Table of Contents
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
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.
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:
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