Moving Ahead Together
New Report Offers Recommendations for Improving Care for Older PLHIV
by Hank Trout
On December 8, 2020, Grantmakers in Aging, a national membership organization of philanthropies that works to amplify the voices of older people and issues of aging, released their report entitled Moving Ahead Together: A Framework for Integrating HIV/AIDS & Aging Services, an initiative that seeks to create closer coordination and expertise-sharing between HIV/AIDS services networks and aging services networks to improve the lives and health of older people living with HIV/AIDS.
The recommendations contained in the report were compiled by the Moving Ahead Together steering committee, comprised of leaders in the aging and HIV service sectors, including Jesse Milan, Jr., President and CEO of AIDS United, Vince Crisostomo, Director of Aging Services at the San Francisco AIDS Foundation, and Peter Kaldes, President and CEO of the American Society on Aging, and by participants in a virtual summit.
It is well known that of the 1.2 million people in the U.S. living with HIV/AIDS, more than fifty percent are over the age of fifty and that, by 2030, that number will be over seventy percent. However, care and services for people aging with HIV/AIDS has not kept pace with the changing demographics of the pandemic. The report offers a detailed framework of recommendations for strengthening the integration of HIV and aging care and services to meet the unique needs of this aging cohort.
The report is divided into three “Focus Areas.” The first, “Complexities and Challenges,” delves into the unique problems faced by those aging with HIV/AIDS, including the racial disparities uncovered by the pandemic, especially among Black cisgender and transgender women; the scarcity of services for older women living with HIV/AIDS; the addition of ageism to the sexism, homophobia, transphobia, and racism to the list of stigmas PLHIV face; the discomfort many older PLHIV experience in accessing services; the scarcity of clinics and trained providers in rural areas; the challenge of creating services for such a diverse cohort; the difficulty of recruiting new HIV providers as older specialists start to retire; and the setbacks caused by the COVID-19 pandemic.
The second Focus Area, “Integrating and Improving Care and Services,” delves into health equity principles that should form the basis of HIV and aging programs and services. The first step, the report posits, is acknowledging the health disparities, racial and social inequities, stigma, marginalization, and discrimination faced by older people with HIV/AIDS. It explains the importance of promoting person-centered care by connecting HIV/AIDS, again, and social care providers. This can best be achieved by offering complementary services where possible, such as providing geriatric consults offered in HIV clinics, social workers embedded in healthcare settings, or social support programming based in healthcare settings. [As an example, the report singles out San Francisco’s Golden Compass (A&U, July 2018), which has earned high patient and provider satisfaction for its many onsite services: cardiology; cognitive evaluations; brain health and exercise classes; geriatric consultation; dental, hearing, and vision screenings and linkage to care; and social activities.) It also highlights the need for primary care providers and geriatricians to learn more about HIV issues, including the onset of various co-morbidities in older PLHIV, including polypharmacy, and for including sexual health in primary and specialty care for older PLHIV, including awareness of PrEP and PEP medications and U=U. It is equally important for HIV providers to gain geriatrics expertise and for geriatricians and general care providers, including staff in long-term care to build cultural competence on HIV issues.
The report also emphasizes the need for mental and behavioral healthcare, especially around cognitive decline, dementia, and Alzheimer’s Disease. It recommends strategies for addressing the power of stigma, preparing community-based support groups for older PLHIV, and addressing the effects of social isolation.
In the third and final section, “The Way Forward,” the report strongly recommends including older PLHIV in the Ending the Epidemic (EHE) plan, to “ensure that prevention-focused programming does not overlook ongoing needs of OPLWH, particularly long-term survivors.” It offers other strategies, such as preparing Medicare to serve the growing population of older PLHIV; strengthening protections of SSDI; addressing discrimination and criminalization issues; and listening to and learning from the resilience, courage, and experiences of older PLHIV.
Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his husband Rick Greathouse. Follow him on Twitter @HankTroutWriter.