Turning 50 two years ago was not an easy birthday, yet it was, in a way, as transformative as it can be for anyone, HIV-positive or -negative. I thought that, due to the fact that I am a 20-year survivor of HIV, reaching the ripe mid-century mark would somehow be more celebratory -- and it was, on paper -- but there were many mixed emotions. I worried about an unsure future with a broken immune system and a community that increasingly discriminates against older people. I worried I would die single. I don't know, perhaps, all in all, I'm just a whiner. But I heard from a lot of people who felt my pain.
The research on aging with HIV/AIDS is starting to bear some fruit since some of us old geezers have stayed around long enough to: 1) get infected with HIV in the first place; 2) live through the early experimental age of antiretroviral therapy; and 3) actually be considered "aged." We have lived long enough to die of "natural causes." What is less understood is the evidence that could definitively prove that HIV exacerbates the aging process and all the complications thereof -- it most likely does. Or that living to an older age makes HIV worse, which is less clear. Cumulative drug therapy, immune dysfunction, and immune capacity most surely will have a long-term effect on most of us who live long enough to see our golden years. We also understand that while constant inflammation is a natural immune response, it most certainly will have long-term negative consequences. We know that stopping HIV drugs will increase mortality due to the inflammation that occurs when HIV has been allowed to cut loose. But assuredly, we now know that antiretroviral medicine is allowing us a much longer life than we ever thought possible.
Unfortunately, HIV exacerbates the aged appearance in most long-term survivors. In the past two years, one of the biggest bees in my bonnet has been the ageism I see and have experienced within the HIV-positive, gay male population. My HIV-positive women friends also express to me their feelings about the ageism they deal with. In reality, discrimination against older people is pervasive in America. We treat our elders like s**t. HIV/AIDS survivors now have to bear yet another stigma -- old age.
Moving to San Francisco in July probably made AIDS ageism all the more apparent, due to the fact that there is a larger ratio of HIV-positives to gay men here. But I cannot understand the old paradigm of people within their own race/gender/ethnicity/sexual orientation and HIV serostatus who discriminate against themselves. After all we've been through, and all the outside discrimination we experience, it has been a rude awakening to witness stigmatization among my HIV-positive brothers.
Where does this stigmatization come from? Maybe it's the attractiveness factor, which is also pervasive in our society, gay or straight, positive or negative. Our society thrives in "looks-ism". Gay men have that creative gene that perpetuates beauty and perfection, yet at the same time, we are loving and supportive. No denying I get excited when I see an attractive man! But it's tragic to witness obvious avoidance of older people with HIV, strictly on sight. Blatant ageism based on wrinkles, grey hair, and a belly is just plain idiotic, and is really dividing our community.
I'm all for choice, but what I'd love to see is younger and older positive people talking, socializing, and networking together. Through survival, we too often grow old only to experience isolation and depression because our own are turning us away. As a poz community, let's not make each other live through the painful discrimination other social groups sometimes perpetuate among themselves -- skin tone in people of color; body weight and shape in women; socioeconomic status in everyone.
Older people with AIDS will probably suffer a multitude of social problems, as many have families or old friends who rejected them long ago due to discrimination. They are left with few choices, but in many cases, can survive fairly well on our HIV social services system. However, I would argue that, in many instances, staying in this entitlement life leads to isolation, which can lead to depression and overall poor heath, including substance abuse. Sadly, some have no choice, as they simply cannot work, or they do not have savings or insurance caps have long ago been met, leaving them uninsured. Much of any money they had was spent on just staying alive.
Ever consider getting back to work? Work provides great stabilization in our society. I have held jobs most of the time I've been positive even though I went on disability for awhile. But I eventually went back to work at the ripe old age of 48 -- when I was not out of the woods in terms of my antiretroviral drug choices. Sure, HIV has caused me to have "bad days" while working, but I'm still a strong advocate for going back to work. Working will help stave off isolation and at the same time bring in a salary. It provides a social framework and foundation. If we now see ourselves living to older age, we should at least be looking at going back to work if it is physically and mentally possible. Also, if full-time work isn't an option, try a part-time job or volunteering! For me, having a daily routine makes me feel so much more alive than staying home, cashing disability checks, and sitting on the couch watching reruns of "Sex in the City." It's just healthier.
Despite my HIV and age, I am damn fortunate to have all that I do: stable health, a great new job, and a supportive and loving companion -- 16 years my junior -- who brings me boundless joy. I never thought I'd get here when I was first diagnosed 20 years ago. The clock ticks and we get older living with what was once considered to be an untreatable virus. You can celebrate every positive, healing moment. Time adds to the knowledge and understanding about AIDS, and just maybe as we survive more years, a cure will be in the works. You can consider growing older as a challenge, or you can find your own ways to embrace it and look forward to many more years.
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