As a member of the Washington D.C. Center for AIDS Research, I’ve been deeply grateful to see how medications such as PrEP are significantly reducing the toll of HIV. Additionally, we have made great strides with limiting the transmission of HIV. A plethora of research has proven that if HIV is undetectable in your system, it cannot be spread to others. This is known as “U = U” or “undetectable = untransmittable.” While it’s miraculous how far we’ve come in diagnosing and managing HIV, my experience paints a different picture. Older adults who came of age in the early days of the AIDS/HIV pandemic are now struggling with the complexities of managing HIV as they age. More than 40 years into this disease, the medical system needs to develop comprehensive systems of care for people like us. And it starts in the primary care setting.
Half of all people with HIV are now over 50, so we must consider its long-term impact and secondary prevention. We are coping with the daily and long-term challenges of aging, but HIV greatly complicates our lives. When you are taking 27 pills in a single day, as I once did, you can’t help but worry about the impact to your body over time. We have a much greater risk of developing age-related comorbidities such as cardiovascular disease, osteoporosis, kidney disease, and cognitive impairment. And HIV itself can contribute to accelerated aging due to chronic inflammation and immune activation.
Clinicians need to step up to support aging HIV patients by emphasizing secondary prevention that can greatly empower patients and assuage their fears. From my experience, education is paramount to promote medication adherence, self-care, and risk-reduction behaviors and help individuals to make informed decisions about their health. Moreover, PCPs should further support secondary prevention by becoming central coordinators – collaborating with infectious disease specialists, pharmacists, geriatricians, and other health care professionals to ensure comprehensive, coordinated care.
This is why I am enthusiastic about the innovative work being done at George Washington University’s new Two in One: HIV + COVID Screening and Testing Model, which emphasizes dual screenings for HIV and COVID vaccines in the primary care setting. Clinicians are trained in culturally responsive communication to better understand and support patients of color and those in the LGBTQIA+ community. I’ve witnessed how health disparities impact health outcomes, especially in Washington D.C., making it even more essential that clinicians recognize this and educate themselves on structural inequities that limit access to quality care.
I’m also proud to have been on the board of Washington D.C.’s Mary’s House for Older Adults, which supports seniors’ mental health in the LGBTQIA+ community by providing friendship and companionship. As a veteran, I know the significance and impact of mental health services being available to those in need. Clinicians becoming aware of these resources, like Mary’s House for Older Adults, that can help reduce some of the loneliness that patients experience; loneliness that can contribute to adverse health outcomes and even death, as research from the National Library of Medicine suggests. Clinicians must be able to openly discuss this issue and be able to provide holistic care – including professional mental health support as needed. Knowledge should not stop at their office door – PCPs must be aware of community resources and recognize the importance of building and maintaining a strong support network for older adults with HIV.
Engaging patients in open conversations about their concerns, fears, and goals can help develop a genuinely healing relationship between patient and provider. I’ve seen how PCPs who use a comprehensive, empathetic, and informed approach can build more productive relationships that improve health outcomes for those facing HIV and the complexities of aging.
George Kerr, III is a community health advocate.
