As an Epidemic Ages, So Do Its Victims

As An Epidemic Ages, So Do Its Victims

More than three years ago, around the time of World AIDS Day in December of 2004, we at Village Care of New York launched an effort to raise awareness of the growing numbers of older adults living with HIV.

We were spurred to do this by our own recognition of the situation within Village Care’s Network of AIDS Services, which was witnessing a trend where those over 50 were making up more than half the enrollees in some of our programs.

Clearly, there were issues that needed to be addressed, not just in our own programs, but throughout the populations most impacted by AIDS and, importantly, among an older population that perhaps didn’t see itself at risk.

Moreover, our AIDS Network professionals – who are those on the front lines of the epidemic and who are frequently among the very first to spot and recognize new, significant developments – were pointing out that a number of those who were aging with HIV were finding treatment being complicated by the different medications they now were taking for age-related health conditions. This includes high blood pressure, diabetes, osteoporosis and heart disease.

In a bitter irony, our staff told us, the life-saving “cocktails” – the multi-drug treatment regimens that were saving and extending the lives of those with HIV/AIDS – also appeared to be contributing to the development and advance of those “age-related” ailments.

Increasingly since 2004, the AIDS care and overall health care communities have come to recognize the problems associated with aging and AIDS, both from prevention and care perspectives.

Perhaps the most important and comprehensive report on the situation was offered in the fall of 2006 by the AIDS Community Research Initiative in America (ACRIA), which studied AIDS survivors in New York City. This landmark work reported:

“Enormous resources have contributed to changing the death sentence of an HIV/AIDS diagnosis to the reality of a longer life. It is disconcerting that those who now live with HIV will face a health care system and communities ill-prepared to care for them as they age with the disease.”

In trying to understand the implications of aging with HIV, ACRIA found an unusually high rate of depression among those who have lived with the infection for many years, at a rate nearly 13 times higher than the general population in NYC. Depression itself, the study reported, “has harmful effects on those aspects of the immune system affected by HIV.”

A few days ago, The New York Times brought further attention to the problem in a front-page story headlined, “AIDS patients face downside of living longer,” focusing primarily on the woes that are facing those who have been granted extended life and are now moving beyond “middle age.” These include comorbidities perhaps brought on, often with early onset, and complicated by HIV’s assault on individuals’ immune systems and by the long-term impact of powerful drug regimens that have kept AIDS at bay but not without other consequences to their health as they age.

As the AIDS epidemic has evolved, certain groups have been impacted with their own particular ramifications, and for certain that is once again true as we are beset with a range of challenges in care and treatment of an aging AIDS population.

Whether they are long survivors with the HIV infection, or they are those who are newly infected, they likely face unique and complex health care needs on top of the demands of an often complicated and rigorous AIDS treatment regimen.