As we’ve been discussing on this blog , aging with HIV involves adapting to a great deal of change. One aspect of optimal aging with HIV is re-evaluating your coping strategies, to make sure they are meeting your changing needs.
This month we will be discussing Self Care. December can be a stressful month and you may want to make sure that you are doing everything you can to take the best care of yourself that you can.
Developing healthy sleep habits is an integral part of self care.
There are several things in life that could impact your sleep. Changes in medication, physical changes that accompany aging, stress, and environmental changes can all affect your ability to get a good night’s rest. The following are some recommendations for getting a good night’s sleep taken from Aging with HIV: A Gay Man’s Guide.
Many people’s sleep habits interfere with getting a good night’s sleep. For example, eating or drinking in bed, reading/playing cards in bed, and falling asleep with the TV on for background noise are just a few. These practices train your body to be awake in bed. If you are having sleep problems, try retraining yourself: go to sleep and get up at the same time every day, remove the TV from the bedroom, make your bedroom quiet and dark (use blackout shades if necessary), do not read in bed, and do not eat or drink in bed. The bed should be only for sleep (and sex). Establish a prebedtime ritual, such as turning off the TV and computer at least 30–60 minutes before bedtime, changing out of your day clothes, and flossing and brushing your teeth, to prepare your body for sleep. When you feel tired, go to bed. If you cannot sleep after 20 minutes, get up and leave the bedroom, but don’t turn on the TV or computer. Wait until you feel tired and try again. If you continue to have trouble sleeping, you should bring it up with your doctor.
Next post: Eating Well.
Someone in AA recovery recently told me that alcoholism is a three-fold disease, “Thanksgiving, Christmas, and New Year’s.” The risk at this time of year is to turn to alcohol as a way to cope with stress. But, the holidays are not only challenging for alcoholics. They are wrapped up with intense meaning for many of us, and, it is difficult not to feel pressured at this time of year. The holidays can also stir up feelings of grief, sadness, and loneliness, and these feelings can be compounded when it seems that everyone else is having fun but you. And, moods can darken when the weather starts getting colder, and the days become shorter.
But, there are things we can do to take care of ourselves at this time of year. That is why for the month of December I will be dedicating my blogs to the subject of Self Care.
Self care can be both simple and difficult. A few activities may mean making only small adjustments to your daily routine. However, maintaining a regimen of self care can also feel like work. People can be surprised at the discipline it takes to take care of oneself.
Please feel free to add your thoughts at any time. I hope that this will spark a discussion about self care and aging with HIV.
Next post: Healthy Sleep Habits
Medscape has been posting discussions with researchers who attended the 1st International Workshop on HIV & Aging in Baltimore on October 4&5. The latest interview is on the role of mitochondrial damage in Aging and HIV-disease with Douglas Wallace, PhD, a leading researcher on mitochondria. The full interview can be viewed here.
Dr. Wallace explains that mitochondria play a key role in aging. As we age mutations in our mitochondria weaken cellular functioning. Over time this damage lead to the clinical symptoms seen in aging.
Dr. Wallace adds that, “chronic HIV infection can result in sufficient mitochondrial dysfunction to generate many of the same clinical problems seen in aging.” While he points out that much more research needs to be done on the interaction between HIV and mitochondria, his statement suggests that this relationship may be an important feature in the symptoms currently referred to as accelerated aging in people living with HIV.
Several of the men I interviewed for my study talked about physical changes that accompanied aging with HIV. They said that often it was difficult to determine which symptoms were age-related and which were HIV-related. Many spoke of feeling older than their HIV-negative peers, and that they had symptoms common to much older men.
The science around aging with HIV has not evolved enough to explain whether these reports are symptoms of the physiological effects of living with HIV, the results of taking HIV medications, or of the emotional impact of living with HIV.
Until this relationship is clarified, people living with HIV must find strategies for optimal aging, addressing the physical and emotional complications of living with the virus into midlife and beyond. Talk to your doctor about any symptoms and develop a self-care regimen that works best for you.
