Dr Limin Mao, National Centre in HIV Social Research: Living with HiV

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Dr Limin Mao, Senior Research Fellow, National Centre in HIV Social Research delivered this presentation at the 2011 LGBTI Aged Care Forum. The two day event offers a platform for discussion on national policy issues, mental and physical health and implementing sensitive quality care and service delivery.

The forum brings together LGBTI community leaders plus senior researchers on LGBTI issues in the aged and health care sectors, to share perspectives on good practice insights for real needs as well as strategies to build community and sector capacity. For more information about the event, please visit the conference website: http://www.informa.com.au//lgbtiagedcare

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Dr Limin Mao, National Centre in HIV Social Research: Living with HiV

  1. 1. Growing old or growing “up” with HIV National Centre in HIV Social Research Dr Limin Mao, NCHSR
  2. 2. Older generation of PLHIV Model estimated changing demographic of PLHIV Mean age of PLHIV to be increased at a rate of 0.49 years per annum Expected proportions of PLHIV 55 years and above to be increased from 25.3% in 2010 to 44.2% by 2020 While the metropolitan areas will still have the highest HIV prevalence, other areas (including rural ones) will have greater percentage growth 2010-2020 Jasson & Wilson (2012) Plos One 7: e38334
  3. 3. Blessings from HIV antiretroviral treatment? Jasson & Wilson (2012) Plos One 7: e38334 Start of the HIV epidemic 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2.7% Before ART 6.7% Before cART 13.6% 18.3% 30.1% 43.2% >=55 years 26-54 years <25 years 1985 1995 2002 2005 2013 2020
  4. 4. Ageing gay men in Sydney: Gay Community Periodic Surveys 100% 10.2 9.1 10.4 12.2 12.9 13.7 14.5 2004 2005 2006 2007 2008 2009 2010 80% 60% 40% 20% 0% under 25 25-29 30-39 40-49 50 and over
  5. 5. Increasing demand for HIV GP services but decreasing supply HIV s100 GP prescriber workforce: Proportions treating per week (increasing workload) based on a GP survey: 10 or more patients stable: 38.8% in 2007 to 42.6% in 2009 2-9 HIV+ patients increased: 36.5% in 2007 to 49.1% in 2009 0-1 HIV+ patients decreased: 24.7% in 2007 to 8.3% in 2009 Estimated demand vs supply-services with at least one s100 GP prescriber: Metro areas: estimated number of PLHIV increased by 12.5% but such services decreased from 60 in 2007 to 55 in 2010 Rural and remote areas: estimated number of PLHIV increase by 16.5% but such services decreased from 31 in 2007 to 25 in 2010. Mallitt et al., (2012) Sexual Health (published online 19th Nov.)
  6. 6. Distribution of sexual health services in 2007: state variations 100 100 90 80 70 60 50 40 30 20 10 0 Gay friendly GP Hospital units SHC 38 42 39 Pell et al., (2008) Sexual Health, 5: 161-8 7 6 NSW Vic QLD SA WA 6 TAS ACT 8 NT
  7. 7. Distribution of sexual health services in 2007: Urban vs rural/regional 100 100 90 80 70 60 50 40 30 20 10 0 Pell et al., (2008) Sexual Health, 5: 161-8 42 38 39 Rural/regional Urban 7 6 NSW Vic QLD SA WA 6 TAS ACT 8 NT
  8. 8. Packages of care for PLHIV: (Models of Access and Clinical Service Delivery 2009) Clinical & allied health care Referral to non-clinical, “formal” care (housing, financial support) Right time, right place, by the right team Specific groups: Those with highly complex needs ATSI CALD ? Informal care by family, partners, friends & community (public or private)
  9. 9. Availability, access & preference: the ageing factor Clinical & allied health care Chronic co-morbidies: CVD, diabetes, depression, dementia, AoD, ageing workforce too! Referral to non-clinical, “formal” care (housing, financial support) Disability pension, re-engaging with the work force & volunteering, unstable housing Right time, right place, by the right team Specific groups: Those with highly complex needs ATSI CALD Cultural and sexual expressions, changing needs, interdependence & mixing Informal care by family, partners, friends & community (public or private) Fear of disclosure, discrimination, non-nuclear family, living alone, peer support, affordibility
