The conversation about HIV/AIDS with LGBT seniors today is part prevention and part survival. There have been major changes in both. Whether you are neg or poz, partnered or single, you should have the latest information.
In prevention news
The FDA has approved Truvada, an anti-retroviral medication, as the first drug that can help prevent HIV infection: great news if you can afford it ($12,000 a year) and want to risk the possible side effects of the medication. This news is especially important for “sero-discordant” couples (one poz, one neg), sexually active singles and sex workers. With a daily dose of Truvada, if you are HIV negative, and your sex partner has a viral load that is undetectable, there is a much lower risk of infection than ever before. It is almost non-existent . . . almost. It is your decision about what risks you are willing to take.
Also on the prevention side for seniors is testing and diagnosis. Testing is now an easy swab of your mouth, in the privacy of your home. Testing is key because many doctors miss the signs of HIV infection in older adults. The symptoms of HIV infection often mimic symptoms associated with infections and age-related medical conditions typically found in seniors. If you are sexually active, make sure that your doctor tests you for HIV and all of the other STDs.
On the survival side
There are now 30 drugs approved by the FDA to treat HIV. For those of you who are poz and who have been paying attention, you know about the side effects. What many don’t know is that there are side effects from the medications, side effects from HIV, and side effects from aging.
Once you are infected or on anti-retroviral therapy (ART), the aging process seems to speed up. People who are on ART seem to get the typical diseases of aging, earlier: cardiac, kidney and liver disease, cancers, diabetes, glaucoma and the like. Scientists aren’t sure if the aging process is actually speeded up or if the illnesses occur earlier in the life cycle because of the virus and the medications.
The next biggest news
The Centers for Disease Control (CDC) issued guidelines in March recommending that anyone over 50 who is poz should be on ART. The CDC said it is better to be on treatment, with the possible side effects, rather than risk the impact of HIV on aging and other health issues.
Following the CDC guidelines may mean having to deal with side effects including diarrhea, neuropathy, dry skin, lipodystrophy and facial wasting, to name a few. Because you are getting older and aging faster, you may have to start taking some of the “aging disease” drugs for blood pressure, diabetes, cardiovascular disease, bladder and kidney function, erectile dysfunction and other conditions. As a result, you have to be aware of possible interactions between those drugs and your HIV meds.
Some good news
For those HIV warriors out there with facial wasting and lipodystrophy, there are some treatments. Sculptra, Botox, Egrifta and surgery are all possible remedies. But there is a snag: money. All of those options are expensive and some are not covered by insurance. The best way to deal with all of these issues is to have conversations with your doctors, get all of the information you can, and then make an informed decision about what is best for you.
Some more good news
Exercise, nutrition and emotional outlook all play a part in successful aging with HIV. A holistic approach to your health – care, meds, exercise, nutrition and outlook all combine to support your immune system in fighting HIV infection, aging and medication side effects.
Then there is stigma
Good old stigma and discrimination. Remember when it was simple and everybody stigmatized LGBT and Haitian folk? Then it was the neg against the poz folk, and vice versa – the original HIV apartheid. Now there is the divide between the people who became poz before the cocktail and those infected after it – those who had opportunistic infections vs. those who were saved that horror show by the cocktail. Throw in some ageism and you have even more challenges with the process of aging with HIV.
The next frontier of stigma and discrimination could be in accessing elder care services. In nursing home and home health care settings, LGBT elders face real or perceived discrimination because of their sexual orientation or gender identity. Will the next wave of intolerance in those and other aging care settings be against poz folk?
Education, information, fitness, nutrition and care. You can only control what you can control, but you must take whatever control you can:
- Educate yourself about your options. Find and absorb all of the information that you can.
- Stay fit and healthy. Exercise. Eat healthy foods and take vitamins and supplements. HIV and the drugs deplete your body of almost everything you need to survive and age well.
- Access the care that is available to you. Despite government cut-backs, there are still many resources available for care and for medications.
AIDS isn’t over, it’s just older. If you are neg and sexually active, you can access the information that you need in order to stay neg. If you are poz, no matter how long ago you were infected, you have more options for care and more control over the infection and your future than ever before. Whatever your HIV status, your own actions have more impact on how well and successfully you age than any other factor. Information = Power. Take control!
Ed Bomba holds a Masters in Business Administration in Marketing from the Pennsylvania State University and a B.A. in Political Science from the University of Delaware; lectures on AIDS-related topics at the undergraduate level; and is communications chair of the LGBT Elder Initiative. The LGBT Elder Initiative (LGBTEI) is committed to assuring that LGBT older adults have rights and opportunities to live vibrant, creative and mutually supportive lives. To achieve this vision, the mission of the LGBT Elder Initiative is to foster and advocate for services and resources that are culturally competent, inclusive and responsive to the needs of LGBT elders in the Delaware Valley and beyond.