{"id":2926,"date":"2024-06-17T09:10:58","date_gmt":"2024-06-17T09:10:58","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=2926"},"modified":"2024-06-17T09:11:02","modified_gmt":"2024-06-17T09:11:02","slug":"americans-with-hiv-are-living-longer-federal-spending-isnt-keeping-up","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=2926","title":{"rendered":"Americans With HIV Are Living Longer. Federal Spending Isn\u2019t Keeping Up."},"content":{"rendered":"
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DECATUR, Ga. \u2014 Malcolm Reid recently marked the anniversary of his HIV diagnosis on Facebook. \u201cDiagnosed with HIV 28 years ago, AND TODAY I THRIVE,\u201d he wrote in a post in April, which garnered dozens of responses.<\/p>\n

Reid, an advocate for people with HIV, said he\u2019s happy he made it to age 66. But growing older has come with a host of health issues.<\/a> He survived kidney cancer and currently juggles medications to treat HIV, high blood pressure, and Type 2 diabetes. \u201cIt\u2019s a lot to manage,\u201d he said.<\/p>\n

But Reid\u2019s not complaining. When he was diagnosed, HIV was sometimes a death sentence. \u201cI\u2019m just happy to be here,\u201d Reid said. \u201cYou weren\u2019t supposed to be here, and you\u2019re here.\u201d<\/p>\n

More than half of the people living with HIV in the United States are, like Reid, older than 50. Researchers estimate that 70% of people living with the virus will fall in that age range by 2030. Aging with HIV means an increased risk<\/a> of other health problems, such as diabetes, depression, and heart disease, and a greater chance<\/a> of developing these conditions at a younger age.<\/p>\n

Yet the U.S. health care system isn\u2019t prepared to handle the needs of the more than half a million people \u2014 those already infected and those newly infected with HIV \u2014 who are 50 or older, say HIV advocates, doctors, government officials, people living with HIV, and researchers.<\/p>\n

They worry that funding constraints, an increasingly dysfunctional Congress, holes in the social safety net, untrained providers, and workforce shortages leave people aging with HIV vulnerable to poorer health, which could undermine the larger fight against the virus.<\/p>\n

\u201cI think we\u2019re at a tipping point,\u201d said Melanie Thompson, an Atlanta internal medicine doctor who specializes in HIV care and prevention. \u201cIt would be very easy to lose the substantial amount of the progress we have made.\u201d<\/p>\n

People are living longer with the virus due in part to the development of antiretroviral therapies \u2014 drugs that reduce the amount of virus in the body.<\/p>\n

But aging with HIV comes with a greater risk of health problems related to inflammation<\/a> from the virus and the long-term use of harsh medications<\/a>. Older people often must coordinate care across specialists and are frequently on multiple prescriptions, increasing their risk for adverse drug reactions.<\/p>\n

Some people face what researchers call the \u201cdual stigma\u201d of ageism and anti-HIV bias. They also have high rates of anxiety, depression, and substance use disorders.<\/p>\n

Many have lost friends and family to the HIV\/AIDS epidemic. Loneliness can increase the risks of cognitive decline and other medical conditions<\/a> in older adults and can lead patients to stop treatment. It isn\u2019t an easy problem to solve, said Heidi Crane, an HIV researcher and clinician at the University of Washington.<\/p>\n

\u201cIf I had the ability to write a prescription for a friend \u2014 someone who\u2019s supportive and engaged and willing to go walking with you twice a week \u2014 the care I provide would be so much better,\u201d she said.<\/p>\n

Malcolm Reid, a longtime HIV advocate, makes it a habit to mark the anniversary of his HIV diagnosis. A recent post on Facebook read, \u201cDiagnosed with HIV 28 years ago, AND TODAY I THRIVE.\u201d (Sam Whitehead\/KFF Health News)<\/span><\/figcaption><\/figure>\n

The complexity of care is a heavy lift for the Ryan White HIV\/AIDS Program, the federal initiative for low-income people with HIV. The program serves more than half of the Americans<\/a> living with the virus, and nearly half<\/a> of its clients are 50 or older.<\/p>\n

