Today the United States Supreme Court struck down the Defense of Marriage Act (DOMA) paving the way for gay marriage. I am exhilarated and so deeply moved that it will take me some time to process the significance of this event. I would like to write a few immediate thoughts as I take in the ramifications of this day.
On a national level the ruling raises the concerns of LGBT people to their rightful place in the discourse on human rights. And, on a very personal level, it means that my marriage is now federally recognized.
Yet, there is so much more.
I am deeply grateful to Edith Windsor. In fighting for her rights as a married woman, she took up a cause that will have implications for all of us. I applaud all the activists who participated in this case and who are fighting for LGBT rights in so many other battles. There are too many people who continue to experience the pain of abuse and oppression.
When I heard the news my mind went immediately to my lover who died of AIDS in 1991. He participated in changing his world for the better and I think he would have been so proud to know how far we have come. There is a long history of activism in our community that has led to this event, and I want to honor those who came before and are not here to reap the rewards.
In my psychotherapy practice I often have to help people through feelings of sadness that accompany a joyful event. They wonder why they should be crying when they are so happy. I let them know that it is normal to feel grief when we get what we want. We are encountering the feelings of loss that have been kept at bay when we couldn’t have what we were longing for.
As with any change, including changes for the better, there will be a period of adjustment. For many of us this ruling will create shifts in how we relate to ourselves and others. We must reexamine the walls that we created to protect ourselves from the homophobia of our pasts. We might find that defenses that were necessary at the time may no longer serve us. As someone I spoke with today said so eloquently, “I need to learn how to be accepted.”
I feel such love for my husband. I have to wonder whether the lack of recognition of our marriage might have affected the quality of our relationship and how this judgment could offer us an opportunity to deepen the commitment we have to one another.
I’m glad to be alive on this momentous day, to learn and grow. Lets keep the conversation going and help each other adapt to the changes ahead.
In a recent article for the American Society on Aging, Nathan Linsk, considers the issues faced by older adults as the significant challenges for the fourth decade of HIV. The article discusses the physical and emotional challenges long term survivors face as they live longer than ever expected. Linsk summarizes recent research developments in the field, offers links to articles, and lists resources available.
To read the article go the the ASA website.
It has been an exciting year since the publication of Aging with HIV: A gay man’s guide. I have met a lot of great people around the country and overseas who are keeping conversations going about the challenges of aging and how people living with HIV can define optimal aging for themselves.
There have been many developments in the field: SAGE developed a policy paper on Aging with HIV; There was an historic White House meeting on HIV and aging; Interesting findings were discussed at the Baltimore Conference on HIV and Aging, the SAGE constituent conference and the 2nd Annual Conference on HIV and Aging in Austin; The HIV and Aging Group built community on Facebook; The National LGBT Aging Resource Center was created; Clinical Guidelines for Medical Management of HIV and Aging were released; and Caring and Aging with Pride published its report on LGBT Aging in the United States.
Aging with HIV was discussed in print and on the web: I talked with Mark S. King on MyFabulousDisease.com; The Philadelphia Gay News; The New York Times; Edge Magazine; And, the book was reviewed in The Bay Area Reporter, Lambda Literary Review, and The Gerontologist. And, I’m looking forward to the publication of an interview with Neal Broverman in next month’s Advocate.
It’s been quite a year!
I am looking forward to keeping you posted on new developments in the field. Aging with HIV is an expanding field. I am hoping that readers continue to share insights, information, and personal stories with me, so that I can pass them on to the community and keep the conversation going in 2012.
In today’s New York Times Austin Considine writes about gay marriage and the bittersweet victory it represents for men in midlife who have lost loved ones to the AIDS epidemic. Considine interviewed several gay men who share their feelings about this previously unimaginable day in New York history. There is happiness and rejoicing, but also sadness and grief. I talked with Considine about my experience and how even successes can trigger old feelings of loss. I think that many gay men will relate to these men and find support in their stories.
Last week the American Academy of HIV Medicine, the American Geriatrics Society and the AIDS Community Research Initiative of America (ACRIA) published recommended treatment strategies for clinicians managing older patients with HIV. This is a major step in the medical treatment of HIV recognizing the unique and complex medical issues faced by this growing population. It is the first time best practice guidance has ever been developed for HIV practitioners and other health care providers who treat diagnose and refer older patients with HIV disease.
The report contains specific guides provided for Diabetes, Cancer, Hypertension, HepC etc. as well as HIV testing and Sexual Health and more. While it is directed at practitioners, people living with HIV may want to familiarize yourselves with the recommendations and discuss their relevance to your care. The full report is 76 pages, but an executive summary outlines the treatment recommendations in each area.
To view the overview, executive summary, or full report go to the American Academy of HIV Medicine webpage.
