In the second installment to the December’s Self-Care posts, I wanted to discuss healthy eating. Well, actually, I do not want to discuss healthy eating, because I have to admit to everyone that I have not been eating well lately. With the release of the book, the stress of the holidays, and my inclination to eat more than I should at this time of year, I have put on a few pounds. So, I need to revisit this topic for myself and will bring you along for the ride.
You may have already made adjustments to your diet to adapt to HIV-related changes in your metabolism and the effects of medication. Aging, too, creates shifts in our body, and as we age we need to alter our diets to compensate.
I consulted with Dr. James Schmidtberger, from the Leicht Clinic, an HIV-clinic in New York City to get some guidance on eating well and aging with HIV. He offered some general suggestions in order to get us started. He also suggested following up with a doctor or nutritionist to respond to changes in your specific physical condition.
Here is what he had to say:
When we age we lose muscle mass and require fewer calories daily. Uncontrolled HIV can accelerate the loss of muscle mass. If you are concerned about HIV wasting you may be tempted to overeat. Without adequate exercise, this may result in excess fat which raises the risk of developing (or worsening) other chronic conditions such as diabetes and heart disease. This is why nutrition and exercise are so important to help you maintain your muscle mass. Nutrition is particularly important if you have other medical problems (such as high blood pressure, high cholesterol, diabetes, or prediabetes) or lipodystrophy. A balanced diet is important to help your body fight HIV and control (or prevent) those other conditions.
A good place to start is to assess your overall dietary habits. In general, you want to eat a balanced diet with plenty of fresh fruits and vegetables. A good rule of thumb is called the “plate method.” This is a simple way to devise a healthy meal and is recommended by the American Diabetes Association. Take your dinner plate and divide it in half. Fill one half with nonstarchy vegetables (such as spinach, broccoli, cauliflower, greens, salad, tomato, cucumber). Divide the remaining half again into two quarters. Fill one quarter with starchy foods (such as rice, pasta, corn, peas, whole grain breads/cereals). Fill the remaining quarter with proteins (lean meats, skinless poultry, seafood, tofu, eggs). Add a glass of nonfat or 1% milk or yogurt and a piece of fresh fruit. You can bring the plate method to the breakfast, lunch, or dinner table.
Consider the following small modifications. If you eat too much, try to limit your portions. If you drink soda, switch to seltzer or diet sodas. Avoid fast food. Switch to healthy oils, olive oil or canola oil, and avoid food with trans fats.
Depending on your situation, your nutritional needs may differ. For example, if you are fighting an opportunistic infection, your calorie requirements may be higher than usual. If you have heart disease, diabetes, or other complications, you may have specific dietary restrictions. Ask about nutrition. You may also want to consult with a nutritionist to assess your dietary needs.
Next week’s blog: Staying Fit
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.
We are at the end of the third decade of the World AIDS epidemic. The disease has impacted the lives of people throughout the globe and reshaped societies. Today the epidemic has a very different meaning in the developed world than twenty-nine years ago. Because of advances in the treatment of HIV disease, Aging is now THE issue in the United States. Not only are people living longer than expected, but by 2015 the majority of people living with HIV in the US will be over fifty years old. The aging of HIV means that we need to develop new policies and treatments for the disease. People living with HIV must adapt to the challenges of growing older and develop new mindset of Optimal aging with HIV. To read my World AIDS day article for Edge magazine follow this link – Edge magazine.
A reader, Loren M., recently completed a course on public policy in Aging with HIV at San Francisco State University, Gerontology program. He has researched the issues around Aging with HIV, and has shared the result of his studies. For a report on Aging with HIV Policy go to my post – Aging with HIV Goes to the White House and read his comment.
Thanks Loren M. for sending that information to us!
I just received an update from Dr. Steve Karpiak from ACRIA about the White House meeting on aging with HIV held last week. Dr. Karpiak was among the 100+ invited attendees at this meeting to “raise awareness about people who are aging with HIV or contracting HIV as seniors (>50 years of age); to explore unique clinical manifestations of HIV infection among older adults; to discuss existing services for seniors living with HIV and highlight successes as well as gaps; and to discuss targeted strategies for Federal and non-Federal stakeholders to realize the vision of the President’s National HIV/AIDS Strategy” according to the White House Office of AIDS policy. There is a link on this page to a youtube video of the meeting.
Here are some observations Dr. Karpiak made of the event:
Education – The need for those in the world of HIV/AIDS and those who work in the Aging universe to know about the increasing number of older adults living with HIV. The epidemic is no longer young only! In fact it is now old – mostly!
Research – This is a given. Research dollars are always scarce, but the need to address this issue is now growing at a rapid pace. Many spoke about ACRIA’s seminal 1000 person study ROAH (Research on Older Adults with HIV) illustrating that community based research can significantly affect the dialogue.
Health Outcomes – There is a need to assess bottom lines – health outcomes. What works – what does not work – and move forward using evidence based information and not conjecture and anecdotes, or, providing services that makes everyone feel good – except the client.
Prevention – There is a vacuum. No systematic evidence based prevention effort targeting older adults (HIV negative or positive) has ever been developed for the over 50 populations – emphasis on the S. Prevention messages for the 50-60 year old are likely very different than those for the 70+ group! ACRIA has much to share with 3+ years experience n developing such initiatives in NYC (funded by the New York City Council) and across the US (funded by the MAC AIDS Fund).
Isolation – Acknowledgement by almost every person who spoke in the room that the older adult living with HIV is socially isolated due to the toxic forces of stigma which contribute to their high rates of depression, substance use and poor mental health management.