\u201cMany of the people aging with HIV were pioneers in HIV treatment,\u201d said Laura Cheever, who oversees the Ryan White program for the Health Resources and Services Administration, or HRSA. Researchers have a lot to learn about the best ways to meet the needs of the population, she said.<\/p>\n

\u201cWe are learning as we go, we all are. But it certainly is challenging,\u201d she said.<\/p>\n

The Ryan White program\u2019s core budget has remained mostly flat since 2013 despite adding 50,000 patients, Cheever said. The Biden administration\u2019s latest budget request<\/a> asks for less than half a percent bump in program funding.<\/p>\n

Local and state public health officials make the bulk of the decisions about how to spend Ryan White money, Cheever said, and constrained resources can make it hard to balance priorities.<\/p>\n

\u201cWhen a lot of people aren\u2019t getting care, how do you decide where that next dollar is spent?\u201d Cheever said.<\/p>\n

The latest infusion of funding for Ryan White, which has totaled $466 million since 2019, came as part of a federal initiative to end the HIV epidemic<\/a> by 2030. But that program has come under fire from Republicans in Congress, who last year tried to defund it<\/a> even though it was launched by the Trump administration.<\/p>\n

It\u2019s a sign of eroding bipartisan support for HIV services that puts people \u201cin extreme jeopardy,\u201d said Thompson, the Atlanta physician.<\/p>\n

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She worries that the increasing politicization of HIV could keep Congress from appropriating money for a pilot loan repayment program<\/a> that aims to lure infectious disease doctors to areas that have a shortage of providers.<\/p>\n

Many people aging with HIV are covered by Medicare, the public insurance program for people 65 and older. Research has shown<\/a> that Ryan White patients on private insurance had better health than those on Medicare, which researchers linked to better access to non-HIV preventive care.<\/p>\n

Some 40% of people living with HIV rely on Medicaid, the state-federal health insurance program for low-income people. The decision by 10 states not to expand Medicaid<\/a> can leave older people with HIV few places to seek care outside of Ryan White<\/a> clinics, Thompson said.<\/p>\n

\u201cThe stakes are high,\u201d she said. \u201cWe are in a very dangerous place if we don\u2019t pay more attention to our care systems.\u201d<\/p>\n

About 1 in 6 new diagnoses are in people 50 or older but public health policies haven\u2019t caught up to that reality, said Reid, the HIV advocate from Atlanta. The Centers for Disease Control and Prevention, for instance, recommends HIV testing<\/a> only for people ages 13 to 64.<\/p>\n

\u201cOur systems are antiquated. They, for some reason, believe that once you hit a certain number, you stop having sex,\u201d Reid said. Such blind spots mean older people often are diagnosed once the virus has destroyed the cells that help the body fight infection.<\/p>\n

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Like others with HIV, Malcolm Reid has developed a host of health issues while getting older. He has survived kidney cancer and has high blood pressure and Type 2 diabetes. But he\u2019s not complaining. \u201cI\u2019m just happy to be here,\u201d he says. (Sam Whitehead\/KFF Health News)<\/span><\/figcaption><\/figure>\n

In acknowledgment of these challenges, HRSA recently launched a $13 million, three-year program to look at ways to improve health outcomes for older people living with HIV.<\/p>\n

Ten Ryan White clinics across the United States participate in the effort, which is testing ways to better track the risk<\/a> of adverse drug interactions for people taking multiple prescriptions. The program is also testing ways to better screen for conditions like dementia and frailty, and ways to streamline the referral process for people who might need specialty care.<\/p>\n

New strategies can\u2019t come quickly enough, said Jules Levin, executive director of the National AIDS Treatment Advocacy Project, who, at age 74, has been living with HIV since the 1980s.<\/p>\n

His group was one signatory to \u201cThe Glasgow Manifesto<\/a>,\u201d in which an international coalition of older people with HIV called on policymakers to ensure better access to affordable care, to ensure patients get more time with doctors, and to fight ageism.<\/p>\n

\u201cIt\u2019s tragic and shameful that elderly people with HIV have to go through what they\u2019re going through without getting the proper attention that they deserve,\u201d Levin said. \u201cThis will be a disaster soon without a solution.\u201d<\/p>\n