Comorbidities, mental health issues, loneliness, and financial problems are the biggest issues faced by older people living with HIV (PLWH), the San Francisco portion of a new report issued by the ACRIA Center on HIV and Aging at GMHC showed. This ROAH (Research on Older Adults with HIV) 2.0 report represents an update on a similar survey conducted by ACRIA in 2006 in New York City. "We hope that service organizations across the country will start to use these findings as they develop services and interventions designed to help this population," Kelsey Louie, M.S.W., M.B.A., of GMHC explained in a related press release.
In 2006, almost 27% of all PLWH in the U.S. were at least 50 years old. By 2018, that percentage had grown to more than half of PLWH in the U.S., and 65% in San Francisco. While some of this increase is due to new HIV diagnoses, much of it is based on better survival rates -- PLWH are growing old, just like the rest of the population. This is reflected in the current survey population, 92% of whom were diagnosed with HIV at least 10 years ago.
The current report draws on the experiences of 197 respondents and 44 focus group participants, while ROAH 1.0 included 914 respondents. Unlike the initial study, the current survey was available in both English and Spanish. Nonetheless, the proportion of Latinx participants declined, from a third in ROAH 1.0 to 19% in ROAH 2.0. The 2006 sample included more cisgender women (28.8%) than the current group (15% are cisgender women), but fewer transgender people (1.09% in 2006 versus 8% in 2018).
Antiretroviral coverage increased between the two reports, from 85% to 96% of participants, and in 2018, 92% of participants reported an undetectable viral load. Nonetheless, 41% of ROAH 2.0 respondents rated their overall health as fair or worse. The most common complaints were fatigue, neuropathy, arthritis, and chronic pain. Neuropathy and arthritis were also common in 2006, in addition to hepatitis and hypertension. The authors of the new report propose that combined HIV/geriatric care programs and training HIV care providers in geriatric care principles might help when dealing with comorbidities and the resulting polypharmacy.
Rates of depression declined, with 52% reporting this condition in 2006 and 38% in 2018. However, they are still much higher than among older adults in the general population (around 5%, according to the U.S. Centers for Disease Control and Prevention). Furthermore, 41% of current survey respondents with depressive symptoms had not received mental health care during the past year, and focus groups considered access to such care an urgent need. More than half of current participants reported sexual abuse before age 16, and a similar percentage were survivors of domestic violence. Older PLWH also lived through the traumatizing years of the AIDS epidemic before effective treatment became available. Medical care for this population should thus be trauma-informed, the authors of the current report recommend.
Up to 17% of older people in the U.S. feel isolated, the AARP Foundation reports. By comparison, 43% of PLWH in this survey reported being lonely or very lonely. This issue does not appear to have improved much since 2006. The older survey had measured loneliness on a scale of 20 to 80 (higher score = greater loneliness). Respondents' average score was 53, compared to 32 in a general-population study of people 65 and over. Reflecting this result, "someone to socialize or meet people" was the most desired service (79%) in ROAH 2.0, but also the one with the largest unmet need (26% did not feel their need was met in this respect). Study authors call for more opportunities for socializing targeted at older adults but cautioned that this population needed to be consulted first to ensure such programs were appropriate.
Financial concerns did not change much over time or between the East and West coasts. In 2018 San Francisco, 49% of participants said they had just enough money to get by, and 26% did not have sufficient income to cover their living expenses. In 2006 New York, the corresponding figures were 53% and 23%. By comparison, 10% of all people age 65 and above in the U.S. had income below the poverty level in 2014, the U.S. Administration on Aging reported. ROAH 2.0 study authors call for finding solutions to help those on fixed incomes cope in high-cost cities, such as San Francisco.
Ultimately, ROAH 2.0 will compile responses from close to 3,000 older PLWH across the U.S., including New York City. Additional reports are expected to be released next year.