Author Archive: Dr. James

Springtime and Play Time

I walked past the elementary school and saw the teachers taking the kids out of the class to explore the neighborhood.  I remember the feeling that started to set in this time of year.  The weather is getting nicer; The school year is coming to an end; And, I just wanted to get outside and play.  In the springtime I am reminded of the need to take time out of my schedule to play.

Play time is not just a luxury. Recreation is an integral part of a healthy lifestyle.  And, being able to play is one of the 10 steps to optimal aging with HIV.  Playful activities can keep us socially involved as well as physically, intellectually, and creatively stimulated – all of which can counteract stagnation and increase adaptation at midlife and beyond.

There are many opportunities for finding play time:

Organized sports can be great forms of play, when they are not taken too seriously, and are not beyond your physical capabilities.  When you are involved in a strenuous sport you get much needed exercise and increase your endorphins.  In team sports, such as  basketball, you stay connected to others.  You can play golf alone or with friends.  And, bowling is a lower energy sport that can still work up a sweat.  Even if you are not an athlete, you can find a sport that isn’t too intimidating.  Jogging, rowing, bicycling, and kayaking are all independent sports that have meditative qualities.  Less conventional sports such as ballet, ballroom dance, fencing, and yoga are all forms of play. Games such as cards, scrabble, and board games have the same opportunities for competitive activity, intellectual challenge, and socialization without the strain of physical activity.

Creative activities can be done alone or with others.  Making art, writing, woodworking, and gardening are all creative activities in which you participate in making something new. Do you enjoy listening to music?  Dancing to rock and roll or drums? Cooking, needlework, collecting?  You can take a class to learn a new hobby or skill.  Join an improvisation group.  Care for animals. Any of these activities can broaden your sense of creative play.

If you need help developing your ability just spend time with a child.  My biggest pleasure is watching a child who has just opened a present make a toy out of the box it came it.  You can invent play from your imagination, too.*

There are many social clubs for gay and HIV positive people that offer ongoing recreation activities.  Check out the list of resources on this site to find an organization near you where you can participate in an event or join an ongoing program.  You can also take a retreat with organized activities.  Blogger, Mark S. King has compiled a list of vacations and retreats (some at low cost) for people living with HIV.  Follow the link to learn more.

Now, I’m going to listen to my own advice and get outside to enjoy a bit of this day!

*excerpt from Aging with HIV: A Gay Man’s Guide

The Issue of Comorbidities

HIV, Aging and Cognitive Impairment

I’ve been spending some time lately on the relationship between cognitive impairment and older age in people living with HIV.  The research is inconclusive.  Recent findings suggest that there could be an increased risk for HIV-associated dementia and minor cognitive motor disorders in this population.  However, as I pointed out in last week’s post, research in this area is new and the findings are complex.  While older age may be a contributing factor in cognitive impairment, other issues to consider are: HIV itself, treatments for HIV, other age-related diseases and their treatments, as well as heredity and lifestyle.

A first step in optimizing your health is to identify the factors that you can control.  In order to do that, older people living with HIV must consider the issue of  co-morbid conditions.

Comorbidities and Cognition

Aging with HIV can create a complicated health-related picture.  In addition to the effects of HIV itself, people taking medications to treat HIV and its symptoms may experience co-morbid conditions from those drugs, such as heart disease and diabetes.

This population also faces non-HIV- related illnesses common to older persons in the general population including: diabetes, hypertension, arthritis, and coronary artery disease. These comorbidities may affect HIV disease progression and may play a role in cognitive impairment.

Depression and other untreated mood disorders can also impact cognition and affect quality of life.  In addition, alcohol and substance use can negatively affect one’s cognitive functioning.

Finally, illness can set in motion a negative feedback loop when physical limitations cause reductions in social involvement, depression and further complications of illness.

Treating Comorbidities

Developing an accurate picture of your health involves appreciating the complex and changing impact of HIV-disease progression, medications, mood, lifestyle and heredity.  That means routine general health maintenance and appropriate diagnosis, treatment, and prevention of non-HIV-related medical and neuro-psychiatric conditions*

There is a great deal you can do to optimize your health outside of your doctor’s office.  Your daily health care regimen can include activities that prevent, treat or modify the presence of comorbid conditions.  Factor’s such as diet, exercise, participating in alternative therapies (such as meditation, acupuncture, yoga and massage), and maintaining an active social life have all been demonstrated to improve quality of life.  Optimal aging with HIV involves working within your limitations to maximize your day-to-day life.

What one step can you take today to enhance your well-being?

*Goodkin, K. & Stoff, D., “Older Age and HIV Infection.” In Cohen M, Gorman J, eds. Comprehensive Textbook of AIDS Psychiatry. New York, NY: Oxford University Press, 2008, pp. 357-376.

