It was not until the first antiretroviral drugs became available in the mid-1990s that there was a faint hope that life could at least be extended a little. By then, however, a good 10% of MSM in the USA alone had died of HIV and the immunodeficiency disease AIDS. Social connections were severed, careers ended - developments in the lives of survivors that continue to have an impact to this day and also have a lasting effect on the ageing of people with HIV.
Thanks to modern ART, it has been possible to transform HIV infection from a fatal disease into a chronic infection. In most cases today, therapy succeeds in repressing the virus below the detection limit so that no further transmission can take place.
This enables these people to age with their HIV infection and achieve a statistical lifespan comparable to people without HIV. Nevertheless, despite lifelong therapy, people with HIV have a weakened immune system and suffer from a systemic inflammatory reaction against the virus, which can accelerate the ageing process. Age-associated diseases therefore tend to occur somewhat earlier in people with HIV, increasing the comorbidity burden in old age.
Closely related to care in old age is the question of whether we really need a difference in care in old age between HIV+ and HIV- populations. With age, psychological burdens due to comorbidities, social isolation and loneliness increase. Although people with HIV are at greater risk of this, these stresses can of course also occur in old age in people without HIV.
Therefore, the goal should be to make elderly care structures sustainable for all. Is a serostatus distinction still necessary? This is an important question because people with HIV would in this way be met with the same appreciation and empathy as every person in elderly care.
However, this idea already shows that today not even the requirements for dignified ageing are met for people without HIV infection. What will be needed above all is an inclusive, empathic and appreciative approach to people requiring support in old age, regardless of their serostatus, gender or sexual identity. It is a long way to go, but it was also a long way to go in the field of HIV therapy - and it is only because of the successes that people are now talking about ageing with HIV.
Dana Rosenfeld is a social gerenterologist currently working as a Visiting Scientist in the College of Liberal Arts and Sciences at the University of Westminster. Her main area of interest is ageing with HIV and the associated challenges for those affected.
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