On Thursday, Aug. 11th Mike Hellman was a guest on the internet TV show Positive OUTlook, hosted by Nayck Feliz, talking about Aging with HIV and the discussion group he has been facilitating at the Shepherd Wellness Community over the past few weeks.
If you missed it, you can see the show at: http://www.outonline.com/
You can also search for Positive OUTlook or Aging with HIV
Tomorrow is National HIV/AIDS and Aging Awareness Day. The AIDS Institute is hosting a Webinar on line conference to discuss the issue. You can join by registering at: https://www2.gotomeeting.com/register/946895474.
I was asked to write an introduction to HIV and Aging for the National LGBT Aging Resource Center. I’m posting what I wrote here. I expect that I may be able to additional contributions, so if you have any comments or ideas for future articles please add them here. Thanks.
Aging with HIV: An Introduction
There was a time when the words “aging” and “HIV” would not be used in the same sentence. Now, with improvements in the treatment of HIV-disease, people are living into midlife and older age in increasing numbers. But, what does it mean to “age with HIV?” And, how can people, who never thought they would live this long, adapt to the challenges that accompany aging?
HIV positive people are charting new territory, and specialists in the field are just beginning to understand the medical, psychological, and social implications of aging with HIV. If you are living with HIV, or know someone who is, here are some points to consider:
You Are Not Alone
It is expected that people over age 50 will represent a majority of those infected by the year 2015. Despite the large numbers of people in this age group, people living with HIV in midlife and beyond often feel invisible within both AIDS care agencies and organizations serving older people. Aging can feel like yet another stigma. Knowing that you are not alone and that your concerns matter can empower you advocate for the care you need.
You Have Unique Concerns
In many respects the challenges people aging with HIV face are no different than those of HIV negative people. We all have to adapt to changes in our bodies as we age (eyesight, mobility, health, etc.); We have new financial considerations as we grow older, including work related changes and planning for our futures; We develop new roles in our families; We live through losses among our friends and changes to our social networks; And, our attitudes, needs, and desires change within our sex lives and intimate relationships.
But, HIV has a way of reshaping all these areas of life.
Lets take, for example, the issue of symptom ambiguity. Many people aging with HIV report that it can be difficult to identify whether their symptoms are age-related or HIV-related. The men I interviewed asked, “Is this ache just normal aging, a complication from medication, or a sign of HIV-disease progression?” Unable to answer these questions, many had difficulty formulating a response. Do they just accept it? Make lifestyle changes? Or is medical intervention necessary?
Doctors don’t always know the answer. There is increasing research in this area, and scientists are looking at changes in bone density, cognitive impairment, and cardiac functioning that may be more prevalent among older people with the virus. More research is coming down the pipeline, but you need to stay informed to keep up with the latest developments.
Much like the early days of the epidemic, people living with HIV are at the forefront of a new era. The information your body is giving you is an important part of the equation, and you have to learn as much as you can and partner with your doctor to determine the best course of action for you.
You Deserve Support
The research tells us that having a supportive social network is one of the greatest predictors of well-being in older age, and studies on HIV over fifty confirm this finding. We adapt better to physical changes, loss, and retirement when we have satisfying emotional and practical supports. In addition, we remain more physically active, emotionally stable, and cognitively stimulated when we remain socially active and involved.
For many gay men aging with HIV, this means rebuilding social networks that have been decimated by AIDS. This is not an easy task, practically or emotionally. Optimal aging with HIV involves assessing the goodness-of-fit of you current support systems, maintaining existing social networks, and finding new support to meet your changing needs.
Many of the men I spoke with have used social service agencies as resources to help them rebuild their social support networks. SAGE has programs for midlife and older, gay and bisexual men living with HIV in New York City. My blog has a page with HIV and Aging resources throughout the country. The National Resource Center on LGBT Aging can also point you to services in your area.
Aging Means Changing
Aging is a gradual process, but it can sneak up on us when we’re not paying attention. Gay men living with HIV have good reason to be caught by surprise – they have spent the past two decades in a battle with the AIDS epidemic. Getting back on track with life means adapting to the physical, social, and psychological changes that accompany aging.
Let’s start conversations across the country that normalize the experience of aging and empower the community to define for themselves what it means to optimally age with HIV.
In his blog for POZ magazine, Scott Daly reviews his experience of aging with HIV in the third decade of the epidemic.
To read the article go to: POZ magazine.
In his Op Ed for the New York Times, “The Death Sentence That Defined My Life,” Mark Trautwein shows us how not dying of AIDS “on schedule” has helped him learn “not to live life on one either.” His story offers insight into the financial, social, and medical challenges of living longer than expected.
My letter to the Editor, published yesterday by the Times discusses the delicate, and sometimes paradoxical, balance between finding your own schedule and getting back on track with life that accompanies aging with HIV.
You can follow the links to read both.