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Older Adults and HIV: A Special Report and Action Plan

By Daniel Tietz

November 2010

Table of Contents


Aging and HIV: An Overview

By 2015 a majority of people with HIV in the United States will be over age 50.1,2

This population is growing in both size and complexity. ACRIA's landmark study, Research on Older Adults with HIV (ROAH)3 brings into sharp relief the emerging medical and psychosocial challenges confronting older adults as they age with HIV. Challenges arising from the early onset of age-related morbidities, high levels of depression, and low-functioning social networks are compounded by a service delivery system frequently hampered by the stigma and discrimination associated with homophobia, ageism, and HIV-phobia.4

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To ensure that older adults with HIV are able to lead healthy and full lives and remain actively engaged in their communities, researchers, providers, service organizations, and policymakers must examine their assumptions about what will soon be the majority of Americans with HIV.

For example, how should health and service providers respond to a 58-year-old with HIV who presents physical or mental health conditions usually associated with people in their 70s? How should the Social Security Administration (SSA) treat the disability status of a 61-year-old with HIV whose health conditions permit only intermittent work? And how should providers coordinate the care of someone for whom HIV-related health challenges are less pressing than other conditions, such as cancer, cardiovascular disease, diabetes, osteoporosis, and depression?

For too long, the needs of older adults with HIV have been neglected or overlooked. The failure of the federal government to fund and mount a bold, large-scale national study of these older adults, many of whom are long-term survivors, leaves us without the data needed to inform effective policies and programming. Primary care providers routinely fail to test older adults for HIV or to screen for behavioral risk factors, leading to high rates of concurrent HIV and AIDS diagnoses.5 AIDS service and aging service organizations have often not recognized this change in the HIV epidemic, have little knowledge of each other, and have rarely if ever worked together. Moreover, they often do not have the competencies or capacities to build the kind of integrated service delivery model that can provide this population with the critical care, supportive services, and health information they need. And the National HIV/AIDS Strategy (the Strategy) makes little mention of prevention and treatment issues related to older adults.

At the same time, the Strategy is moving our collective efforts in the right direction. Its call for a more highly coordinated, integrated, and responsive HIV and AIDS service delivery model signals a turning point. Its call for targeting resources toward the most highly affected communities is also welcome. Allocation of resources according to disease burden and level of risk is certain to advance the goals of reducing new infections, increasing access to care, improving outcomes, and reducing HIV-related disparities. But these goals can be achieved only after indicators of health and quality of life of the over-50 population are explicitly and consistently incorporated into the Strategy's definition of the problem, its goals and objectives, and its implementation plan.


Older Adults and HIV: Recent Findings

This new approach should be informed by the growing body of literature that is defining the unique challenges faced by someone aging with HIV. Key findings include:


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:

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:

The Department of Health and Human Services and the Department of Education, among others, should:

The CDC should:

The Administration on Aging should:

The SSA should:


Conclusion

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.


Footnotes

  1. Effros, 2008.
  2. Justice, 2010.
  3. Karpiak, Shippy & Cantor, 2006.
  4. Brennan, Karpiak, et al., 2009.
  5. Sweeney, M.M., 2009.
  6. Havlik, 2010.
  7. Cantor & Brennan, 2010.
  8. Karpiak & Brennan, 2010.
  9. Applebaum & Brennan, 2010.
  10. Christian Grov, et al, 2010.
  11. Karpiak & Brennan, 2010; Applebaum, 2010.
  12. Emlet 2010; Karpiak & Brennan, 2010; Golub, et al.; 2010; Bhavan, 2008.
  13. Schick, 2010.
  14. Golub, et al., 2010.
  15. Golub et al., 2010.
  16. Karpiak & Brennan, 2009.


References




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