This year's SYNChronicity conference, a national meetup on HIV, hepatitis C, sexually transmitted infections, and LGBT health held in Washington, D.C. and hosted by HealthHIV, shined a spotlight on HIV and aging. It even had a designated track dedicated to the subject, "Generational Health," which was novel in that it looked at both building alliances among various ages along with addressing needs of people older than 50, who represent nearly half of all people living and diagnosed with HIV in the U.S.
This track of workshops discussed themes of social isolation, lack of social support, stigma, and housing insecurity. These issues, combined with what are considered typical signs of aging like cardiovascular disease, dementia, and mobility, made for in-depth discussion. Most speakers presented research that shows the need for these areas to be addressed.
"When we say elders, hopefully that means respect and influence versus old," said Brian Risley, Director of Education and Programs at APLA Health in Los Angeles.
Sixty-three percent of APLA's 15,000 patients are at least 50 years old living with HIV. Risley shared research from APLA Health's Healthy Living Project, a study showing a high rate of both physical and mental health challenges in its series of focus groups. The focus groups -- eight in total -- included men who have sex with men (MSM), transgender people, and gender nonconforming people. The focus groups, however sorted by race or ethnicity, confirmed that social isolation is a major roadblock to people living with HIV over 50 achieving improved health outcomes, Risley said.
"Older adults with HIV in Los Angeles fall into a significant gap in innovative efforts to address the psychosocial, the social, and the physical health complexities for those aging with HIV," said Risley. "Their needs are definitely immediate and more pressing for us."
To address these issues, APLA began the HIV Elders (HIVE) program last July, specifically for MSM of all ethnicities living with HIV who are 50 years or older. HIVE hosts monthly events to tackle social isolation head-on. HIVE uses the social determinants of health framework. The four tenets of HIVE include life skills support, health education, discussion groups, and community building. Topics range from how to manage comorbidities to taking multiple medications at various times of the day. In addition, there is a life skills training dinner every third Thursday of the month.
"We try to create programs where they can come out of their houses and participate," Risley said. "We know a lot of people are still self-isolating at all income levels, and we want to try to encourage them to just have some social connection, some peer support."
The Elizabeth Taylor 50-Plus Network, based out of the San Francisco AIDS Foundation, is much like HIVE though not exclusively for people living with HIV. The network is comprised of gay, bisexual, and trans men in San Francisco. Vince Crisostomo, program manager of the network, presented at the same session.
"We try to foster connection. We look at civic and social engagement and build community," he said.
Crisostomo shared anecdotes from the launch of the Elizabeth Taylor 50-Plus Network, which included lessons learned. He spoke about the changes in the community that people aging with HIV have had to face.
"At the time [in the early part of the epidemic], the greatest fear in everybody's life was that they were going to die alone with no one to love them and they would be homeless -- because housing is one of the more important issues we face," he said. "That perspective has shifted, and I do believe it's because of social connection."
For some, support groups may be needed but not enough to deal with some of the structural issues that living with a chronic illness while aging in a major metropolitan city may bring. George Kerr, III -- a conference attendee and Washington, D.C.–based advocate -- offered his perspective, stating that a combined effort to bridge housing needs with solutions for social isolation is necessary. Kerr serves as a board member of the LGBTQ Task Force for the D.C. Department of Aging and Community Living.
"I think there's a lot more than support groups that's needed. There's a deeper conversation in building up trust within each other so social isolation can be addressed. There's not enough discussion of what individuals on the grassroots level have to go through," Kerr said. "The two top priorities are housing and social isolation for seniors."
For the Elizabeth Taylor 50-Plus Network in San Francisco, aging with escalating rent costs can drive both isolation and poverty among its 60 to 80 active members. According to the U.S. Census, about 34% of the city's population are people at least 50 years old. A 2016 study from the City of San Francisco found that while only 16% of seniors over the age of 60 live below the federal poverty line, an estimated 57% of single senior households and 39% of two-person senior households have inadequate income to meet a basic standard of living, based on the cost of living in one of the most expensive rental markets in the United States. The network tries to address this gap by providing resource navigation, education, financial literacy, community mobilization, and advocacy trainings. Once a month, the network hosts a "coffee chat" where about 50 participants gather and service providers drop in to answer questions and receive feedback from community members.
"I also think it's important that you should try to reach people before they slip into isolation, because once they're isolated it's very hard to pull them out," Crisostomo said.
Food is an essential component, he added; the program orders enough food so that people may take food home.
"It might be rough, but we should do it anyway," Crisostomo concluded. "This is the generation who survived the epidemic. I tell people, 'You can do whatever you want to do, but do you want to do it alone or in company? Most choose company.'"