GMHC Treatment Issues: April - June - Volume 21, Number 2
Special Issue on HIV and Aging
Guest Editor Steven Karpiak, Ph.D.,
AIDS Community Research Initiative of America (ACRIA)
A signal event in the history of the HIV/AIDS epidemic occurred in June 2007. The New York City Council passed a $1 million initiative to provide HIV education and prevention information to older adults. The leadership for this initiative came from council member Maria del Carmen Arroyo, chairwoman of the council's Committee on Aging. Key support for the initiative came from the prestigious and influential Council for Senior Center Services in New York City as well as many AIDS service organizations and agencies serving older adults.
Judith G. Rabkin, Ph.D., MPH; Martin McElhiney, Ph.D.
Little is known about the effects of aging on mood and cognitive abilities on people with HIV/AIDS. There is some basis for concern that older HIV+ people may have elevated rates of distress and disorder. Older people in general have fewer sources of social or institutional support, fewer surviving peers, and fewer family members to provide emotional and material support. For older adults who are HIV+, additional sources of strain include illness management, often-complex medication regimens, and psychosocial challenges such as the likelihood that their non-HIV+ peers may consider HIV infection more stigmatizing than do younger people.
In the past 10 years, mortality and complication rates for HIV/AIDS have fallen because of the use of highly active antiretroviral therapy (HAART). This experience is a remarkable success story. As a result, many now consider living with HIV a chronic disease. The average age of living HIV/AIDS patients is increasing. This increasing age in HIV patients will raise the risk of cardiovascular disease, which increases with age. Each year, heart disease kills more Americans than cancer. Diseases of the heart alone caused 30% of all deaths, with other diseases of the cardiovascular system causing substantial further death and disability, including stroke. There is increased emphasis on preventing cardiovascular disease by modifying risk factors, such as diet, exercise, and smoking.
One of the most important findings in every study of older adults with HIV is that social support is critical to successful adaptation to life with HIV. Social support is the functional content of relationships, such as emotional and practical assistance. When family and friends are not able to provide needed assistance, people must rely on community-based services, government agencies, and the health care industry. Social support is particularly important for people as they age. Older adults living with HIV may be particularly challenged because they experience a great deal of distress because of the physical effects of their illness as well as the stigmatization of HIV.
GMHC Treatment Issues: January / March - Volume 21, Number 1
The current terrain for wasting patients in the era of HAART On March 20, 2007, Watson Laboratories stopped the production of nandrolone decanoate (old brand name: Deca Durabolin), a low-cost injectable anabolic steroid used for HIV wasting, citing the lack of raw-material suppliers for the product. Patients found out when they went to their pharmacies for a prescription a week later.
Policies and programs to address the use of illicit drugs at both the national and the international level are fundamental to the success of government responses to HIV/AIDS. In countries where HIV transmission among people who inject drugs is very low, that outcome is usually the result of policies and programs that ensure ready access to sterile syringes (including in prisons in some countries); accessible and affordable opiate substitution therapy for people who inject heroin; and, in some cases, measures such as supervised injection facilities and decriminalization of syringe possession.
Microbicides have been heralded as an "HIV prevention tool of the future,"1 and indeed, the last two decades have seen significant strides in their promotion. However, considerable challenges to microbicides research and development have emerged. One of the most consequential has been the lack of investment by the pharmaceutical industry and, to a lesser degree, by the U.S. government.2 Considering the exponential increase in seroprevalence rates for women who have sex with men, and men who have sex with other men, even a moderately effective microbicidal product could avert an estimated 2.5 million new cases of HIV in men, women, and infants over a three-year period.3
There are three new drugs coming to pharmacy shelves in the next 12 months that might conceivably herald a revolution for HIV-infected people who have developed resistance to many or most available drugs. (This group of so-called "salvage patients" also includes previously untreated people who were infected with drug resistant HIV).
This information is designed to support, not replace, the relationship that exists between you and your doctor.