Power – The power of the voice of the peer PLWHA over 50 is unquestioned. There were community members, ASO staff, people of faith communities, and government staff who were HIV+ and over 50, some LGBT – their bearing witness is potent.
Partnerships – The HIV world must collaborate with the Aging world. Those in HIV/AIDS cannot ignore the massive knowledge and experience of those who work in Aging. Time and resources will have been wasted unless there is collaboration from both domains. ACRIA is unique in that it has done this for the last 8 years.
Thank you Dr. Karpiak for sharing your thoughts. I will continue to pass on more information about the event and of any policy changes that emerge as a result.
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.
Thank you for including me in your blog posting on Aging with HIV for MyFabulousDisease.com. Your site is a perfect forum for this timely dialogue.
In your note you asked several questions about the physical complications of aging with HIV and the emotional interaction between living with HIV and aging into midlife and beyond. Both, are very big subjects. And, while there is growing interest in this area, we are just beginning to understand what it means to age with HIV. We are at the forefront of a new era in HIV treatment, and much like the early days of the epidemic, people living with the virus are the experts and have to keep updated on new developments and partner with their doctors in order to determine the best course of action.
This is the reason why I wrote Aging with HIV: A Gay Man’s Guide – to help gay men who have lived longer than they ever expected as they manage the transition of aging.
The literature presents several emotional challenges that accompany adult development. They include, among others, physical changes, new roles in the family, and shifts in our work lives. For gay men living with HIV adaptation to aging also involves responding to changes in the AIDS epidemic and the transition of HIV from a terminal illness to a chronic disease.
Aging is a challenge for all of us. But, for gay men living with HIV it is even more complex. As you know, this generation of gay men living with HIV have spent the last two decades embroiled in a battle with the AIDS epidemic: Caring for themselves and loved ones; living through immeasurable losses; and managing their own threat of mortality. This war has utilized all their emotional resources and few have had the time to consider the challenge of aging.
It is easy to get stuck in the task of adapting to aging with HIV. Signs of stagnation include living in the past, isolating, and avoiding social involvement. Research has found higher rates of depression, lack of social support, and reduced quality of life among middle aged and older people living with HIV. Adapting to aging with HIV can become complicated when emotional issues such as HIV-stigma, internalized ageism, unresolved grief, or survivor guilt impact one’s ability to care for oneself fully in the present.
Aging with HIV: A Gay Man’s Guide offers guidance to navigate this uncharted territory. The book draws from my qualitative research, as well as my training as a psychotherapist and 20 years of experience in the field. Questions and exercises guide the reader through self-examination to evaluate how he is adapting to the challenges of aging with HIV and to develop tools to optimize their experience. There are quotes from gay men living with HIV, as well as brief text boxes that review the relevant research. The book also includes a chapter by James Schmidtberger, MD, Director of the Leicht Clinic, an HIV-clinic in New York City, reviewing the medical research on HIV over fifty.
My hope is that Aging with HIV: A Gay Man’s Guide will start conversations across the country that normalize the experience of aging and empower gay men to define for themselves what it means to optimally age with HIV.
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%.
Next week the White House will be holding a meeting on HIV and Aging. The purpose of this meeting is to raise awareness about people who are aging with HIV or contracting HIV at age fifty or older; to explore the unique clinical manifestations of HIV in older adults; to discuss existing services for seniors living with HIV and highlight successes as well as gaps; and to discuss targeted strategies for federal and non-federal stakeholders to realize the vision of the President’s National HIV/AIDS Strategy. This meeting is part of a series of discussions that have been convened at the White House by the Office of National AIDS Policy (ONAP) over the past year. The invitees are leaders in the field of research on HIV Over Fifty and include Charles Emlet, PhD, Professor of Social Work at the University of Washington, Tacoma and Dr. Stephen Karpiak from ACRIA.
I am excited to learn of this meeting, as it tells us that the concerns of middle aged and older people living with HIV are being discussed at the national level. I will relay to readers the results of this meeting when I get them.
In San Francisco this weekend I attended ArtSpan’s Open Studio tour of artists’ spaces and work in the Castro, Noe Valley, and Mission Districts. I had the opportunity to meet with many of the artists and talk to them about their work. These discussions reaffirmed my belief in the transformative and healing powers of creativity, and the important role that artistic expression has in gay aging and adapting to aging with HIV.
Gay themes were present in many works. There were sculptures, paintings and photography that depicted the beauty of the male form. Some of the work was homoerotic, and I thought of gay men’s reminisces of San Francisco in the 1970’s and 80’s when I saw the open, playful sexuality expressed in these pieces. Some of the artists included political statements about HIV or gay rights in their work. And, others were fun and campy reflections of the gay sensibility. When talking with the artists I learned about their craft and the dedication and commitment it takes to master a form and develop a work to completion.
The qualities found in creativity (playfulness, self-expression, empowerment, and mastery) can be utilized for continued growth in adulthood. When we engage in creative pursuits, as professionals or amateurs, we discover new parts of ourselves, engage with our environment in new ways, and express our unique perspective of the world for others to share. We can use our creativity to re-engage in life, to reconnect with forgotten parts of ourselves, to mourn losses or bridge former views of ourselves and experiences of others into the present. As one artist explained, “The work expresses itself through me. I am not sure what the final product will be until it emerges.”
For many gay men, HIV interrupted the flow of life. Caring for yourself and others, grief and anticipating mortality knocked you off course. In order to get back on track you need to review what you have come from, consider where you are, and determine what to take with you as you move into the future. Creative expressions, like painting, sculpture and photography (or music, dance, writing etc.) can free you up to experience yourself in a new way. If you make the time, you may be inspired by what emerges.
Please feel free to share your creative expressions on aging with HIV here or on the community page.