There has been much discussion lately in the blog-o-sphere about accelerated aging among people living with HIV. The term “accelerated aging” refers to a collection of conditions (heart disease, bone loss, cancer and cognitive decline) that are more common in HIV-positive people in their 40s and early 50s, compared with HIV-negative people of the same age. There is a great deal of controversy about using this term given the lack of research in this area. Many argue that one cannot combine these conditions under the heading “aging.” Researchers are also unclear whether these conditions are a result of age, long-term HIV-infection, long-term use of highly active antiretroviral treatment (HAART), or the presence of other infections. The researcher, Dr. Charles Emlet, sums up the research on his blog and links to a POZ article on the subject.
In another related article, Medscape writer Bob Roehr, interviews Steven G. Deeks, MD, a professor of medicine in residence at the University of California, San Francisco (UCSF), and codirector of the Population and Clinical Sciences Core at the UCSF-GIVI Center for AIDS Research. In the interview Dr. Deeks discusses the controversial topic of accelerated aging. He focuses on chronic low-level inflammation demonstrated among people living with HIV taking HAART. He states that while the presence of elevated markers for inflammation is “well accepted” among scientists, the effect is “not particularly dramatic.” Dr. Deeks suggests that more research needs to be done on the relationship between chronic inflammation and CMV disease. He adds that inflammation levels are much higher in people who are untreated with HAART than in those who are treated. His recommendation – “For now, lifestyle changes such as diet and exercise may be the most useful interventions. They have demonstrated efficacy in dampening immune overactivation and restoring a more normal homeostasis.”
I am sure that there will be much more to say about this topic. Add your thoughts, personal reflections or research updates here or on the “community” page.
The CDC released its HIV surveillance report 2005-2008 in June and Dr. Stephen Karpiak of ACRIA just sent me the data on HIV prevalence in the over fifty population. The number of people over age fifty is increasing exponentially, and one of the greatest population increases is for people between the ages 50-65. These figures include increases in the rates of new reported cases of HIV, as well as people living with the virus over age 50. Looking at these figures I conclude that midlife and older people living with HIV are going to represent a growing percentage of those living with HIV in the US and the specific issues faced by this age group are a growing health concern.
|In 2007 the total estimated number of people living with HIV/AIDS climbed over the million mark, and the percentage of people estimated to be living with HIV/AIDS over age 50 was 31%. This percentage rose in 2007 from less than 26% estimated in 2005. Given the rate of increase (2.2%) we can estimate the current (2010) number of people living with HIV over fifty to be closer to 40%.
The CDC also estimates that in 2008 16% of new diagnoses of HIV occurred in people over fifty. This is an increase from the 2006 CDC estimate of 10%.
I am pleased to be presenting a workshop with Dr. Stephen Karpiak at the SAGE National Conference and LGBT Expo, “The Future of Aging Is In Our Hands” in New York City. This session will take place on Saturday November 13th at 10:45-12:15pm in the CUNY Graduate Center, room # 9204. The conference theme is “Empowerment” and will be organized by and for the LGBT aging community. Scholarships are available. For more information about the conference and how to register for our workshop go to the SAGE website.
Here is the workshop description:
By 2015 half of all people living with HIV will be over age 50 in the US. Effective antiretroviral treatment has transformed HIV into a chronic illness, where a longer life span is achieved. But the aging process for this population is often characterized by the early onset of chronic age-related conditions. Often a 55-65 year old with HIV has the clinical profile of a 75-85 year old.
A lead researcher on HIV and Aging, Dr. Stephen Karpiak, will provide an up to date assessment of the health and psychosocial needs of this dominating HIV population. He will provide an overview of clinical data as well as research which has identified critical psychosocial issues including depression and social isolation. He will present challenges to social networks and successful aging for people living with HIV.
Dr. James Masten will lead a discussion of the challenges of aging with HIV. He will present a ten-step strategy to optimal aging with HIV, found in his new book, Aging with HIV: A Gay Man’s Guide. This workshop will help you identify the complications of successful treatment of HIV-disease and develop skills to adapt to the changes of growing older when you’ve lived longer than you expected.
If you like, please let me know if you will be attending and what you would like to get out of the workshop.
