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Is There no Place for Us? The Psychosocial Challenges and Rewards of Aging with HIV

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  • Charles A Emlet
  • Mark Brennan‐Ing

Abstract

According to the Centers for Disease Control and Prevention (CDC), nearly half a million people aged fifty years and older have human immunodeficiency virus (HIV) in the US. This population will continue to grow and some estimates suggest that approximately 70% of all persons with HIV (PWH) in the US will be 50 and over by 2030. This pattern is found globally, as access to antiretroviral therapy becomes widespread. This population includes newly infected older adults and long‐term survivors aging with HIV. This article reviews the challenges and opportunities for older PWH, focusing primarily on psychosocial issues. While the growth of this population testifies to the success of HIV treatments, older PWH encounter numerous difficulties in later life, including high rates of multi‐morbidity, behavioral health issues, HIV stigma, and social isolation. Many older PWH face difficulties finding care in fragmented systems poorly aligned for the dual challenges of aging and having HIV. We address these structural problems and misalignment with eight policy recommendations to improve access to care and support healthy aging. These recommendations fall into three main categories: 1) increased recognition of this population in planning and the National HIV/AIDS Strategy, 2) improved access to programs through the Ryan White and Older American's Act programs, and 3) better surveillance data on this population globally. Short of a cure, the dramatic increase in the population of older PWH will continue for the foreseeable future. It is the duty of advocates, gerontologists, health and social service providers, and policymakers to meet the needs of those growing older with HIV. Según los Centros para el Control y la Prevención de Enfermedades (CDC), casi medio millón de personas mayores de cincuenta años tienen el virus de la inmunodeficiencia humana (VIH) en los Estados Unidos. Esta población continuará creciendo y algunas estimaciones sugieren que aproximadamente el 70 por ciento de todas las personas con VIH (PWH) en los EE. UU. Tendrán 50 años o más para 2030. Este patrón se encuentra en todo el mundo, a medida que el acceso a la terapia antirretroviral se generaliza. Esta población incluye adultos mayores recién infectados y sobrevivientes a largo plazo que envejecen con VIH. Este artículo revisa los desafíos y las oportunidades para las personas con discapacidad mayores, centrándose principalmente en cuestiones psicosociales. Si bien el crecimiento de esta población atestigua el éxito de los tratamientos contra el VIH, los PWH mayores se enfrentan a numerosas dificultades en la edad adulta, incluidas las altas tasas de morbilidad múltiple, problemas de salud conductual, estigma del VIH y aislamiento social. Muchos PWH mayores enfrentan dificultades para encontrar atención en sistemas fragmentados mal alineados para los desafíos duales del envejecimiento y el VIH. Abordamos estos problemas estructurales y la desalineación con ocho recomendaciones de políticas para mejorar el acceso a la atención y apoyar el envejecimiento saludable. Estas recomendaciones se dividen en tres categorías principales: 1) un mayor reconocimiento de esta población en la planificación y la Estrategia Nacional contra el VIH / SIDA, 2) un mejor acceso a los programas a través de los programas de la Ley Ryan White y Older American's Act, y 3) mejores datos de vigilancia sobre esta población globalmente A falta de una cura, el aumento dramático en la población de personas mayores con PWH continuará en el futuro previsible. Es deber de los defensores, gerontólogos, proveedores de servicios sociales y de salud y formuladores de políticas satisfacer las necesidades de las personas mayores con VIH. 根据疾病预防控制中心（CDC），美国近50万50岁及以上的成人患有人类免疫缺陷病毒（HIV）。这一人口将继续增加，并且一些预测暗示美国HIV携带者（PWH）总数中近70%将在2030年达到50岁及以上。随着抗逆转录病毒疗法的可及性得以扩散，该模式在全球都是如此。这一人口包括新感染的中老年人和长期伴随HIV衰老的生存者。本文审视了中老年PWH的挑战与机遇，主要聚焦于心理社会问题。尽管这一人口的增长证实了HIV治疗的成功，但中老年PWH在之后的生活中面临诸多困难，包括多种疾病的高发病率、行为健康问题、HIV耻辱、以及社会隔离。许多中老年PWH在分散的医疗卫生体系中寻求护理时面临困难，这些体系无法良好应对老龄化与HIV的双重挑战。我们提出八项政策建议应对这些结构性问题和不一致，以期提高护理可及性并支持健康老龄化。这些建议分为三个主要类型：1) 在规划国家艾滋病毒/艾滋病战略时提高对这一人口的重视；2) 通过瑞安•怀特项目和《美国老年人法案》项目提高相关项目的可及性；3) 提升全球在这一人口上的监测数据。鉴于无法痊愈，中老年PWH人口的显著增加情况将在可预见的未来中继续存在。满足那些携带HIV衰老的人口的需求，是倡导者、老年学家、卫生与社会服务提供者、以及决策者的职责。

Suggested Citation

  • Charles A Emlet & Mark Brennan‐Ing, 2020. "Is There no Place for Us? The Psychosocial Challenges and Rewards of Aging with HIV," Journal of Elder Policy, John Wiley & Sons, vol. 1(1), pages 69-95, June.
    • Handle: RePEc:wly:eldpol:v:1:y:2020:i:1:p:69-95
    DOI: 10.18278/jep.1.1.4
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    References listed on IDEAS

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    1. Christine S Autenrieth & Eduard J Beck & Dominik Stelzle & Christoforos Mallouris & Mary Mahy & Peter Ghys, 2018. "Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000–2020," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-11, November.
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    4. Peter Piot & Michael Bartos & Peter D. Ghys & Neff Walker & Bernhard Schwartländer, 2001. "The global impact of HIV/AIDS," Nature, Nature, vol. 410(6831), pages 968-973, April.
    5. Cahill, S. & Valadéz, R., 2013. "Growing older with HIV/AIDS: New public health challenges," American Journal of Public Health, American Public Health Association, vol. 103(3), pages 7-15.
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