Antiretroviral drugs, introduced from 1996, have taken us a long way from the dark days of the 1980s and early 1990s, when people were dying of HIV/AIDS in the UK on a daily basis. There is no difference now between the lifespan of HIV positive and HIV negative men who have sex with men (MSM) in the UK. More than a third of people accessing HIV care in the UK are now aged 50 years or above. HIV positive people are living longer lives. Ageing and HIV is set against a background of falling HIV diagnoses in the UK, with new diagnoses decreasing from 6286 in 2015 to 5184 in 2016. This was a fall of 18 %, with the decline in diagnoses among MSM even more marked at 21 % (Public Health England, Towards elimination of HIV transmission, AIDS and HIV-related deaths in the UK, November 2017).
There is, however, another side to this story. As a 32-year-old HIV positive gay man, I am fortunate that I am in great health, have a wide circle of friends and that both my parents are still alive. I was co-infected with Hep C, but I cleared my Hep C last year. Many older HIV positive people do not have the same support network and, whilst my HIV diagnosis took place in 2010, the treatments developed for HIV in previous decades had more side effects over the long term.
Some older HIV positive people lost a lot of friends to AIDS. Loneliness is a major issue facing older people living with HIV. Family members may be deceased, or in need of support themselves. I have a core group of LGBT friends from my twenties, some of whom have moved abroad or are increasingly busy with their careers, but I know that I can always reach out to them. Life for older HIV positive people can be very hard. Some are still grieving for the loss of loved ones, or even experiencing survivor guilt.
Many people living with HIV face financial uncertainty and this is particularly the case for older people. Those diagnosed before 1996 were dealing with a huge amount of uncertainty. I spoke to one gay man in his sixties who told me that after his HIV diagnosis he quit his job, sold his home and spent the next three years travelling the world. He was trying to squeeze a lifetime’s worth of experiences into a few years, as he thought death was imminent. Personal choice and responsibility have to be acknowledged, but it is the case that many older HIV positive people do not own their own homes or have private pension plans.
The health situation around older HIV positive people is increasingly complex. Comorbidities, where an individual has multiple chronic conditions, can be harder to treat. The older an individual gets the more likely they are to be impacted by illnesses such as cancer or Alzheimer’s. HIV positive people are no exception to this. It is unclear at the moment how HIV impacts all of these diseases and disorders.
I recently took part in a campaign called HIV is: Just a Part of me. This looks at how HIV positive gay men can live more healthily, limiting the risk of complications in the future. The campaign included a diverse range of men, in terms of age, nationality and ethnicity. Around, for example, bone health there are simple things that we can do to limit the risk of bone disease. It is important to get enough calcium and Vitamin D, as well as doing weight-bearing exercises to increase bone density. Other areas examined included heart, liver and mental health. For anyone living with HIV, the earlier you start discussing these areas with your health specialist, the more likely you are to avoid comorbidities and age healthily.
As HIV positive people live longer, the implications of ageing with HIV are becoming more apparent. The UK has much to celebrate around HIV/AIDS, but we must do more so that HIV positive people are not just living longer, but also healthier and happier lives. We need to be more aware of the issues that older HIV positive people face and younger people living with HIV need to be educated in how they can live healthily. No HIV positive person should be left behind.