Older adults living with HIV are expressing high levels of anxiety. Uncertainty drives that anxiety. As the finite nature of life comes into focus, older adults with HIV face the uncertainty of their health. They exhibit higher rates of illnesses associated with aging, especially cardiovascular disease, cancers and diabetes. Most do not have access to the coordinated geriatric-based care they need as they die from non-HIV/AIDS conditions. They are socially isolated by stigma that fuels their high rates of unmanaged depression. Most have no one, no community, with whom to share to help dispel and blunt the oppression of uncertainty. And now the COVID-19 virus enters, pushing that uncertainty into the extremes.

But these are the Long-Term Survivors of another epidemic that remains in our communities The HIV epidemic has greyed, its community dynamism sapped by time and loss of purpose. End AIDS efforts divert precious community fellowship, human attention, and needed human touch. The AIDS epidemic is rapidly forgotten by the forces of ageism and the loss of both community and political will – to care. That chasm of need must be addressed again. The AIDS Service Organizations will need to partner with and learn from CBOs experienced in providing supportive services for the growing older adult communities.

The older adult living with HIV has demonstrated a resiliency that has allowed them to look beyond the uncertainty that an HIV/AIDS diagnosis imparts. They will need that resiliency even more. And maybe they can share with all of us how we too can overcome the uncertainty of tomorrow.

COVID-19: What You Need to Know

The older adult with HIV confronts uncertainty daily – not knowing if their health care will be adequate as they age. Are health providers’ age-related knowledge and skills adequate? Financial uncertainty is a constant. The uncertainty of transition to retirement, long-term housing and care, is clouded by the not knowing who will provide care when home bound. While not directly attributable to aging, the episodic nature of HIV left many with uncertainties related to when their next episode of illness would occur. The older adult with HIV find themselves often unable to plan in advance. Data highlights the need to focus on the notion of successful and positive aging with the goal to identify and develop effective interventions that reduce disability and enhance the overall health of older adults with HIV.

The COVID-19 pandemic is problematic and quite insidious. This is a new respiratory borne infection that spreads easily from person to person. Infection can occur even when there are no physical manifestations and/or underling conditions. COVID-19 is not entirely similar to the seasonal influenza virus, which has a mortality rate of 0.1 %. The mortality rate for COVID-19 is ten times greater. The vast majority of people infected with COVID-19, more than 80%, will survive infection. But the virus can seriously impact, even be fatal, to a subset of the general population. Demographically, older adults with underlying comorbidities like diabetes; heart conditions, lung diseases and cancers are at high risk and account for the majority of deaths due to this virus. Many older adults with HIV have one or more of these comorbid conditions.

The greater risk for infection is posed when someone coughs or sneezes emitting those droplets with viruses. Shaking hands should be avoided and disinfecting close objects is advised. Social distancing must be practiced, with the hand washing procedures as directed by CDC.

Absolutely no one is invulnerable to the coronavirus disease (COVID-19). Some people, with no underlying medical conditions (self-diagnosed as ‘healthy’) can still be infected and may be asymptomatic. This level of unawareness increases the transmission to other persons who are more susceptible. Therefore, social distancing and home isolation are mandatory to minimize community spread of the COVID-19 infection. This is the societal and moral responsibility essential for infection control and prevention during the pandemic.

The coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Do not dismiss the severity of this viral infection; it can catastrophically progress to an acute respiratory distress syndrome (ARDS), leading to an Intensive care unit admission (ICU) and even damage to the alveoli (air sacs in the lungs). The potential damage at this site of the lung(s) can physiologically affect how gases (oxygen and carbon dioxide) are exchanged between alveolar spaces and small blood vessels (capillaries). If diffusion is blocked, the capillaries can reduce oxygen delivery to the red blood cells resulting in systemic hypoxia (adequate oxygen deprivation). The body can respond to the insufficient oxygen supply both circulatory and metabolically. This why underlying conditions such as coronary artery disease, hypertension, diabetes, lung conditions and any other hematological disorders affected by hypoxia, can increase susceptibility and mortality to the COVID-19 infection.

As of today, there is no proven safe and effective direct therapy against COVID-19 infection. There are a few randomized trials to seek a definite solution of what may work effectively. Self-medication is not recommended and most of the present drugs on the market are intended for a specific condition, not COVID-19.

It is unpredictable when the crisis will end. This may vary by country and region. The basic guidelines which can be found at the top banner of this site should be followed. The older adult is aging with HIV and confronts uncertainty. Aging in itself is an uncertain process and, the threat of infection with COVID-19 adds to this uncertainty.

The aging population is resilient and has overcome so many challenges throughout decades. This pandemic is yet another challenge. It is of vital importance that you understand the role we each play in the preparedness and control of this infection. Throughout the website, you can find positive reinforcements to mentally and physically cope and protect yourself amidst the pandemic. We need you to combat this new virus, you are not alone. Remain engaged and alert and the uncertainties will be addressed.

Marvin Mario Nunes MD, AICB, IFC
Richard Havlik MPH, MD
Stephen Karpiak PhD