“The Changing Face of HIV/AIDS in America”

Over the past several decades, improvements in modern medicine have significantly prolonged the lives of those diagnosed with HIV/AIDS. Our success in combating HIV/AIDS, however, has presented a new challenge for policymakers, researchers, and those living with this disease, namely, controlling its adverse effects and preventing its spread among older adults. Recently, the Senate Special Committee on Aging, of which I am Ranking Member, held a hearing that coincided with National HIV/AIDS and Aging Awareness day. The Committee heard testimony from a panel of health officials and community advocates such as Kenney Miller, Executive Director of the Down East AIDS Network in Ellsworth, and focused attention on the issues facing older Americans regarding HIV prevention, testing, care, and treatment.

Thanks to major scientific advances in antiretroviral drugs, the type of medicine commonly prescribed to treat HIV/AIDS, HIV is no longer an early death sentence, and people with HIV/AIDS can now enjoy a near-normal lifespan. Today, 50 percent of people living with HIV/AIDS in Maine are over age 50, and 16 percent are over 60, a testament to just how successful our research and treatment efforts have been.

The fact that increasing numbers of older adults are being diagnosed with HIV has also contributed to the “graying” of the HIV/AIDS population. According to the CDC, people older than 50 accounted for 17 percent of new diagnoses in 2011, up from 13 percent in 2001.The success of HIV treatments combined with increasing numbers of newly diagnosed older individuals means that people aged 50 and older will account for the majority of the people living with HIV in the United States by 2015.

At the beginning of the AIDS epidemic in the 1980s, people who were diagnosed with HIV could expect to live only a year or two after their diagnosis. Consequently, issues associated with aging were not a major focus for people with HIV. New medications and treatments, however, have changed all that. These individuals now have to face the challenges of aging with HIV.

While living with HIV is not easy at any age, older individuals face different issues than their younger counterparts. HIV is still viewed as a young person’s disease, and older adults with HIV may encounter ageism and additional stigma. This may make it even more difficult to disclose their status to family or friends, limiting their access to emotional and practical support and increasing their sense of social isolation.

In his testimony, Kenney Miller of the Down East AIDS Network informed us of the unique challenges confronted by those diagnosed with HIV who live in a rural state with an older population like Maine. Such difficulties include barriers to treatment which are not present in more urban communities, including fewer physicians who are experienced in treating HIV/AIDS and long geographical distances separating patients from their providers. Moreover, rural HIV/AIDS patients are at increased risk for developing neurocognitive dysfunction, functional decline, and depression.

While HIV patients are living longer, many appear to be aging prematurely and are coming down with chronic conditions related to aging such as dementia and cardiovascular disease a decade sooner than their uninfected peers. Antiretroviral drug therapy can affect, and possibly even worsen, these medical conditions. Moreover, the decreased immune function that naturally results from aging makes older persons more vulnerable to a more rapid progression from HIV infection to AIDS.

Currently, the CDC only recommends routine HIV testing up to age 64, which prevents some older adults from learning their HIV status. This can delay a diagnosis, which in turn delays treatment and reduces its effectiveness. It also increases the opportunity for further HIV transmission. In order to increase the efficacy of care provided to those with HIV/AIDS, particularly those who are older, we must begin by recognizing that this disease affects individuals of all ages.

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Photo 1: (From L to R) U.S. Senator Susan Collins and Kenneth "Kenney" Miller, Executive Director of DEAN.

Photo 2: (From L to R) Kenneth "Kenney" Miller, Executive Director of DEAN and U.S. Senator Susan Collins