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HIV & PTSD, Lifetime Trauma/Mental Health,
Adherence - Aged HIV+ Deserve Better
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from Jules: HIV has a unique patient population. Lifetime trauma and recent trauma increases risk for HIV-infection, non-adherence to HIV medications, depression, and depression & trauma increase rates of sleeping disorders & comorbidities; HIV itself causes sleeping disorders which in turn increase risk for comorbidities including depression. The HIV patient population is mostly composed of MSM and those with a history of substance abuse with a smaller segment composed of women who have sex with women, lesbians, and heterosexuals, and transgenders. And of course there is the pediatric population who face a lifetime of HIV and comorbidities as they age through adolescence and adulthood. The majority of women with HIV are minorities - African American & Latinos. Lifetime & recent trauma causes PTSD. in my opinion everyone with HIV has PTSD to one degree or another, although some may suppress this. Aging with HIV is an epidemic and public health problem. As the HIV patient population ages all of these concerns or you can call them comorbidities too worsen, the mental health of these individuals will suffer. PTSD & self stigma will worsen as aged HIV+ start to blame themselves & become depressed, anxiety is worsening, this is already happening; many HIV doctors have been putting increasing numbers of patients on anti-depressants because that is all they know on what to do about this. This aging generation deserves better. With aging & having HIV we know isolation, depression, income & housing, mobility problems all surface for many. The first generation of HIV survivors is now elderly and many are suffering from these "comorbidities". Substance abuse & suicide ideation is likely to increase. These problems MUST be addressed in a full front on comprehensive way BUT they are NOT being addressed in any way. On a federal and local level HIV health officials are ignoring these problems. I warn - This will come back to haunt them. My advocacy & policy on these issues are ahead of the curve as I was with HCV/HIV coinfection in 1998 and when I warned & alerted everyone in HIV about the coming aging problem 15 years ago. But now its 15 years later & the patient population is older and many now are suffering the affects of premature frailty and disability, and this will only worsen over time for individuals & the broad HIV community as well. This is a global problem. As disability progresses home health care & long term facility care for those who become fully disabled & need to live in such facilities WILL BECOME a major issue. Right now 80% with HIV in the USA are 45 years old or more, 50% are over 50, and 25% over 65. Soon 50% will be over 60-65. This trend is on the upswing. We need a National Discussion on Aging & HIV and strategize solutions. Governments, industry, advocates and researchers are obligated to step up to put this issue FRONT & CENTER. Aging HIV+ deserve better than they are getting. It sometimes feels as though everyone is merely waiting for them to just die!
Coping with HIV/Aging: managing health & psychological factors & HCV - (01/15/12) "In many ways, HIV-positive people over 50 are like guinea pigs, says Chew: they are the first to age with HIV, and the first to experience that process truly out of the closet"
A key to aging will be managing stressors of physical & psychological health which include the usual & expected stressors HIV-negative individuals face and in addition those due to having HIV. Many of the usual stressors of aging will be magnified among those with HIV including less money, loneliness, difficulty in mobility (shopping, getting out for social activities), managing one's home, of course managing one's increasing health issues, and keeping busy and satisfied. Although older people in general have at times difficulty with loneliness & companionship, people with HIV may be more acutely affected for many reasons, so more support services will be required.
............ future studies must incorporate the duration or chronicity of HIV on the overall quality of life, including an examination of long-term stress and coping, depression and anxiety, retirement and financial issues, sexual and familial relationships, loneliness and social networks, cognition and everyday functioning, and so on. "When considering ageing with HIV, we must keep in mind that this disease affects the whole person, not just one's immune function", he concludes.
"Sleep disturbance and fatigue are highly prevalent and disabling symptoms in a majority of individuals infected with HIV.
The combination of physiological and mental impairments in older HIV-positive patients will put severe pressure on medical and social resources. ...Growing old with HIV : The Lancet Infectious Diseases
Stigma related to disease and age-and, in many cases, sexual orientation, too-has been shown to cause depression and anxiety. (rates of depression in HIV survivors [are] higher than in the general population.) Many of those aging with HIV don't have social networks they can count on, either: gay seniors, who make up a big chunk of this group, are twice as likely as their straight counterparts to live alone. "People with better social networks are more adherent to their meds, less likely to be depressed, and we know from the gerontological literature that those with better social networks live longer-outside of HIV disease," says Charles Emlet, a social worker at the University of Washington who studies the virus and aging.