SAGE has developed a policy paper on HIV and LGBT Aging that addresses key prevention, education, treatment, and accessibility issues. To read the paper go to the SAGE website or follow this link:
The American Journal of Nursing recently published an article on aging with HIV to be used in nursing education. The article contains an overview of the issues affecting middle aged and older people living with HIV, and presents a review of research relevant to adults with HIV on a range of topics, including: successful aging, cognitive impairment in aging with HIV, use of social support, coping and mood issues, as well as co-morbidities and medical complications for an aging population. To read the article, click on the link below.
Vance, David E. (2010) HIV and Aging: Clinical Considerations for an Emerging Population, AJN, American Journal of Nursing
Volume 110 Number 3
Pages 42 – 47
We’re just two months away from the publication of Aging with HIV: A Gay Man’s Guide. I am including this excerpt from the Preface to acquaint you with the book:
Is This Book For You?
- Have you lived with HIV longer than you ever expected to?
- Have you spent the past 5, 10, or 20 years dealing with the impact of HIV on your life, your friends, and your community?
- Do you wonder whether changes in your body are due to AIDS or age?
- Have you made plans for your future?
- Are you satisfied with your life today?
If you’re like the men with whom I spoke, you probably didn’t think you would live long enough to concern yourself with aging. All of a sudden you’ve become aware of changes in the way you feel physically, in the way others treat you, and in your interests and priorities. Aging with HIV means adapting to a whole list of unexpected changes.
See if you relate to these gay men as they talk about aging with HIV:
Tim*: I never thought I would live this long. I’ve buried all my friends. I didn’t think I’d see forty, and I’m over fifty!
Mario: Now I, pardon my Armenian, I don’t give a flying fuck, you know? I just don’t care. So I find that the older I’ve been getting and my friends my own age say the same thing, most of us, you just get to a point where you realize life really just isn’t about anything that anybody else thinks. It’s about you. It’s about what you think. You know and who cares what anyone else thinks?
Luis: Because I don’t think of the virus has… has changed me. I think it’s changed me is my age. My wisdom. My experiences. Times. I don’t think it’s been the virus. I don’t think the virus has slowed me down. I think I’ve slowed down. I’m seeing life different. Because of being a middle aged man. Not because I’m a gay man, or because I’m an HIV man. Because I’m a middle aged man. And I see life and I see people and I see the times and I see how things have changed.
Peter: Bette Davis had it right, “Getting old ain’t for sissies.”
If you identify with these statements, then consider this:
Research on aging tells us that, in general, we follow a somewhat predictable path of development from childhood to old age. Each era of life presents a series of challenges that, when mastered, help us prepare for the next stage of life. In middle adulthood we deal with common issues in the areas of physical changes, career issues, family, and relationships that help us plan for the future. We make decisions such as whether to take a job in a new city, how to care for aging parents, and when to make commitments in our relationships. We travel on this path of development with a cohort of peers who are involved in many of the same tasks. Our peers are not only friends we can rely on for support, they also serve as mirrors of our experience. We compare ourselves to others in our age group to evaluate how we are progressing along our life course.
But AIDS has knocked many gay men off their life course. As Mark put it, “We are the generation wiped out by HIV.” Since AIDS was first identified in 1981, gay men have been engaged in a consuming battle with HIV. Just as a country at war diverts its resources from areas such as health care to military funding, gay men of this generation have put their efforts into fighting the effects of HIV and AIDS in their bodies and communities.
Meanwhile time has rolled on and aging has affected all the areas of your life: Your body has changed; your friendships and social life are no longer the same, you have a different perspective on work and money, you have a new role in your family, and you have a new attitude about sex and dating. The strategies that you had been using to cope with the challenges of life no longer work in the same way. Whether you recently learned your status or you’ve been living with HIV for decades you need help getting back on your life course to make the most of this phase of your life and to prepare for the future.
That’s where this book comes in.
*All names have been changed.
Welcome to the forum! This page is currently under construction. When it is completed we will have a description of the book, the authors and endorsements from professionals in the field. The site will have links to resources in your area and a section where you can add your thoughts and get feedback and information from other people living with HIV in midlife and beyond.
Look for Aging with HIV: A Gay Man’s Guide in your bookstore soon! Publication date – November, 2010.