults, and whether the course and severity of depression is similar to that of the general population.
- Assess which lifespan factors (e.g., mental health issues, substance use, etc.) contribute to HIV risk and how best to address these factors.
Integrated Service-Delivery Demonstration Projects and Structural Interventions
The Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration, among others, should:
- Fund capacity building, technical assistance, and training for AIDS services organizations, faith-based organizations, community-based organizations, lesbian/gay/bisexual/transgender (LGBT) organizations, and aging services providers to integrate evidence-based over-50 HIV prevention, treatment, and care programs into larger organizational, cultural, and programmatic frameworks.
- Fund/conduct Special Projects of National Significance grants or other demonstration projects to develop effective evidence-based capacity building, technical assistance, and training, not only among health care workers but for all HIV and senior services providers, to reduce HIV and LGBT stigma and discrimination and to improve knowledge and understanding of the prevention and care needs of older persons living with or at risk for HIV.
The Department of Health and Human Services and the Department of Education, among others, should:
- Urge the development of gerontology, social work, and other curricula at colleges and universities, as well as medical schools, that train aging specialists and service providers in the particular characteristics and needs of the over-50 HIV-positive population and those who are at-risk.
The CDC should:
- Adjust its epidemiological surveillance systems and requirements to collect and deliver complete age and risk category data for both HIV incidence and prevalence/total cases.
- Fund research to develop new (or adapt existing) evidence-based HIV/STI behavioral interventions targeting older adults at risk for HIV and older adults with HIV, particularly for the most at-risk populations, such as women of color and, especially, older men who have sex with men.
The Administration on Aging should:
- Expand the definition of "vulnerable populations" to include those with HIV or a larger group of "specific health minorities" that could include seniors with HIV and other diseases.
- Encourage service systems to become more flexible and responsive to the needs of older adults with HIV, e.g., consider functional status and need in addition to chronological age in determining eligibility for services.
The SSA should:
- Amend its disability eligibility criteria to take into account improvements in treatment (the last revision was in 1993) and to allow for greater flexibility for those who are able to work only intermittently.
Older HIV-positive adults will soon be the majority of Americans with HIV, and more people over age 50 are being diagnosed every year. Yet the U.S. research agenda, the health care system, and aging and HIV service providers have only begun to respond to this reality, and our systems remain quite unprepared to deal with these emerging issue. In this report, ACRIA presents specific policy recommendations to address the needs of older adults with HIV and those at highest risk of contracting the virus. These recommendations are by no means exhaustive, but constitute vital first steps. We urge immediate adoption of these recommendations and stand ready to do our part to understand this population better and to ensure quality care and services for older adults with HIV and those at risk.
Daniel Tietz is the executive director of ACRIA.