In 2012, Medicaid spent $5.3 billion on HIV care, with 36% of that federal spending going to treating the disease, according to the Kaiser Family Foundation. Medicare spent $5.9 billion, accounting for 39%. States spent $4.3 billion. Financial support for HIV patients available through the Ryan White Care Act is limited in scope; services such as the federally funded AIDS Drug Assistance Program, which pays for medications, often cover patients only when their white cell counts have dropped very low.
The exact reason why chronic diseases are so prevalent among older HIV patients is not known for sure. One leading theory has to do with the way the virus causes inflammatory responses, making patients more susceptible to various health conditions.
Another potential factor could be HIV treatment itself, whose effects on the body after several decades of drug therapy remain unclear.
“Even on good antiretroviral therapy, it's hard on the body to have HIV infection for decades,” said Dr. Wayne McCormick, president of the American Geriatric Society and a professor of medicine at the University of Washington. “Most people now in their 50s with HIV have had HIV for a couple of decades and been on powerful drugs for that long.”
It also takes close monitoring of all of the drugs patients are taking for their non-HIV related health conditions to make sure they don't negatively impact the effectiveness of their antiretroviral medications.
While HIV specialists have improved in delivering the kind of care normally provided by primary-care physicians, Van Sickels thinks more could be done to provide clinical guidance on the best ways to manage chronic disease for those living with HIV. “Right now, the guidelines are lacking,” he said.
Those who have lived with HIV for decades are now being joined by a growing number of older Americans who are newly diagnosed, as well as those who are newly infected. That increase is due in part to denial and ignorance about HIV and sex.
“Neither older individuals nor their physicians often think of HIV quite the same way younger individuals do,” said Dr. Amy Justice, a professor of medicine at Yale University. “Even older individuals with identified risk factors like men who have sex with men will often say, 'I just didn't think it would happen to me—that happened to younger gay men.' ”
Aging with HIV can take a heavy emotional and financial toll on older patients. “Many didn't really prepare or plan to have an older life experience,” said Hugh Cole, a substance-abuse counselor at Howard Brown Health Center in Chicago, a comprehensive-care facility for the city's LGBT community.
Older HIV patients also may feel isolated because of the stigma associated with HIV that remains in some parts of American society, and they may not seek specialized HIV care.
“That works against people maintaining good health,” Mehdi said. “If you don't feel like it's safe for you or comfortable for you to be open about your HIV diagnosis, which many people don't, then you're not going to feel comfortable walking into a clinic that is known to specialize in HIV care.”