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.
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.
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.
On the Radio
No, I’m not referring to Donna Summer. (Well, not exactly.) I will be on the radio to discuss Aging with HIV. I am being interviewed by Michael Signoreli for his radio program this Tuesday, March 1st. You can hear the live interview on Sirius XM’s Out Q: Sirius 109, XM 98 and on the Sirius XM iPhone app.
New Group for Gay Men in Midlife
I am pleased to tell you about a group that I will be running with a colleague in the Village.
The focus of the group is gay men and midlife. For the generation of gay men now facing mid-life the AIDS epidemic shaped young adulthood. Gay identity was defined by the emergence of AIDS and young gay men were faced with the tasks of caring for loved ones, grieving, creating community and learning how to care for oneself in the face of homophobia and discrimination.
For this generation of gay men, the fact of being in mid-life is to have survived. It may helpful to reassess their coping strategies in order to meaningfully respond to changes in careers, relationships, bodies and sex lives that accompany aging. This group will allow its members to reflect, reassess and address questions such as:
What does it mean to be a middle-aged gay man now?
What wisdom have we achieved and what coping strategies have we developed in order to arrive at this place?
How has my earlier experience with AIDS and HIV affected my view of myself and aging?
What new strategies and skills do we need?
This 12 week group should prove to be a rich and rewarding opportunity to connect, receive support, learn from shared experiences, draw on past lessons and achieve new understanding.
If you are interested, or know of someone for whom such a group would be helpful, you can contact me at this link, or by using the “Dr. James” tab, above:
AIDS Activism 101
I recently read a post by Mark S. King for his blog “My Fabulous Disease” that I thought would be especially relevant for people aging with HIV.
In it he gives an overview of the ADAP crisis that is going on across the US. He explains that there is growing concern that ADAP programs that provide access to HIV medications will be cut. He has video coverage of the “emergency summit” to discuss the growing ADAP crisis. And, he presents what we can do to make sure that people living with HIV can continue to receive their medications.
This issue is relevant to all people living with HIV and he offers clear guidance on how to get involved.
To read the post on how you can get involved, go to: http://marksking.com/my-fabulous-disease/aids-activism-101-steps-to-end-the-adap-crisis/
Activism and Aging with HIV
For many of you activism is not a new subject. AIDS activism may have been a part of your day-to-day life in the eighties and nineties. You may have even been a part of the gay rights movement of the seventies or earlier.
Is activism a part of your life today?
The men I interviewed for Aging with HIV: A Gay Man’s Guide answered this question in different ways. Some continued to participate in political and social groups and called themselves “activists.” Others were no longer as “out there” as they were ten and twenty years ago. They wrote letters, signed petitions on line, and supported organizations that shared their concerns. Some continued to read updates and were concerned, but no longer participated in causes.
Several felt alienated from activist organizations that, they felt were oriented toward younger people. Some had become fatigued from years of activism, and hopeless that they had any voice in creating change on a larger scale.
Why Get Involved?
Activism can offer many benefits to people in midlife and beyond. When you participate in social cause, you have the possibility to effect change on a larger scale. Activism also offers an opportunity for you to get out of yourself and to think about others. This is what developmental psychologist call generativity, and it is an significant aspect of continued personal growth at midlife. Getting involved also offers you opportunities to meet new people, stimulate your mind and broaden your social network.
Other Activities
There are many causes that you can get involved in. And, activism is only one level of involvement. Some of us work better on a smaller scale. Volunteering at a social service organization is a great way to get involved, feel like you are making a difference, and being part of something beyond yourself. Check out the resources page (see tabs above) to find an agency near your.
Study Suggests HIV Causes Rapid Aging of Key Immune Cells: POZ Magazine
A new study by researchers at the University of California at Los Angeles (UCLA) suggests that HIV causes immune cells to age quicker than normal—potentially causing more rapid HIV disease progression in older people with HIV and earlier onset of aging-related diseases in younger people.
To read the full article discussing these findings, go to: http://www.poz.com/articles/hiv_telomere_sensescence_761_19813.shtml.
This article supports the concept of accelerated aging. Accelerated aging refers to a recent phenomenon in the HIV literature. Studies are finding that people living with HIV are demonstrating higher rates of illnesses typically found in older HIV-negative populations. Comparisons of brain scan patterns and bone marrow density of people living with HIV with the HIV-negative, and found that significant percentage of the HIV-positive participants have results similar to HIV-negative participants 10 and 20 years older. This article suggests that an explanation for accelerated aging lies in the way HIV impacts immune cell functions.
This area of research is still in a beginning phase, and the findings in any of these areas are not conclusive, nor can they be extrapolated to determine how living with HIV into midlife and beyond will affect any one person’s physical aging. Illness progression or age-related physical changes can be the result of many factors, including, but not limited to: the presence of HIV; aging; heredity; environment and lifestyle. Research on aging with HIV has correlated healthy aging with modifiable issues, such as social involvement, mood, treatment adherence, and alcohol use.
This research could result in treatment interventions that address accelerated aging on the cellular level. A growing concern for the expanding population of those living with HIV into midlife and beyond. Until this issue is more clearly understood efforts need to be taken to address the health concerns of people who have lived longer than they ever expected, and to help individuals determine what steps they can take to improve their lives.
AHA Project 