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Aging and HIV: How Can Psychology Better Serve the AIDS Generation?

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By Perry N. Halkitis, PhD, MS, MPH

Living out your golden years with HIV – once unimaginable – is becoming a reality for hundreds of thousands of Americans. The AIDS epidemic in the United States is vastly different from when we first encountered this disease in 1981. After hundreds of thousands of deaths, especially for many in the gay population, the course of the disease hit a turning point in 1996 with the development of effective antiretroviral therapies (i.e., ART), which when used in combination and properly dosed can halt the replication of the virus.

In the early days of AIDS, most were diagnosed when they developed AIDS-related opportunistic infections. Duration of survival after such infections were detected was usually two years or less. The men whom I interviewed for my book The AIDS Generation: Stories of Survival and Resilience, are all now in or about middle age, but they all became aware of their infections prior to 1996 and were convinced that their lives would end in two years. In the book I explore this concept as “the myth of two,” And despite their apprehensions they have survived and thrived to tell their stories.

The 15 men who constitute the heart and soul of my book are part of a growing number of individuals living with HIV who are in their middle age. It is estimated that by 2015, half of all Americans infected with the virus will be ages 50 and older. This epidemiological trend is due both to the successes of ART as well as an increasing number of individuals who are becoming infected later in life. This phenomenon has also been called “the graying of AIDS.”

Many of these older adults living with HIV are members of the baby boomer generation. And as we grapple on how to best meet the needs of aging baby boomers, which are vastly different from those of previous generations, we are also confronted with the complexities facing boomers infected with HIV.

So, what role does psychology have to play in this arena?

Many of the complications of aging with HIV manifest themselves with regard to mental health burdens and psychosocial conditions, such as racism, homophobia, and poverty, which diminish the quality of life for older HIV-positive individuals. The men in my book speak clearly and loudly of a need to develop a new set of services to address these psychological and psychosocial states.

We psychologists must be at the table with all other health care providers as we develop comprehensive and holistic approaches to care for older HIV-positive adults. The approaches should recognize that HIV and all other disease states are informed best by biopsychosocial perspectives and not simply biomedical ones. APA is a leader in this regard having passed a resolution that calls for the integration of biomedical and behavioral technologies for HIV prevention.

At APA’s 2013 convention, the Committee on Psychology and AIDS (COPA), on which I serve, conceived and organized a powerful and informative symposium by addressing the biopsychosocial challenges of aging with HIV. Many of the papers presented will appear in a 2014 special issue of Behavioral Medicine, and the session was recorded for use by the HOPE training program. COPA’s upcoming issue of its newsletter the Psychology & AIDS Exchange focuses on the topic of HIV and aging.

As psychologists forge ahead in seeking to understand and ultimately meet the needs of an aging HIV-positive population, it is imperative that we do not direct our efforts from a model of deficit but rather from one of resilience. For a population that is aging with HIV, some of whom are long term survivors, the experience of aging should not be directed by addressing what is wrong but rather what is right. The 15 men, all long-term survivors, whose stories are shared in my book have demonstrated resilience throughout the course of their entire lives. From their acts we can glean lessons that inform the development of programs for aging as well as all HIV-positive individuals, and more broadly for those confronting any chronic and demanding disease.

We want to hear from you. Tell us in the comments:

  1. How can psychologists and other healthcare professionals better serve those aging with HIV?

  2. What does the future hold for this and future generations of those aging with HIV?

  3. How do we shift the conversation in both research and practice from one of deficit to one of resilience, and how can a resilience approach be used to work with aging HIV+ clients?

Perry N. Halkitis, PhD, MS, MPH is Professor of Applied Psychology and Public Health (Steinhardt School), and Population Health (Langone School of Medicine), Director of the Center for Health, Identity, Behavior & Prevention Studies, and Associate Dean (Global Institute of Public Health) at New York University. Dr. Halkitis’ program of research examines the intersection between the HIV epidemic, drug abuse, and mental health burden in LGBT populations, and he is well known as one of the nation’s leading experts on substance use and HIV behavioral research. Dr. Halkitis holds degrees in psychology, education, and public health. He is the author of The AIDS Generation: Stories of Survival and Resilience. Dr. Halkitis blogs regularly for his own website, the Huffington Post, and the Oxford University Press. Follow Dr. Halkitis on Twitter: @DrPNHalkitis

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