Aging / HIV / Latinos - Report Released Illuminating The Needs Of The Forgotten - "Olvidados": A National Health Assessment Of Latinos Growing Older With HIV
Download the PDF here
July 5, 2017
Latino Commission on AIDS Press Release
New York, New York- The Latino Commission on AIDS and the Hispanic Health Network release a national report "Illuminating the Needs of the Forgotten "Olvidados": A National Health Assessment of Hispanic/Latinos Growing Older with HIV". The impetus for this assessment was our concern that current research does not adequately address the needs of the aging Hispanic/Latino population that is living with HIV. Since Hispanics/Latinos generally encounter many obstacles in accessing health care, it is important to understand whether these barriers remain consistent through the life course or whether they aggravate among this more ignored and vulnerable subgroup.
There is a pressing need to examine the health care of a population that is too often forgotten- "Olvidados" This report, the first of its kind, describes the results of a national community needs assessment for primarily Spanish speaking Hispanics/Latinos, aged 50 and older, who are living with HIV. In a yearlong project, the Commission visited cities with high rates of HIV including Houston, and San Antonio, Texas; Fajardo, Camuy, and San Juan, in Puerto Rico; New York City, New York; Los Angeles, California, and Miami, Florida.
"It is urgent to understand the needs of people growing older and living with HIV. We must be the voice of the voiceless to ensure we meet their prevention, care and social needs free of stigma and discrimination at every level", said Guillermo Chacon, President of the Latino Commission on AIDS and founder of the Hispanic Health Network.
"It is important to study the structural and social determinants of HIV/AIDS disease among older Latinos and to develop effective responses. Special attention must be dedicated to understanding the unique realities of both U.S.-born and foreign-born Hispanic populations in our nation," said Dr. David Garcia, Director of Research and Evaluation and Principal Investigator for the Latino Commission.
We are grateful to Gilead Sciences, the Hispanic Federation and AIDS United for their financial support and dedication to this important project.
⇒Mental Health Concerns. Older individuals living with HIV/AIDS tend to exhibit
higher rates of psychological disorders. There is no doubt that living with HIV, a
chronic, life-threatening, and highly stigmatized illness, can exacerbate or even trigger
certain debilitating mood disorders. Clinical depression, generalized anxiety disorder
and post-traumatic stress disorder are among the most prevalent diagnoses affecting
older individuals with HIV. Depression is the most common psychiatric condition
affecting HIV diagnosed adults, with those aged 65 and older reporting higher rates
both of depressive symptoms and suicidal behaviors (Brooks et al., 2012).
As HIV-positive adults grow older, they face added social, psychological, and physical
challenges compared to their younger counterparts, particularly higher levels of
psychological distress (Grov, Golub, Parsons, Brennan, & Karpiak, 2010). Intense
anxiety, depressed mood states, suicidal tendencies, and post-traumatic stress disorder
have been widely reported in numerous studies on the mental health of individuals
living with HIV/AIDS (Cohen et al., 2002; Kalichman, Heckman, Kochman, Sikkema,
& Bergholte, 2000; Miles, Isler, Banks, Sengupta, & Corbie-Smith, 2011).
The strong correlation between HIV and depression is partly due to poorer cognitive/
physical function resulting from HIV’s impact on the body as well as to the side effects
of antiretroviral medicines, health-induced anxiety, stress, stigma, and social isolation
(Grov et al., 2010). Depression and anxiety undoubtedly affect the physical health
outcomes of HIV-positive individuals. Research has found that chronic depression and
anxiety severely affects HIV’s progression-- associated with decreased CD-4 count,
increased viral load, and greater risk for clinical decline (Leserman, 2008; Vanable,
Carey, Blair, & Littlewood, 2006).
Due to a multitude of social and physical factors, older individuals living with HIV/
AIDS are at a higher risk of developing severe, debilitating psychological disorders.
These may ultimately affect their ability and willingness to access health care. Stresses
associated with racial and ethnic discrimination, in conjunction with the experiences
of lifelong poverty and low income, also contribute to poorer health and wellbeing in
older age. Furthermore, the interaction of these stressors and experiences over the life
course may result in a compromised immune system that leaves older HIV-positive
minorities more vulnerable to the development of AIDS, as well as at increased risk
for comorbidities such as cardiovascular illnesses and diabetes.
⇒The Latino Commission on AIDS, the Hispanic
Health Network, and the community networks we work with call on
city, county and state health departments to take action to address
the needs of the aging Latino population living with HIV/AIDS
and other chronic conditions in our nation and U.S. territories.
Growing older and healthy must be a national goal for all of us.
⇒Fully half of the respondents reported issues with
depression, highlighting the critical gap in mental-health services.
⇒One in three respondents indicated some level of difficulty
with treatment adherence, warranting further exploration and
⇒Although the sample reported relatively low frequency
of substance use, 12% indicated that they were in recovery.
Respondents may be under-stating such problems because of
social-desirability bias, but regardless, provider conversations
related to substance use were also reported as low.
identified to optimal health and wellbeing include fear and mistrust,
experience of comorbidities, and access-to-care challenges.
Such obstacles complicate patient adherence and management of
side effects as well as increasing the likelihood of social isolation,
which can in turn exacerbate depression, increase stress and further
compromise the immune system. The most vulnerable may find
it harder to self-regulate, and may instead use maladaptive coping
mechanisms such as substance use, poor diet/exercise, addictive
behaviors or participating in unhealthy relationships.
⇒The facilitators for improved quality of life and health
included a strong relationship with their provider, high levels
of social capital or support systems, sex positivity, and work/
⇒Low Levels of Educational Attainment. Older Latinos are among the least
educated groups in the United States, with significantly lower levels of secondary and
higher education than the general population.
⇒Inadequate Health Coverage. Older Hispanics face many health disparities and
burdens resulting from their lack of access to quality health care. Access to care remains
a major challenge among the Hispanic community more generally: in 2016, about 25%
of Hispanic adults (18-64 years of age) lacked health insurance, compared to 9% of
non-Hispanic whites and 15% of non-Hispanic blacks (CDC, 2017d).