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White House Meeting on HIV/Aging
  from Jules: I attended this meeting 2 days ago hosted by Jeff Crowley and his staff at the Office of National AIDS Policy at the White House. Amy Justice started the day with a review of data on accelerated comorbidities and frailty and disabilities in HIV+ and some of the causes including immunosenescence. This was followed by several panels which highlighted a number of concerns patients are facing after 50 yrs old including higher rates of depression, isolation, higher rates of comorbidities, fear of aging, economics of aging, and stigma. There was plenty of audience participation & comment by the several dozen attendees during Q&A. As well Carl Dieffenbach was on a panel and briefly mentioned research efforts on aging at DAIDS. Sitting in the audience but not commenting were two ACTG researchers Judy Currier and Steve Deeks. I commented after Dr Justice's talk about research and the morbidity & mortality concerns persons aging with HIV are facing. Jeff Crowley commented at the end of the 3 hour meeting by saying we would have followup meetings. I commented we need to bring together a good panel to figure out how to educate clinicians about providing adequate care for aging issues, that HRSA needs to be involved, and we need 'Aging Clinics' so patients can access the specialists they need. The economy was mentioned as a pushback. This meeting is one in a series ONAP is holding, so it highlighted issues and what is going on in aging/HIV and confirms the issue has gotten traction as it is receiving research attention but much more is needed to in fact achieve progress in addressing these serious health concern. HIV+ individuals over 50 are facing increased risk for frailty, bone fractures, cognitive impairment, disability, diabetes, heart disease, liver disease (HCV, HBV) kidney disease, as evidenced in numerous studies. Of course how bad will this be? I think it will get worse in the near future.
Amy Justice, Yale professor speaks at White House on HIV and aging
posted: October 27, 2010
School of Medicine professor Dr. Amy Justice was invited to the White House to give a presentation on HIV and aging.
Justice's appearance, as part of a larger meeting on the subject, took place on Wednesday, Oct. 27, between 8:30 a.m. and noon.
The purpose was to raise awareness about HIV infection among older Americans, a subject that concerns Justice. "By 2015, half of those living with HIV in the United States will be 50 years or older," she says. "We must prepare now to care for these individuals, who are likely to experience a greater burden of disease from HIV infection, toxicity from HIV treatment and other co-occurring HIV and aging-associated conditions. As a greater proportion of older individuals live with HIV infection, a greater proportion of new infections will occur in this age group."
The meeting, which was sponsored by the White House Office of National AIDS Policy, also aimed to highlight the successes and challenges of people aging with HIV, to explore existing services for older Americans with HIV and potential gaps in meeting their needs.
Justice is professor of medicine and associate professor of public health/health policy. She serves as section chief of general internal medicine in the Veterans Administration Connecticut Healthcare System. She is affiliated with Yale's Center for Interdisciplinary Research on AIDS.
For more than 20 years, Justice has conducted research focusing on outcomes in chronic HIV infection. Her goal is to use HIV infection as a model for improving outcomes for chronic disease. She is the principal investigator on the Veterans Aging Cohort Study. This research, primarily funded by the National Institute on Alcohol Abuse and Alcoholism and the National Heart, Lung and Blood Institute, considers the complex roles of aging, symptoms, medical treatment, adherence, patient-provider relationships, disease severity, and medical and psychiatric illness in determining survival and quality of life for people with HIV infection.
More Older Americans Living With HIV
Many have multiple conditions, posing new challenges for U.S. health care system

By Jenifer GoodwinHealthDay Reporter
THURSDAY, Oct. 28 (HealthDay News) -- Better treatments are extending the lives of people with HIV, but aging with the AIDS-causing virus takes a toll that will challenge the health care system, a new report says.
A survey of about 1,000 HIV-positive men and women ages 50 and older living in New York City found more than half had symptoms of depression, a much higher rate than others their age without HIV.
And 91 percent also had other chronic medical conditions, such as arthritis (31 percent), hepatitis (31 percent), neuropathy (30 percent) and high blood pressure (27 percent). About 77 percent had two or more other conditions. About half had progressed to AIDS before they got the HIV diagnosis, the report found.
