September 19, 2013

Health care a challenge for elderly with HIV

As people with the disease age, the need for services gains urgency in older and more rural states like Maine.

By Kevin Miller kmiller@pressherald.com
Staff Writer

WASHINGTON – The growing number of Americans who are living longer with HIV and AIDS is creating new health care challenges and could compound existing challenges in rural states with older populations, such as Maine, a Senate committee was told Wednesday.

click image to enlarge

Kenney Miller, executive director of the Down East AIDS Network, testifies Wednesday, Sept. 18, 2013, during a U.S. Senate Special Committee on Aging hearing on the challenges Maine and other rural states face as numbers increase of people over age 50 who have HIV or AIDS. Miller’s agency works with HIV/AIDS patients in Hancock and Washington counties.

Photo by Vein Miller

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Once perceived as a young person's disease, HIV is increasingly a problem for the middle-aged and the elderly as advances in treatment help those people live longer and older adults stay sexually active.

Those trends force health care professionals and policymakers to adapt HIV treatment to a graying population with more complicated medical needs.

"While living with HIV is not easy at any age, older individuals face different issues than their younger counterparts," Sen. Susan Collins of Maine, the top Republican on the Senate Special Committee on Aging, said at a hearing on the changing face of HIV across the country. "HIV is still viewed as a young person's disease, and older adults with HIV may encounter ageism and additional stigma."

Just four years ago, the U.S. Centers for Disease Control and Prevention estimated that one-third of all Americans with HIV were 50 or older. That figure is expected to hit 50 percent between 2015 and 2020, depending on the data source.

Maine, which has the oldest population in the U.S., has already hit that threshold, although HIV incidence rates in the state remain low.

According to data from the Maine CDC, 831 of the 1,654 people diagnosed with HIV were at least 50 as of last year.

Nearby Massachusetts -- another state that's statistically grayer than the national average -- is already at 52 percent.

"This is an urgent problem in Massachusetts and it is a coming problem for the rest of the country," said Sen. Elizabeth Warren, D-Mass.

The challenges of aging with HIV can be particularly acute in rural states, said Kenney Miller, executive director of the Down East AIDS Network, a service provider in Washington and Hancock counties.

Miller told the committee that people with HIV in rural areas often face additional obstacles accessing specialized care, and more intense discrimination because of lingering stigma against HIV or, in some cases, men who are gay. That can lead to greater isolation and depression.

In Maine, just eight infectious-disease physicians specialize in HIV treatment. The only one for Hancock and Washington counties is in Ellsworth -- a four-hour round-trip for his clients in the Calais area -- and that doctor is semi-retired and works part time, Miller said.

"I think it's a reasonable hypothesis that the challenges posed by aging and living in a rural area amplify one another," Miller said. "People aging with HIV in a rural environment face significantly greater stigma, isolation and barriers to care compared to their younger, more urban counterparts."

First documented in the U.S. in the early 1980s, HIV is a virus that attacks the immune system and can eventually lead to AIDs. While there is no known cure, advances in drug treatments now allow many people to live near-normal lives for decades without serious complications.

But as people with HIV live longer, doctors are finding that they are more likely to develop chronic conditions such as cardiovascular disease, cancer and dementia at an earlier age than people who aren't infected.

Earlier onset of those diseases appears to be attributable, at least in part, to the fact that HIV forces the immune system to be on nonstop "overdrive" as it fights the virus, said Rowena Johnston, vice president and director of research at The Foundation for AIDS Research.

"It actually runs itself down," Johnston said. "The immune system literally is tired out and is unable to function properly anymore."

Also discussed Wednesday was the fact that 11 percent of all new diagnoses in the U.S. in recent years have been for people older than 50.

Speakers called for routine HIV testing of older adults and spending on research and development for a cure. They also said there must be a campaign to educate older adults about the importance of condom use and to counter misconceptions about older people's love lives.

"I think where we are still challenged is the fact that too many health care providers don't know how to talk to their clients and patients about sex," said Dr. Ronald Valdiserri, deputy assistant secretary in the U.S. Department of Health and Human Services' Office of HIV/AIDS & Infectious Disease Policy. "And they also make the assumption that older Americans are not sexually active."

Maine is actually ahead of many other states in ensuring that HIV patients have access to health care. The state made it easier for more people to qualify for Medicaid coverage by raising the cutoff for income.

James Markiewicz, who directs the Maine CDC's program for HIV, sexually transmitted disease and viral hepatitis, said 98 percent of the people in a special federal program for HIV clients have some form of insurance. So while the aging of HIV patients presents challenges, Markiewicz said it is one of many health care issues facing Maine's graying population.

"HIV has become one of those things that we think about when we discuss how to deliver health care to an aging population," Markiewicz said in an interview from Maine.

Kevin Miller can be contacted at 317-6256 or at:

kmiller@mainetoday.com

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