Support systems and community resources play a critical role in the lives of older adults with HIV/AIDS by providing emotional, social, personal and informational support. These systems are crucial in helping older adults manage their health conditions, combat social stigma, access necessary medical care and maintain quality of life as they age. This is especially important when they face challenges like decreased mobility, falls, decreased cognition, complex medical systems and mental health issues such as isolation, loneliness, substance use and depression.

By addressing these needs, community resources can help older adults with HIV live healthier and more fulfilling lives. Moreover, the support of a knowledgeable and culturally responsive healthcare team can help older adults achieve their healthcare needs resulting in better outcomes.

Substance use disorders (SUDs) can be particularly challenging for older adults living with HIV. While substance use may decline in the general population of individuals without HIV, this trend does not hold for those who are HIV-positive. Therefore, healthcare providers should be aware of the impact of SUDs on this population, especially concerning medication adherence, interactions with HIV medications and co-morbidities. It is equally important to consider the dual stigma associated with both substance use disorders and HIV.

Healthcare providers can enhance their ability, knowledge and skills in caring for older adults by incorporating the principles of cultural humility. According to Elevance Health, cultural humility has emerged as a more effective approach to reducing cultural biases within the healthcare system. It emphasizes seeing all individuals as unique, with diverse characteristics that contribute to their culture. This perspective fosters respect for individuals, rather than viewing them as part of a larger group and helps eliminate long-standing inequities. It encourages curiosity and lifelong learning about the complexity of identities.

According to the Gerontological Society of America, we should use person-first language when referring to older individuals. For example, instead of the term “addict,” the preferred term is “an older person with a substance use disorder.” The CDC provides a comprehensive list of preferred terms for various social factors affecting older adults.

You can find the terms here. In this context, the preferred terms for this population include “older adult,” “older persons,” or “older people.” These terms are recommended for describing individuals aged 65 and older, as opposed to “seniors,” “the elderly,” “old folks” or “the aged.”

A game changer came in 1996 with the introduction of highly active antiretroviral therapy (HAART), which is now the standard of care in the US. Miraculously, this medication resulted in a dramatic decline in AIDS-related deaths. According to the CDC, HAART has become so effective that when taken as prescribed, the virus can be rendered undetectable. This means that the amount of HIV in a person’s blood is so low that it can’t be detected by a viral load test. The most important thing about this is that a person with an undetectable viral load cannot transmit the virus to another person. We call this U=U or Undetectable = Untransmittable.

Another game-changer was the introduction of pre-exposure prophylaxis (PrEP) in 2012. This medication is for HIV-negative persons, is highly effective and helps prevent HIV transmission for those at risk of contracting HIV, including older persons.

For older persons, particularly underserved populations, cumulative exposure to social, environmental, and economic factors may significantly impact their quality of life, self-image, and behaviors, and may prevent them from disclosing their HIV status or seeking the healthcare services they need. In addition, lack of access to healthcare for many older adults can also prevent them from receiving needed services. 

Other factors such as stigma, provider lack of understanding of older adult needs, and a lack of cultural humility may prevent this population from receiving the care they need. For example, LGBTQ+ persons often find it difficult to find providers that are understanding and culturally responsive to their specific needs, this is particularly problematic among transgender persons.

In terms of intersectionality, elderly LGBTQ+ persons living with HIV may experience additional issues, such as stigma and discrimination resulting from HIV status, race, homophobia, transphobia, and ageism. Connecting these individuals with a multidisciplinary team of providers that are culturally responsive and knowledgeable about older adult care is the best approach for older adult care. Finally, it has been my personal experience that providing safe spaces for those living long-term with HIV to tell their stories helps put a human face on older adults living with HIV, and in the process helps destigmatize the disease.