"The good news is antiretroviral therapies are working and people are living. If all goes well, they will have life expectancies similar to those without HIV," said Daniel Tietz, executive director of the AIDS Community Research Initiative of America.
"But a 55-year-old with HIV tends to look like a 70-year-old without HIV in terms of the other conditions they need treatment for," he said Wednesday at a meeting of the Office of National AIDS Policy at the White House in Washington, D.C.
The research included interviews with 640 men, 264 women and 10 transgender people. Dozens of experts on HIV and aging attended the meeting, which was intended to identify the needs of older adults with HIV and to explore ways to improve services to them.
Currently, about 27 percent of those with HIV are over 50. By 2015, more than half will be, said the report.
Because of their special needs, this poses challenges for public health systems and organizations that serve seniors and people with HIV, Tietz said.
HIV can be isolating, Tietz said. Seventy percent of older Americans with HIV live alone, more than twice the rate of others their age, while about 15 percent live with a partner, according to the report.
The survey found that loneliness was higher among HIV-positive adults than for other older Americans. One reason is that many men and women conceal the condition from friends and family for fear of stigma or rejection, both real and imagined, Tietz said.
Lack of social and family support increases the likelihood of needing costly health care, such as home health aides and nursing homes as they get older, Tietz said.
Dr. Amy Justice, an HIV researcher who also attended the meeting, spoke of the need for health care professionals to learn about specific issues facing HIV-positive seniors.
HIV organizations tend to gear messages toward younger people, and senior services organizations often don't know much about the needs of HIV-positive seniors, said Justice, principal investigator of the Veterans Aging Cohort Study. This ongoing study involves some 40,000 veterans with HIV and 80,000 without HIV from 10 Veterans Affairs medical centers nationwide.
"There are a lot of people with HIV who are 60 or 65 and even 80 or 85," Justice said. "Those individuals feel older than their stated age and may have some of the same problems people 10 or 15 years older would normally experience."
Many older Americans with HIV are still sexually active and should be encouraged to practice safe sex, Justice said. While 57 percent of older Americans with HIV said they disclosed their HIV status to sexual partners, about 16 percent didn't, the report found.
About half the survey participants were black, one-third were Hispanic and 14 percent were white. About 67 percent considered themselves heterosexual, 24 percent were gay and 9 percent bisexual.
Why people with HIV are more likely to have other chronic diseases is still unclear, Tietz said. The cause could be the HIV itself or long-term side effects from taking multiple medications, he said. Early HIV drugs were especially toxic, he added.
HIV-positive retiree who was evicted from assisted living to attend White House meeting on AIDS and aging
October 25th, 2010
WASHINGTON -- Lambda Legal client Dr. Robert Franke, who was evicted from a Little Rock, Ark., assisted living facility because he has HIV, has been invited by the White House to participate this week in a conference on HIV and aging. Dr. Franke, a retired educator and former minister, will attend the meeting with his daughter, Sara Bowling, and Lambda Legal HIV Project Staff Attorney Scott Schoettes. Schoettes will speak on a panel addressing issues likely to affect seniors living with HIV.
Lambda Legal represented Franke and Bowling in a lawsuit against Fox Ridge, an assisted living facility in North Little Rock owned by Parkstone Living Center. Franke returned to Arkansas and moved into Fox Ridge to be closer to Bowling, but was evicted almost immediately due to his HIV status. The lawsuit was settled last month.
"We're excited and honored that the White House has recognized Lambda Legal's decades of work on behalf of HIV-positive Americans," Schoettes said. "And this recognition underscores the message we want to send to long-term care providers and others: ignorance about HIV transmission does not exempt you from laws that prohibit this kind of discrimination."
The meeting takes place at the White House on Wednesday, Oct. 27, and is part of an ongoing series of discussions on HIV organized by the White House Office of National AIDS Policy.
"My father and I are grateful for the opportunity to go to the White House," Bowling said. "We are also encouraged that the administration is addressing the issue of HIV/AIDS and aging and the discrimination that goes along with it. We hope that one day discrimination and prejudice against others will no longer exist."
Previous meetings have addressed HIV and women, HIV and youth, and HIV and Latinos. Schoettes, Franke and Bowling will be in Washington through Thursday.
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