  10. 10. GLBT in aged care services Barrett (2008) report “My people…” Sexuality & lifestyle HIV infection & management Safety & Quality of formal aged care Chronic illness & mental wellbeing
  11. 11. HIV and ageing: important knowledge gaps • Promotion of healthy lifestyles and reducing comorbidity: stop smoking; control blood pressure, decrease alcohol consumption, lose weight, exercise, poly-pharmacy, substance use, ART adherence • Neurocognitive function & mental health • HIV prevention: safer sex, new sexual partners, sexual dysfunction High et al. (2012) JAIDS, 60: s1-s18
  12. 12. HIV and ageing: important knowledge gaps • Successful ageing: resilience • Stigma in relation to networks and care giving • Community resources: the role of informal support, nonmedical community-based services, training service providers of GLBT issues, faithbased orgs, paid helpers etc High et al. (2012) JAIDS, 60: s1-s18
  13. 13. HIV and ageing: important knowledge gaps • Women – Menopausal transition and beyond: sex hormones – Bone health – Gender roles: prioritising care for others over self care, silencing the needs of the self to avoid relational conflict and loss, subordinating to male partners – Immigrants with a traumatic experience in the past High et al. (2012) JAIDS, 60: s1-s18
  14. 14. Socially constructed ongoing ageing process: the Fox (2005) Sociology 39: 481-98 illusion of “successful ageing” • Pension & income earnings (financial) • Health care (illness & access) • Structural deprivation: people with complex needs but often having low trust towards the system Interpersonal interactions: personal support networks, professional carers, HCW Cultural/religious beliefs & norms Independence & interdependence Social, structural & physical constraints Expectations & Perceived QoL
  15. 15. Where to from here? • What are the key issues we already know?
  16. 16. High rates of current Major Depressive Disorder (NHMRC HIV & Depression project 2007)
  17. 17. High co-existence: MDD & male sexual problems (NHMRC HIV & Depression project 2007) Most common: ED or loss of libido
  18. 18. GCPS: UAIC rates doubled in 15 years 800 700 600 500 HIV+ gay men 400 300 200 HIV- gay men 100 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
  19. 19. Where to from here? • A doom & gloom picture? – Infectious diseases (HIV and other STIs) and safer sex – HIV treatment initiation, disease monitoring and lifelong adherence – HIV-related co-morbidities, pre-mature ageing and poly-pharmacy – Alcohol, smoking and recreational drug use – Depression, Sexual dysfunction – Living alone and lack of social support from significant others or community
  20. 20. Where to from here? • How to involve aging GLBT population who are living with HIV?
  21. 21. Patient, consumer & citizen: expand beyond selfmanagement Patient following a self-management plan Increased self-efficacy and enhanced skills Compliance (Medicine, Nursing, Cognitive Psychology) Greenhalgh (2009) BMJ 338: 629-31
  22. 22. Patient, consumer & citizen: expand beyond selfmanagement Copying with chronic illness Coherent self (disease narratives & meaning making), adaptive and pragmatic response Informed choices, resilience, understanding of the lived experiences of illness (Sociology of health & illness) Greenhalgh (2009) BMJ 338: 629-31
  23. 23. Patient, consumer & citizen: expand beyond selfmanagement A holistic, personalised care plan drawing on available community resources Engaged citizen, aligned with prevailing norms and values, seeking to develop health and community services Emergence of new structures and opportunities for supporting healthy living and managing illness (Social Ecology) Greenhalgh (2009) BMJ 338: 629-31
  24. 24. Patient, consumer & citizen: expand beyond selfmanagement Recognising and challenging structural barriers to good health (poverty, discrimination, social exclusion) Engaged citizen, opposed to prevailing norms and values, seeking social justice Fundamental change in the social and political structures that constrain individual action and underpin health inequalities (Critical Sociology) Greenhalgh (2009) BMJ 338: 629-31
  25. 25. A comprehensive, co-ordinated, people-centred, evidence-based care model: Patient, consumer & citizen Greenhalgh (2009) BMJ 338: 629-31

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