Jeff BerryWhen I was younger, much younger, I used to daydream about what my life would be like once I reached 50. I imagined I would have a successful career, own a big, white house with a picket fence, be "settled down" and perhaps have started a family, boast a wide circle of friends, and of course I would, above all, be immensely happy and satisfied.

I was almost certain that my hair would prematurely turn shock white -- as did my father's -- before the ripe age of 30, and that, as I aged, I would not necessarily appear "old," but, rather, I would be "distinguished-looking," as men my age are often described. And as a child, in my mind's eye, my adult self exuded an air of supreme confidence, and people flocked to me for advice, or at the very least, when they needed a shoulder to cry on.

Well, as we all know, life doesn't always end up exactly the way we planned.

I suppose one could say that I have achieved a moderate level of success in my life, both personally and professionally. I have an immensely rewarding career, one that pays the bills and then some, which has allowed me to journey to faraway lands and meet some interesting folks I might otherwise never have met. But instead of a big, white house, my partner and I own a condominium. Our family, made up of two gay men along with our two cats, is what would be considered by many to be non-traditional. I have a small group of extremely close, lifelong friends (thankfully), who are there for me just as much as (if not more than) I am for them. And my hair never did turn white, but instead became silvery-gray.

For me, these realities are a metaphor for what aging is like for many of us living with HIV. As my virus and I both approach our sunset years together, hand in hand, I look back at a life full of uncertainties and lowered expectations, disappointments and challenges, regrets and missed opportunities. At the same time, my life has often been extremely rewarding and gratifying. But one thing is for sure -- it was never what I expected.

Getting older with HIV is, at times, a double-edged sword. Yes, I am certainly grateful for having survived this long. But at a time in our lives when we should still be creating memories, many of us now suffer from early memory loss, either due to the effects of HIV, or sometimes from the medications we take to control the virus.

As a youngster, I can remember cringing when ordinary conversations at family gatherings would invariably morph into a litany of everyone's recent ailments, impending surgeries, hospitalization horror stories, and deteriorating health. But nowadays, and in an ironic twist of fate, the snap, crackle, and pop of bones made brittle by HIV and ARVs makes for titillating dinner conversation with friends.

Depression, stigma, neurocognitive impairment, non-AIDS malignancies, osteoporosis, liver failure, kidney and cardiovascular disease -- the list goes on and on. Weren't these supposed to be our golden years? Is there ever going to be light at the end of the tunnel, or do we just resign ourselves to the fact that we'll be "walking towards the light," and at a very early age?

Happily, the answer to the latter is no. During the course of researching this issue, I learned that there may indeed be light at the end of the tunnel -- we just may need to put on our granny glasses in order to see it. Researchers are only now beginning to uncover some of the mechanisms that may be responsible for early aging in people with HIV, including inflammation and advanced aging of the immune system brought on by the virus itself. Understanding just how and why these effects occur may not only help those with HIV, but also those with other diseases. It may one day even help tackle some of the problems associated with the effects of aging for everyone.

Unfortunately, research is taking place at a snail's pace. According to most estimates, over half those who are HIV-positive in the U.S. will be over the age of 50, in just a few short years. Not only will this create a tremendous burden on our present health care system -- one that we are ill-prepared for -- it will also demand of us an innovative and forward thinking response to address the needs of this ever-growing population.

A special thanks to Nelson Vergel, Jules Levin, and Dr. Victor Valcour for their contributions to this issue of Positively Aware. It is only through the continued efforts of advocates and researchers like them that we will continue to bring much needed attention to the unique issues that are part of the graying epidemic.

Take care of yourself, and each other.

Jeff Berry

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