The aging of AIDS

New support method offered for older adults with HIV/AIDS

By Colleen Kiphart

The HIV support group is filled with young faces. They talk about dating, slowing work-out routines, body image, college stress. But one face, a bit more worn than the others, holds thoughts he can’t bring himself to voice. How will he tell his grandchildren? Can he add more medications to his staggering daily regimen? How many more friends can he lose? What will people think?

According to the Centers for Disease Control, in 2005, 24 percent of those living with AIDS were 50 or older, compared to 17 percent in 2000. At this rate, by 2015, half of all new cases of HIV in the U.S. will be in people over the age of 50.

Given these data, and the increasing life spans of people with HIV and AIDS, Tim Heckman, Ph.D., noticed a research oversight; among major studies, research samples all reflected people in their 20s and 30s. “We need to assess the psychological needs of older adults, too,” said Heckman, who is a professor of geriatric medicine and gerontology at the Ohio University Heritage College of Osteopathic Medicine.

To do so, Heckman, secured a four-year National Institutes of Health research grant in 2006. In its first two years, the research expanded nationwide and yielded a breakthrough study on the benefits of telephone support groups for older adults with HIV or AIDS who suffer depression.

About 35 percent of older adults with HIV live alone, according to Heckman. Many “don’t feel connected to the older community because of their HIV-positive status,” he says. Meanwhile, they often don’t relate to the younger HIV-positive community, or they simply avoid seeking support to avoid social stigma. Telephone support groups provide community with anonymity.

Heckman recruited ninety adults in New York, Ohio, Pennsylvania and Arizona, all of whom recently were diagnosed with HIV or AIDS in addition to a serious depressive disorder, to participate in telephone support groups.

The participants were divided into two groups, with one half receiving immediate intervention—group telephone sessions moderated by graduate students—and another receiving delayed intervention. Participants in both groups reported some reduction in their depression and loneliness, but the immediate intervention group saw the greater benefit.

Charles A. Emlet, Ph.D., MSW, associate professor of social work at the University of Washington Tacoma, who also studies AIDS in older populations, explains the difficulty in classifying the psychological needs of this group.

“Older adults living with HIV/AIDS are not a homogeneous group,” Emlet says. “The newly diagnosed face challenges with medication regimens, understanding the disease, disclosure and potential social stigma. Long-term survivors also face [additional] health conditions and psychological impacts of the disease such as depression.”

The trick, Emlet says, is in managing both the virus and the process of aging—which requires concurrent expertise in infectious disease, chronic care and geriatrics. He adds that the intersection of these conditions is not well understood, and [treatment] resources are limited and concentrated in metropolitan areas.

Heckman agrees that more research is needed, “There are no long-term studies on the effects of [antiretroviral] medications…We need to better understand how HIV medications interact with other therapies [in older adults].” 

Heckman cites data showing that people 55 and older at the time of their diagnosis have the lowest survival rate of any group and are usually diagnosed later into their illness—sometimes not until the disease has progressed into AIDS.

Heckman explains that both patients and doctors often assume HIV symptoms are just part of getting older. “There’s a reluctance to think of sexually transmitted infections in older adults. Physicians don’t think of it.” Heckman recalls one HIV-infected older woman who went to 25 doctors before one asked her if she had been tested for HIV.

Many older people are often misinformed about safe sex and HIV, correlating condoms exclusively with birth control, for example. This, combined with vaginal dryness and tearing in older women, erectile dysfunction drugs, drug use, and rising rates of separation and divorce, makes a perfect storm for the spread of HIV in people over 50.

The disease is not spreading evenly across demographics. While gay men still make up the majority of the HIV-positive older population, African-American women over the age of 50 are now among the most at-risk populations for contracting HIV, and diagnoses among African-American and Hispanic populations are growing at 12 and five times the rate of Caucasians, respectively.

Heckman’s next study will examine the patterns and needs among this diverse population. His work will include 360 people, nationwide, including Hawaii, urban areas, rural areas—anywhere there is a need. His ultimate goal is to “identify intervention programs that work, and help organizations and communities implement them.” 

Over the last two decades, HIV has gone from a death sentence to a manageable, chronic disease. Heckman was among the first to identify the long-term implications of this shift for older adults, and is helping them find their way to a better quality of life.