Gay and Gray X: Red Ribbon Redux: The Challenges of Long-term Survival with HIV

Abstract

In 2016, the CDC found that nearly half of the individuals living with HIV in the United States were 50 years-old or older. Although new infections occur in older adults, the overwhelming majority of those who are over 50 and living with HIV became infected when much younger and did not expect to survive long-term. Although antiretroviral therapy (ART) has made a very positive impact on the course of HIV illness and promotes longevity, HIV is well known to exert deleterious effects on the nervous system. Approximately 50% of those living with HIV can be diagnosed with HIV Associated Neurocognitive Disorder (HAND) which is comprised of several syndromes that occur along a continuum of cognitive impairment severity. The growing number of older adults living with HIV mandates that both primary care providers and geriatric specialists understand the long-term consequences of HIV infection. In addition to HAND, these individuals may be impacted by the "triple stigma," resulting from having three characteristics: older, gay and HIV-infected. The fact that many older adults living with HIV have fragile social networks that may not sustain their needs as they grow older makes life for these individuals even more difficult. Older adults living with HIV identify a number of barriers when accessing support including inability to disclose HIV status, the irrational fear others may have of HIV/AIDS, not wanting to be a burden, no available family members and death of friends from AIDS. Unfortunately, older adults living with HIV can fall between the cracks of the aging and the HIV services systems. The 63-year-old gay man who became infected with HIV when in his 20s and who is the subject of a case presentation highlights many of these issues. In addition to living with HIV, he has obsessive compulsive disorder, generalized anxiety disorder and lost his partner and many of his friends to AIDS-related illnesses. Although research is limited, age-contextualized interventions may combat stigma, help this individuals overcome barriers to health care, and improve both the physical and mental health of HIV+ older adults.