“The Jury is Out” on HIV/Dementia Link: ACRIA

Once again, Stephen Karpiak, PhD, has forwarded me the latest research commentary from ACRIA (AIDS Community Research Initiative of America).  In a review of the literature, Karpiak finds that the data is “conflicting and inconclusive.”  The panel of experts concludes: “The jury is out as to whether HIV alone is a significant factor contributing to cognitive dysfunction or dementia.  There are likely many other factors, some of which might be controlled to prevent or ameliorate cognitive decline.”

I have met many midlife and older people with HIV who are worried about dementia.   While many people living with HIV may evidence cognitive impairment on tests, few have the diagnosis of dementia.  There are many variables that may effect mental functioning, including: depression, socioeconomic variables, drug toxicities, trauma, other illnesses, and diet. HIV alone may very well not cause dementia and there may be many other treatable c0-factors that influence cognitive functioning in people aging with HIV.  As new research on this issue emerges we will, hopefully, get more clarity on the relationship (if any) between aging with HIV and mental functioning.

Lambda Literary Reviews Aging with HIV

“At last, the book we’ve been waiting for.”  That is how Mark Thompson begins his review of Aging with HIV: A Gay Man’s Guide for Lambda Literary.

Mr. Thompson gives both a social and personal context for this statement.  His review provides the reader with a description of the book’s contents, tone and relevance for people living with HIV.  I was encouraged by the way he used the book to further a discourse on the subject of aging with HIV.  Lets keep the conversation going!

To read the review go to lamdaliterary.org.

Illness More Prevalent Among Older Gay Adults: New York Times

In yesterday’s New York Times, columnist Roni Caryn Rabin reported on the results of the California Health Interview Survey. The study, conducted by the by the Center for Health Policy Research at the University of California, Los Angeles, presented alarming statistics about the health of the aging LGBT community in California.

Among the statistics reported on gay men’s health and aging were the following: “Older gay and bisexual men — ages 50 to 70 — reported higher rates of high blood pressure, diabetes and physical disability than similar heterosexual men. Older gay and bisexual men also were 45 percent more likely to report psychological distress and 50 percent more likely to rate their health as fair or poor. In addition, one in five gay men in California was living with H.I.V. infection, the researchers found. Yet half of older gay and bisexual men lived alone, compared with 13.4 percent of older heterosexual men.”

Reading this article, I was once again reminded of my early career as a social worker in the field of LGBT aging. In the 1990s I was one of a team of clinicians who presented similar statistics to service providers in order to change public policy and advocate for LGBT sensitivity in programs for the elderly. We were invited to senior centers and other agencies to teach providers how to adequately care for their LGBT clients, and much of our work involved explaining how the stigma of homosexuality impacted that generation of seniors and how agencies need to assess their programs to root out ways they perpetuate that stigma.

We shared our clients’ histories of discrimination – how they had been rejected by families, fired from jobs, dishonorably discharged from the military, harassed, evicted from apartments, beaten, arrested, and institutionalized just for being gay. We talked about the effect this stigma could have had on their self-esteem. How many had to hide their sexuality and create dual lives.

We demonstrated how stigma can lead to shame and low self-esteem, and how many people react to being labeled “deviant” by hurting themselves through neglect and self-destructive behavior.

And, we stated that while things had changed during their lifetime, discrimination was still a reality in the lives of LGBT seniors. Their sexuality was not represented, and often shunned, at the very agencies in which we were invited to speak. The conclusion – “Given their histories of stigma, it is understandable that many of our clients are distrustful of health care providers. It is the service providers’ responsibility to earn the trust of LGBT seniors.”

Our model of service provision came from the clients we served. I had heard many stories of resilience from LGBT seniors, and these people helped me figure out how sensitivity and empowerment can be used to help others who had experienced lifetimes of homophobic oppression.

Reading the New York Times article I was saddened, but not surprised. I had hoped that things had gotten better in the last two decades. That this generation of LGBT elders had not experienced the same health-damaging effects of stigma. And, that service providers had learned to eliminate the barriers that prevent people  in the LGBT community from getting the care that they need. But, these statistics show that these problems persist.

While researching Aging with HIV: A Gay Man’s Guide, I interviewed men who shared stories of discrimination. They told how stigma affected their self-esteem and self care. They also demonstrated resilience in the face of homophobic discrimination, how they had built on their strengths, sought out support from the community, and developed strategies to empower themselves and others.

There are many challenges of aging, but for gay men living with HIV they are compounded by the realities of homophobia and AIDS stigma. I hope the release of these new findings encourage a conversation to find new ways to fight stigma and improve the health and well-being of the aging LGBT community.

