Aging Positively: Bringing HIV/AIDS into the Aging Services Mainstream

Aging and HIV/AIDS: A New Era of Convergence

For decades, aging and HIV/AIDS and their medical, governmental, community, and philanthropic structures and services were worlds apart. This made sense at first, when the majority of the first generation of people affected by HIV were young gay men, many of whom got their care in HIV-specific or infectious disease settings. The odds of living a long life with HIV/AIDS were small, and even survivors did not seek traditional aging services.

Those circumstances have now changed. Thanks to advances in treatment, the ability to live for decades with HIV has become a remarkable success story. Add to this the reality of older people who are acquiring the infection in their 50s or 60s, and HIV/AIDS must now be included as an aging issue. Of the 1.1 million people in the United States who are living with HIV/AIDS, half are 50 or older (50+). By 2030, it is anticipated that three out of four people who are living with HIV will be 50+.

This serendipity creates some unanticipated needs. While 50+ may seem young for aging services, many people living with HIV experience a cascade of other health challenges, including classic geriatric syndromes, even when their HIV is well-controlled, and need aging- and geriatrics-expert help at much younger-than-usual ages. This transition can be jarring and even traumatizing because HIV preparedness in mainstream primary, specialty, and geriatrics care settings is often woefully inadequate. Stigma and fear of being rejected or “outed” in unfamiliar care settings can drive people living with HIV into isolation and depression, dangerously sabotaging their ability to remain in care.

Good care also requires far more than medication. Social support and attention to the social determinants of health are critical and the ability to achieve a good quality of life, pursue personal goals, and engage with family, friends, and community requires a degree of security in housing, food, mobility, and social connection that seems unattainable for many.

As the profile of the epidemic has changed, new issues of diversity and social justice have also surfaced. The fastest growth in new infections is in the African American and Latinx communities, and women now account for a quarter of all people living with HIV. Bringing down barriers and finding ways to deliver the best possible care to these distinct communities will require research and sensitivity. The whole-person outlook and community-based approach of aging services has the potential to bring comfort to this resilient but overlooked group of people. This report will raise the voices and examine the needs of older people living with HIV, while exploring opportunities for philanthropies to create meaningful impact in public and personal health and wellbeing.

Read the full report here.