One of the most glaring issues impacting older adults living with HIV is HIV criminalization laws, although there have been some positive movements in Georgia regarding the criminalization of HIV, much more needs to be done. The laws have not kept up with science in many locations, including Georgia.  In 2022 Georgia reformed its HIV criminalization laws to include the following

• Prosecutors must prove that a person with HIV intended to knowingly infect others, rather than simply being aware of their HIV status.
• The felony charge penalty was reduced from 10 years to 5 years.
• The heightened reckless conduct charge against peace and correctional officers was removed

Politically, in AA communities, dismantling DEI and AA history threatens to undermine much of the progress made toward equity and inclusivity, these conservative political efforts are perpetrated both locally and nationally. Moreover, rural areas experience these health-related factors more severely. A recent study (Quinn, et, al., 2021) found that racism and poverty; culture, politics, and religion; as well as a lack of healthcare infrastructure collectively shape access to HIV care for older adults in the rural South.

According to the latest data from the Centers for Disease Control and Prevention (CDC), of the nearly 1.1 million people living with diagnosed HIV in the United States and dependent areas in 2021, over 53% were aged 50 and older. Additionally, this population may also experience significant comorbidities associated with aging, such as cardiovascular disease, diabetes, renal disease, substance use disorders, and various cancers. 

A growing number of older adults are living long-term with HIV (some were born HIV+) one reason is that improved treatments and testing efforts help people with the disease live longer and healthier lives. According to the Department of Health and Human Services (DHHS), nearly half of people living with HIV in the United States are over fifty. The problem is that healthcare providers often do not recommend HIV testing for this population because they think they are not at risk. Well, I’m here to dispel that myth, as a 71 y/o person living long-term with HIV (27 years), my sex life is still active.

Why should the general public be concerned about HIV?  A major concern regarding HIV is stigma. For many older adults with HIV, stigma and its associated social manifestations can have a cumulative effect. For example, discrimination based on HIV status and race can have deleterious effects, for the LGBTQ+ community, the added element of homophobia and transphobia can be formidable challenges.  

Stigma can adversely affect one’s self-image, and quality of life, and may even prevent persons from seeking HIV/AIDS services. As healthcare providers, we must become agents of destigmatization, by dispelling myths and promoting language and practices,  that are affirming, respectful, and evidence-based.

In contrast to younger persons, signs of HIV may be mistaken for “old age”. Consequently, older adults are more likely than younger adults to be diagnosed with HIV later in the course of their disease. With this oversite, they are less likely to receive the benefits of early detection and lifesaving Antiretroviral Treatment (ART). 

This oversite can result in them possibly sustaining more damage to their immune system with poorer outcomes.  Some older adults may be embarrassed or afraid to be tested for HIV, and often face additional challenges, such as social isolation, loneliness, and lack of social support.

In a historical context, I can recall the year 1981. Working as a respiratory therapist at Cedar Sanai Medical Center, many of the patients who came into our respiratory intensive care unit with pneumocystis pneumonia and other respiratory ailments, many of these patients went on ventilators for respiratory failure and often died. Interestingly, many were young, White gay men. Subsequently, the disease was named Gay Related Infectious Disease (GRID), setting the stage for stigma, discrimination, and hostilities against this community. It wasn’t until 1987 that the antiretroviral azidothymidine (AZT) offered hope to a community reeling from the devastation of HIV/AIDS; however, AZT was only moderately effective and often had many toxic side effects. Later medications such as highly active antiretroviral therapy (HAART), proved to change the trajectory of the epidemic such that it is now a manageable, chronic disease, no different than asthma, diabetes, or heart disease. The good news is that older adults have been living full and active lives for 20, 30, 40 years.

As a dissertation mentor at Capella University, I recently directed a student dissertation entitled: “LONG-TERM SURVIVAL STRATEGIES FOR SAME GENDER LOVING AFRICAN AMERICAN MALES LIVING WITH HIV”. In this study, we examined the positive attributes of long-term HIV survivors and provided recommendations for a younger generation of newly diagnosed HIV+ persons. I’ll share 3 of our recommendations from this study:

1. Medication adherence is extremely important to long-term survival.
2. Incorporating spirituality as an important component of sustainability and self-fulfillment 
3. Developing a positive relationship with healthcare providers is extremely important