The HIV (human immunodeficiency virus) epidemic burst into our lives decades ago, sparking widespread media attention and global mobilization. Who doesn't remember the advertising campaigns linked to HIV-AIDS or the dramatic films Philadelphia, Dallas Buyer Club and Bohemian Rhapsody? Although medical advances have allowed people with HIV to lead almost normal lives, the fact remains that the epidemic is still very real.
More than 39 million people are living with HIV worldwide. At the end of 2020, approximately 63,000 Canadians were estimated to be living with the virus, diagnosed or undiagnosed.(1) HIV is transmitted through the bodily fluids of an infected person (blood, breast milk, semen and vaginal fluids). Today, the most common risk factors are sex between men, sex between men and women, injection drug use and blood transfusions.
Thanks to continued medical advances in medications, HIV can now be considered as a chronic disease. Today, most people do not die from the virus. This means that more and more doctors specializing in geriatrics (the medical discipline that involves prevention, diagnosis, therapy and the social aspects of illnesses in the elderly) are called upon to provide care to people with HIV.
HIV-geriatric medicine is intended to be collaborative work between HIV specialists and geriatricians. It is a fairly young discipline which aims to ensure a global and specific approach to elderly patients with HIV, focused on function and the continuum of care.(2) How geriatricians feel about providing care to older adults living with HIV?
What research tells us
A recent evidence synthesis identified six studies on geriatricians' perspectives on the care of older adults living with HIV. The geriatricians interviewed in these studies were mainly heterosexual women with approximately ten years of experience.
Six themes emerged from the analysis:
1. General knowledge of HIV
The results of self-administered questionnaires on HIV show that geriatricians understand the disease fairly well.
2. Attitude towards people living with HIV
Overall, geriatricians have positive attitudes toward older adults living with HIV and are open to providing care.
3. Experience in caring for people living with HIV
Studies reveal that geriatricians treat very few patients with HIV (between 0 and 5 patients per year), which means that they may lack experience with this patient population.
4. Specific knowledge related to older adults living with HIV
The management of HIV among older adults remains a challenge for geriatricians. While they are specialists in the care of older adults and the diseases that affect them, they do not necessarily have the in-depth knowledge related to HIV and how it affects older adults. Studies reveal that fewer than half of geriatricians could correctly classify risk factors for HIV infection in older adults, and only a third knew that HIV-related dementia can be reversible or slowed down with proper diagnosis and treatment. If they want to optimally care for this clientele, they will have to take into account common comorbidities associated with aging, such as heart problems, diabetes and neurodegenerative diseases, while managing HIV. The trouble is that the first signs of HIV resemble ailments associated with aging, and medications to control HIV can interact with other medications older adults may take.
5. Knowledge related to HIV testing among older adults
Geriatricians surveyed said they do little HIV testing because they fear offending or embarrassing their older patients by offering testing or talking about sexuality. Due to the increasing number of new HIV diagnoses among older adults,(4) to reduce stigma and identify the undiagnosed, routine annual screening for all patients, regardless of risk, should be performed.
6. Experience caring for LGBTQ+ older adults
Although the attitude of most geriatricians is positive, the fact remains that there are persistent prejudices against members of the LGBTQ+ community: almost 40% of geriatricians surveyed said they had witnessed discrimination against LGBTQ+ patients, families or staff in their workplace. A 2010 study found that more than half of lesbian, gay and bisexual people and 70% of transgender people have experienced discrimination from health care providers (bias, incorrect assumptions, derogatory statements or refusal of care) .
HIV affects people of all ages
It is important to get tested and treated as early as possible, because antiretroviral drugs suppress the viral load in the blood and prevent transmission of the virus. Learn more about HIV and don't be afraid to talk to your healthcare professional.
Furthermore, diagnosis or not, remember that HIV is not transmitted through kisses, hugs or sharing food: so do not hesitate to show your affection to your loved one who lives with HIV!