As the American population with HIV grows older, it becomes ever more important to understand both the health and social implications of aging with this disease. The Centers for Disease Control and Prevention estimates that in the United States, more than 50 percent of the 1.3 million people with HIV are 50 years of age and older.
Until the late 1990s, most people living with HIV inevitably experienced the infection’s most serious form, AIDS, a series of life-threatening secondary infections resulting in early death. These losses devastated historically disenfranchised segments of our society — most notably men who had sex with men, injection drug users, and communities of color. Fortunately, the prognosis of people living with HIV has significantly improved in the last 20 years. The introduction of combination antiretroviral therapy turned things around, dramatically increasing life expectancy and improving quality of life.
However, living with HIV is not without its physical and psychosocial challenges, which occur at a higher rate in this population than in those without the disease. HIV increases systemic inflammation, which, in turn, triggers the manifestation of diseases associated with aging, such as cardiovascular disease, certain forms of cancer, osteoporosis and fractures, metabolic syndrome and Type II diabetes, renal disease, and chronic neurological complications.
We know that aging takes a toll on a person’s health and well-being, but imagine combining that with the long-term impacts of HIV. Due to increased isolation and smaller social support networks, older populations suffer declines in psychological well-being, including depression. Studies have shown that for individuals with HIV, social support is linked to better medication adherence, consistence with attending medical appointments, less distress, and slower disease progression. Thus, we need to add attention to more than prevention, early diagnosis and proper treatment for HIV. We need to add attention to appropriate geriatric care, including support systems, for those living with HIV.
Adding to the challenges of those living with HIV is that a stigma still remains around the disease. Society’s attitudes regarding HIV have changed, but only to some degree. Unlike cancer or heart disease, HIV is a communicable disease, and those affected are often seen as vectors for transmission. Blame is frequently assigned, not just to the infected individual, but to an entire population, whether they be gay men, injecting drug users, or people of color.
HIV stigma adds to the psychosocial challenges faced by people with HIV of any age, and it becomes a barrier to testing and treatment. We must stop perceiving HIV in this light and instead offer social support to affected individuals.
According to the CDC, about 36.7 million people were living with HIV around the world in 2016, and more than half were receiving medicines to treat the disease. Unfortunately, there were about 1.8 million new cases of HIV worldwide that same year, and an estimated 1 million people died from AIDS-related illnesses in 2016. While the global number of HIV-related deaths continue to decline, the rate of new HIV infections is not falling fast enough to meet the 2020 goals of fewer than 500,000 newly infected individuals, per the Joint United Nations Programme on HIV and AIDS.
When World AIDS Day was first observed in 1988, there was no effective treatment for AIDS. Extraordinary advances have been made in the treatment of HIV in less than four decades, including remarkable increases in life expectancy and quality of life. However, on this the 30th anniversary of World AIDS Day, let us also reflect on the challenges that stubbornly remain. As a society, we are not meeting our goals of eradicating this disease by 2030. It is time to step up our efforts and take action to end this public health threat worldwide.
Alberto Cortés is the executive director of Mama’s Kitchen, a community-driven organization delivering three nutritional meals a day, seven days a week, at no charge to men, women and children living with HIV, cancer or other critical illnesses throughout San Diego County. Mama’s Kitchen’s annual Tree of Life Candlelight Vigil and Tree Lighting Ceremony will be at 6 p.m. on Sunday, Dec. 1, in honor of World AIDS Day.