Ageism Perpetuates Invisibility of Aging HIV Population

Individuals with HIV are living longer due to antiretroviral therapy (ART), which has shifted the virus from what was once a death sentence into a chronic disease. Despite this, the aging HIV-population is being overlooked, according to a presentation at the 125th annual convention of the American Psychological Association in Washington, DC.

Almost half of all individuals living with HIV are 50 years or older in developed countries, and that number is expected to increase to 70% by 2020 in some countries. Furthermore, this subpopulation accounts for 17% of new HIV infections and they are more likely to be diagnosed with AIDS upon discovering their HIV status than younger adults.

“The lack of perceived HIV risk in late adulthood among older people themselves, as well as providers and society in general, inhibits investment in education, testing, and programmatic responses to address HIV in an aging population,” said Mark Brennan-Ing, PhD, director for research and evaluation at ACRIA. “Ageism perpetuates the invisibility of older adults, which renders current medical and social service systems unprepared to respond to the needs of people aging with HIV infection.”

Prior studies suggest that as many as two-thirds of all older HIV-positive Americans have experienced stigma due to the disease and their age. This may be even more pronounced among men who have sex with men and bisexual men, because of internalized ageism and age obsession with this community.

This stigma—–due to age, sexual orientation, race/ethnicity, and HIV status––helps fuel negative outcomes, such as poor mental and physical health.

“Stigma results in social isolation, either through rejection by social network members or self-protective withdrawal, leading to loneliness and, ultimately, depression,” Dr Brennan-Ing said. “Stigma also makes people reluctant to disclose their HIV status, which could affect their health care treatment or prevent them [from] taking precautions to reduce transmission.”

Negative stereotypes and expectations regarding aging have been associated with poor cognitive test performance among older adults. It also can increase stress, which can lead to health problems such as heart disease.

Dr Brennan-Ing noted if an HIV-positive individual believes aging leads to a decline in health and other physical problems, they may stop engaging in healthy behaviors.

“These mechanisms may be responsible for empirical findings that internalized ageism is related to both chronic disease and longevity,” Dr Brennan-Ing said.

To help reduce the impact of ageism on HIV-positive individuals, Brennan-Ing suggests the following approaches:

• Train health providers in HIV screening, early diagnosis, and ART initiation for the aging HIV population, and integrate key services.
• Prevention, education, and outreach targeting older adults.
• Treatment guidelines for older HIV-positive patients.
• Funding in-line with the aging of the HIV epidemic.
• Engaging communities, community-based organizations, and social service providers in outreach, mental health, and social support.
• Address the specific needs of special populations.

“With the demographic shift toward older adults in the HIV population globally, and the elusiveness of a cure, addressing the care needs of this aging population are paramount,” Dr Brennan-Ing concluded. “The aging of the HIV epidemic will be very challenging, but provides the opportunity to mount a global response that will address the needs of this population across regions and settings.”