Ageing with HIV – It is my hope that this brief would open the Pandora’s Box in all stakeholders…
Even with the availability of effective treatment, people living with HIV cannot avoid the inevitable effects of ageing that everyone experiences. On reflecting, one can see that quality of life decreases with age. This process can be much more complicated for the person living with HIV.
Persons ageing with HIV may encounter experiences that are associated with their age, compounded by the stigma—external and internal—associated with HIV and AIDS. Said stigma invariably issues from persistent, entrenched attitudes that are inextricably linked to the public’s misconception. Imagine, after 38 years there are many, too many people who hold inaccurate beliefs about the causal transmission of HIV. By virtue of their retaining these perceptions, such individuals facilitate a multiplicity of barriers to the HIV-positive person receiving psychosocial support from friends and family. These barriers are only natural corollaries of the social stigma associated with ‘AIDS’ and the sexual and drug-using behaviours through which many people became HIV-infected.
However, the object of this short article is not to address public misconception, or how someone may become infected, but to flag some questions I hope will elicit appropriate responses. My questions or concerns are relevant to: the interactions between HIV medication and medication to treat other conditions in the ageing process; the impact of the combination of HIV and ageing on the immune system; whether such impact leaves HIV-positive persons susceptible to chronic immune activation; what constitute the long-term effects of inflammation in people living with HIV and whether inflammation directly affects major organs like the heart, liver and kidneys?
These questions and concerns are pertinent because of the wisdom gained by research and observation of the natural process of growing old, which can complicate the issue of enjoying healthy life. The ageing process affects the immune system by lowering the production of T cells needed to defend the body against dangerously infectious attacks, resulting in possible cardiovascular complications, liver and kidney infections, the loss of muscle mass and the redistribution of fat, in several persons. Having considered that, now ruminate on the HIV infected individual whose immune system is already fighting this virus, with the additional challenge of coping with medication that can have further impact on the liver, kidney, muscle, heart and the redistribution of fat.
In the course of my research, the data I have encountered suggested that certain combinations of ARVs can cause abnormal bone metabolism, obesity and some mental health issues, such as ‘depression’. How effectively can the issue of depression be addressed by physicians operating under programmes that are focused primarily on the physical effects caused by HIV and ARV use?
Older people living with HIV can experience a number of comorbidities that should be addressed through prevention, screening, and early detection. The body’s defence mechanism, now attacked by HIV, is constantly at war with a host of other harmful organisms—viruses and bacteria that have invaded. The situation now is one where the virus reproduces itself, and the immune system, receiving stimulation to be on high alert, fights against the invader, —a syndrome called inflammation. While inflammation is not inherently bad, if unchecked it can cause havoc on the body, facilitating heart attack and stroke-causing plaque in the arteries, encouraging the growth of some types of cancers and burning out the immune system.
It is my hope that this brief would open the Pandora’s Box in all stakeholders. As I close, to the infected:
Do not allow your HIV-positive status to define you. In times preceding the advent of effective treatment, people infected struggled with uncertainty, but asserted control over their lives, not allowing their infected status to govern their lives. They strove instead, despite their HIV, to accomplish professional goals in what was perceived to be their few remaining years. Do likewise.
Founder, Educator and Counsellor of the foremost and first NGO in Central Trinidad to seriously address the issues of HIV and Substance Abuse.