Follow the link to read the NY Times article.

My Career in Gerontology and HIV Care: Inspired by Bethsheba Johnson’s blog

In her blog post, Nurse Practitioner Bethseba Johnson discusses her path from work with the elderly to people living with HIV.  I enjoyed reading her story and related to some of her experiences.

In the early nineties I went back to school to get my Masters in Social Work.  Before graduate school I had worked at the New York City Department of Health, Office of Gay and Lesbian Health Concerns and the New York City AIDS Hotline and had been an HIV educator and activist.  I had also just lost my life-partner to AIDS and had decided to dedicate my career to social work and HIV.

So, one day while at my job at the AIDS Hotline, I received a call from Hunter College to tell me that in the coming fall I would be Interning at SAGE (formerly, Senior Action in a Gay Environment.)  “Old people!”  I thought, “I don’t want to work with the elderly!”  I had a million reasons why this would not be a good placement for me:  I was an activist, work with the aged is boring.  I was a very young man, myself and couldn’t relate to older people.  I wanted to do HIV work.  Looking back, I know now that I was afraid.  I was intimidated by the idea of working with older people, and thought I had little to offer them.

I look back on that year with a deep sense of gratitude – to my supervisor, Arlene Kochman, to the staff and volunteers at the agency, and to the clients I worked with.  I think I got back far more than I gave.  The work was far from boring.  I was constantly busy – doing home visits, helping people get entitlements, doing individual counseling, running support groups.  I learned so much about aging in general: the physical, emotional and social changes that accompany growing older.  And I grew to appreciate the importance of the gay community for that generation of older adults.  I was privileged to hear the life stories of gay men and women who were part of the early gay rights movement.  I observed their strength and resilience in the face of discrimination and abuse.  And, I saw the impact that stigma can have self-esteem and social involvement – a potentially damaging combination for older adults.  I received training on end of life care. And, I learned a strengths-based approach to help people make the most of older adulthood.

Because of my background in HIV education, I was assigned several older gay clients who were living with HIV.  Eventually, I took over a support group for people living with HIV.  Ours was one of a handful of groups for people aged fifty and older.  Many men came to the group, because they felt like outsiders in HIV-support groups for younger men, they couldn’t talk about HIV in mixed settings and they wanted to be in a group of their peers.  This was before the era of Protease Inhibitors, so much of our time was spent discussing mortality.  I continued to run this group for several years after my placement ended.  During those years, we lost several members, and the group was a supportive environment (for me, and, I believe, for the members) to deal with the losses we were experiencing inside and outside the group.  But, the group wasn’t just about death, it was was about life, and each week people brought in their concerns, challenges, achievements and hopes, and they knew they could talk about whatever they needed, that they wouldn’t be judged and that people would understand.  It was through this work that I developed my appreciation for the healing power of group work.

My experience at SAGE was a great foundation to build a career in social work and psychotherapy.  And, now that people are living with HIV into midlife and beyond in increasing numbers, I appreciate my early training in the intersection between HIV and aging even more.  By 2015 over half the number of people living with HIV in the US will be aged 50 or older, and we will all need to educate ourselves on the realities of aging with HIV.

To read Bethsheba Johnson’s story go to The Body Pro.

Bay Area Reporter Reviews Aging with HIV

Jim Piechota referred to  Aging with HIV: A Gay Man’s Guide as “essential reading” in his review for the Bay Area Reporter.   I appreciate the opportunity to get people talking about this important topic.  To read his article follow this link.

Talking about Aging with HIV on the Michelangelo Signoreli Show

Tune in to hear my interview with Michelangelo Signoreli Show live on Sirius XM’s Out Q: Sirius 109, XM 98 and on the Sirius XM iPhone app this Friday, March 18th at 3:30.

Aging with HIV Featured in The Philadelphia Gay News

Larry Nichols from The Philadelphia Gay News asked me to talk about Aging with HIV.  In answering his questions, I tried to talk about the issues facing this group and stress the importance of addressing the topic of aging in the discourse on living with HIV.    Unfortunately, I rambled a bit.  (I’m not quite used to being interviewed, yet.)  And, he got hold of an old photo of me that looks a little scary, but I appreciated the opportunity to talk about aging with HIV.  Aging with HIV is a growing concern and people living with the virus in middle and older age often feel isolated and invisible.  With increased attention being paid to the concerns of midlife and older people living with HIV we can empower people to get support, build community, and participate in a dialogue to define what it means to age well with HIV.   To read the article, go to the Philadelphia Gay News website.

Michael Signoreli Interview Postponed

Will keep you updated when it is rescheduled.