HIV and Aging: A Time for Celebration?

On Sept. 18 the United States government observes National HIV/AIDS and Aging Awareness Day. On such an occasion one is left to ponder whether the aging of the HIV-positive population is a cause for celebration. Is this day intended to be a celebration?
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On Sept. 18 the United States government observes National HIV/AIDS and Aging Awareness Day. This commemoration is the latest addition to a series of such HIV-related remembrances and is one that has particular salience given the ever-evolving demographic landscape of the HIV-infected population in the U.S.

On such an occasion one is left to ponder whether the aging of the HIV-positive population is a cause for celebration. Is this day intended to be a celebration?

Currently, 30 percent of persons living with HIV in the United States are 50 or older, with age 50 marked as a demarcation point in terms of age-related physical and cognitive decline and various other health concerns. Data collected by the Centers for Disease Control and Prevention (CDC) suggest that by 2015, fully half of those living with HIV in our country will be 50 or older, a situation that has arisen because of the long-term survival of HIV-positive individuals given effective antiretroviral treatments, and because of the increasing number of individuals contracting HIV in older adulthood.

Within this population of older adults living with HIV is a substantial population of gay men who have lived their entire adult lives with and in the context of the HIV epidemic. For this group of men, the "AIDS generation," there is no life without HIV -- and that life is marked by loss, combating the physical ravages of the illness, and the emotional social burdens engendered by the stigma and discrimination directed at HIV-positive persons in our society.

It would be simple to enumerate the challenges that these men, my generation, have faced and continue to endure in light of this AIDS epidemic. Like soldiers who have fought bravely in the midst of unforgiving circumstances, we find that our bodies are worn from years of living with the disease and the natural process of aging, that our emotions are heavy from the trauma created by the epidemic, and that our social conditions are troublesome in a society where older adults become invisible, and in a gay community where even a 30-year-old is considered "over the hill."

Compounding these conditions is a burgeoning body of research that documents the deficits of aging with HIV in my generation of gay men. Studies demonstrate the accelerated development of cancers and cardiovascular disease; high rates of neurocognitive deficits; life conditions characterized by loneliness, social isolation, and depression; and ongoing battles with substance use sexual adventurism.

I suppose this is one manner in which to view the aging of the AIDS generation, often fueled by sensationalist research that misses the forest for the trees. However, I espouse a different approach to understanding my generation of gay men.

In my view the AIDS generation is the bravest generation. And as we would do for our World War II heroes, whom we honor as the "greatest generation," on this National HIV/AIDS and Aging Awareness Day we should focus on the strength, courage and determination of the AIDS generation. We should celebrate our collective resilience, for in the midst of the most dire and harrowing circumstances, we have managed to not only survive but thrive. I know this not only because I am a researcher in this domain but because I lived it.

Over the course of the last several years, my program of study has provided me with the privilege of speaking with myriad gay men of my generation about their lives, their loves, and their loss. On May 9, 2013, I witnessed a collective outcry from our generation of gay men in a community forum that we organized in New York City. The forum, which was aptly named "Is This My Beautiful Life?" has created national momentum. Similar events are being organized across the country, including one in San Francisco on Sept. 18 that is perfectly named "Definition of Brave."

This is all to say that there is much to learn from the generation of gay men who lived through the darkest hours of AIDS before the turning point in 1996, when our ability to combat the disease was greatly improved in light of effective antiretroviral treatments. Before that time, and to this day, the gay men of my generation fought for their lives physically, emotionally, socially, and politically. We used all the tools in our arsenal to ward off the unfortunate outcome faced by hundreds of thousand of gay men: death at the hands of this despicable disease.

From our experiences we can glean models of resilience and strategies for survival that not only help inform our work with a new generation of gay men (who, sadly, continue to become infected with HIV) but offer hope for all those who battle chronic and life-threatening illnesses. In that regard National HIV/AIDS and Aging Awareness Day is not only a day of remembrance but a day when we should take pride in what we have survived and celebrate the life accomplishments of my generation of gay men, the AIDS generation.

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