The document discusses three topics related to aging and HIV: 1) Premature aging among people with HIV, as HIV infection is associated with more severe age-related comorbidities at an earlier age. The average 55-year-old with HIV has health issues equivalent to a 75-year-old without HIV. 2) Challenges in addressing the needs of an aging population with HIV, as they face issues related to both aging and HIV. Services and policies are not adequately prepared. 3) Educational needs to address misunderstandings around aging with HIV and promote healthy lifestyles, as prevention is also important for older adults.

1. HIV and Premature Ageing Ross Duffin AFAO Educators Conference

2. Three Stories of Ageing GLBTI Ageing The ‘natural’ ageing of the Australian HIV Epidemic Premature ageing

3. GLBTI Ageing GLBTI Ageing A discussion which began in the 1970s The appearance of HIV interferred with the discussion esp. for gay men Generation of ‘baby boomer’ GLBTI accessing aged services Dominant aged services paradigm / beliefs Sexuality – what’s that? There are no GLBTI Versus a generation who won’t be silent about their identity Similarities and differences with HIV ageing GLBTI ageing discussion inside HIV/AIDS organisations or GLBTI ‘health deficits’ organisations

4. ‘ Natural Ageing’ 1980s – mathematical modelling suggests average age of seroconversion in the early 80s mid/late-20s Each year people who had HIV got older and on average so did their sexual partners – average age of diagnosis has increased by approximately one year every two years since the mid 80s – average age of people with HIV has increased more A common interpretation of the increase in average seroconversion is differences in behaviour – in the 1980s ‘risk’ was associated with all gay men, often in their 20s – now its seen as attached to men closer to 40. Death rate has fallen dramatically since 1996 – usually people with HIV die from other causes Average age of diagnosis almost 40 by 2010 New diagnoses increase to over 1000 per year – biggest increase in people over 40 AIDS becomes invisible – response wound back 33% of people with HIV over 50, will be over 50% this decade, 15% per year increase in people with HIV over 65 HIV changes from a young persons disease to an infection you get when you are younger that dramatically affects your health when you’re older Typically in established HIV General Practice waiting rooms it now becomes rare to see people under 40

5. Natural Ageing of HIV Epidemic So generally it was understood that people with HIV had close to a normal life expectancy, they may have a higher incidence of co-morbidities particularly due to drug side effects, lifestyle factors or the impact of HIV in the immune system or of HIV disease on their bodies before effective treatments began – but as treatments improved the picture was expected to get better and better HIV changes from a young persons disease to an infection you get when you are younger that dramatically affects your health when you’re older Typically in established HIV General Practice waiting rooms it now becomes rare to see people under 40 HIV Ageing not seen as a huge problem – people with HIV die a bit younger – and may have some unique issues and there may be some mainstream service issues to be dealt with

6. Premature ageing Was described as early as 1980s – HIV disease like the fast forward button on your video player This decade – as HIV population ages we get a description of HIV disease as you get older Gradual realisation that more was going on than just ‘natural but faster ageing’ A number of studies began to show that premature ageing is a ‘disease’ caused by HIV infection completely independent from HIV treatment and lifestyle Cardiovascular risk Blood flow to the brain Prospective studies show that typical ageing in a person with HIV is characterised by more co-morbidities experienced more severely – average 55-year old HIV+ equivalent to 75 yrs old A new phase of HIV disease

7. Premature Ageing Causes of premature ageing Genetic factors HIV treatment drugs Lifestyle factors Smoking Alcohol Drug use Lack of exercise Diet HIV itself (inflammation) The average 55 year old with HIV has more typically ageing related co-morbidities than a 75 year old without HIV

8. HIV and premature Ageing – denial and myths Denial about AIDS early 1980s Denial 2010 – we’ve been here before It’s caused by ‘bad’ treatments – New York cohort There’s now a lot of people in their 50s and we’re coping A ‘beat-up’ for funding It’s just ‘normal ageing’

9. The political issue – who pays and who plans - Ageing or HIV – between a rock and a hard place? Typically State AIDS Bureau see the typical co-morbidities associated with HIV as ‘not HIV’ even though their increased incidence in younger people is directly caused by HIV infection Typically ageing bureaucracies don’t see 55-yr olds who when they have had HIV infection for 25 plus years have an effective biological age of 75 as ‘ageing’ Although there is a huge lot of work occurring to gear up services for older people with HIV, the current models and strategies do not have the capacity to deal with the coming prevalence of premature ageing and there has been little effective planning for what is coming – where death rates of people with HIV will grow to >1000 per year during the next decade (up from 150-200 currently) and where the medical and treatment costs for the last years of a person with HIVs life will be significantly increased because of the increased incidence and severity of typically ageing-related co-morbidities – and the additional costs will probably be greater than those incurred by AIDS from 1990-1996

10. HIV and premature ageing – some medical service issues Fundamental change in role of GP – pharmacologist to gerontologist HIV medical workforce issues Poly pharmacy issues Lack of treatment guidelines for HIV and co-morbidities Numbers of different specialists Lack of self-patient care programs Over occupying acute-care hospital beds because of lack of alternative facilities A focus on prevention – lifestyle as important as treatments? Perceptions of what HIV means Looming casemix funding issues

11. HIV and premature ageing – policy and service issues Definition of ‘ageing’ Access to pension / other benefits ‘Premature ageing’ and DSP Employment and ‘premature ageing’ Aged care Recreational therapy / meaningful lives

12. Premature ageing and HIV – social issues – talking with the first generation of ‘older’ people with HIV Old? You’re kidding (language) Isolation / diminished view of the world Reoccurrence of (unresolved?) grief and loss Transition into ‘retirement’ – models and stories of success Lack of family support Reliance on health system Appropriateness of HIV services Huge fears about Aged Care Control of end of life (suicide / euthanasia)

13. Challenging ageing discourses Ageing as disease Ageing as a burden Utilising all this talent It isn’t all bad! Ageing disgracefully

14. The educational issues How does premature ageing alter the meaning of HIV infection (versus current understandings) and who tells the new story? Medical Community Media

15. Educational Issues Lifestyle change becomes as important as treatments Healthy lifestyle often seen as boring How do we make the very unfashionable fashionable?

16. HIV prevention in over 40s Last decade HIV diagnoses increase by 30% - by 15% in people under 40 and by 75% in people over 40 (not being driven just by people close to 40) There is a new dimension to the HIV epidemic not only in terms of where illness is occurring but where new infections are happening

17. Educational issues Helping GLBTI and HIV+ people transition into retirement Visibility

18. Thanks My mum Ghosts and survivors Our voices