major depressive disorder associated withincreasedheart attack risk [acute myocardial
infarction] by 30% in HIV+
Association Between Depressive Disorders and Incident Acute Myocardial Infarction in Human Immunodeficiency Virus-Infected AdultsVeterans Aging Cohort Study - depression & mortality in HIV - (09/07/16)
The poorer responses to HAART found in African American and Latina women, however, were explained largely by HAART discontinuation and to a lesser extent, by depression....http://www.natap.org/2012/HIV/040212_02.htm
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Trauma Drives HIV Epidemic in Women - (03/20/12)
Recent Trauma is Associated with Antiretroviral Failure and HIV Transmission Risk Behavior Among HIV-Positive Women and Female-Identified Transgenders - (03/20/12) .....One prior study reported a positive association between past trauma and ART failure in a cohort of HIV-positive men and women [27].......Low social support was the only statistically significant correlate of ART adherence on univariate analysis (OR 5.6.....Recent trauma (within the past 30 days) was reported by 17.3% participants; lifetime trauma was reported by 71.8%. Recent coercion to have sex (within the past 30 days) was reported by 8.2%; lifetime sexual coercion was reported by 64.5%.....The mechanism(s) by which trauma and PTSD impact HIV-related health outcomes and transmission risk behavior have been the subject of increasing analysis. Prior studies demonstrate an association between trauma and/or PTSD and non-adherence to ART [38-45]. Drug abuse and mental health problems (e.g., depression) have also been identified as potential, often interrelated, mediating factors between trauma, medication non-adherence, and poor HIV-related health outcomes [41, 46-48].
Women & HIV: Women & HIV: Black Women in USA; trauma; childhood sex abuse; heart disease in HIV+ women - (03/29/12)
Childhood Trauma and Health Outcomes in HIV-Infected Patients: An Exploration of Causal Pathways- (03/23/12)
"greater lifetime trauma exposure was associated with all outcomes considered (Table 3). Each additional type of lifetime trauma was associated with 18% increased odds of unprotected sex, 13% (3% to 24%) increased odds of ARV nonadherence, 12% (4% to 21%) increased odds of hospitalization, 14% (6% to 22%) increased odds of ED use, 13% (5% to 22%) increased odds of more than 4 days in bed, a 12% (0% to 24%) increased hazard of HIV disease progression, and a 0.8-unit (0.4-1.2) lower SF36 physical health score."
The Pervasive Effects of Childhood Sexual Abuse: Challenges for Improving HIV Prevention and Treatment Interventions EDITOIRAL-- (03/23/12)
Associations of Sexual Identity or Same-Sex Behaviors With History of Childhood Sexual Abuse and HIV/STI Risk in the United States-- (03/23/12)....."Men and women sometimes or frequently abused had significant increases in risk for HIV/STI incidence compared with those not abused....."Overall, 14.9% of women and 5.2% of men reported CSA. Among women, bisexuals, lesbians, and heterosexuals with same-sex partners had 5.3 times, 3.4 times, and 2.9 times the odds, respectively, for CSA - childhood sexual abuse - occurring sometimes/more frequently (vs. never) compared with heterosexuals not having same-sex partners or attractions. Among men, bisexuals, gay men, and heterosexuals with same-sex partners had 12.8 times, 9.5 times, and 7.9 times the odds, respectively, for CSA. Men and women sometimes or frequently abused had significant increases in odds for HIV/STI incidence compared with those not abused. Among women, sexual minorities had 3.8 times the odds and heterosexuals had 2.8 times the odds, whereas among men, sexual minorities had 4.2 times odds and heterosexuals had 1.5 times odds."
2nd Intl Wrkshp HIV & Women: Sexual Abuse as Child Raises Heart Disease Risk in HIV-Positive Women - (01/14/12)
Study of the Day: 1 in 4 Adults With HIV Were Sexually Abused as Kids-- (03/23/12)
Depression Tied to Worse Cognitive Function in MACS Men With or Without HIV.....http://www.natap.org/2015/AGE/AGE_13.htm
Aging & HIV - an unaddressed timebomb waiting to explode - slide presentation by Jules Levin, NATAP-- (03/14/17)
HIV & Aging - Mental Needs: Policy, Mental Health Services Program, Comorbidities, Services for Aging/Older HIV+-
- inability to function:loss of income/housing, depression, increased substance abuse, emotional instability, suicide, non-adherence
9-YEAR TRENDS IN NON-LIPID CARDIOVASCULAR DISEASE PREVENTION STRATEGIES IN HIV+ WOMEN in WIHS-women have poor control of diabetes & hypertension
"Use of hypertensive and diabetes medications increased among both HIV+ and HIV- women but coincided with only small or no improvements in risk factor control" "HIV+ women more effectively manage hypertension and diabetes than HIV- women from the same risk population - However, more than 40% of hypertensive and 25% of diabetic HIV+ women still did not achieve target control levels"
WIHS - Depression and Social Isolation Mediate Effect of HIV Stigma on Women's ART Adherence - (02/26/16)
"findings suggest that potential predictors of adherence may operate differently by race.....contribute to our understanding of different rates of adherence and health outcomes by race among women living with HIV.....also suggest that interconnected psychosocial mechanisms affect ART adherence.....internalized stigma was a significant predictor of sub-optimal adherence....Predictors of better adherence included non-Hispanic white race/ethnicity, older age, less years on ART, and nonuse of non-injection drugs.....the association between internalized stigma and adherence was significant for those in racial and ethnic minority groups.....Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and sub-optimal adherence in the whole sample, as well as in the subsample of minority participants.....internalized stigma predicted less perceived social support (or higher loneliness), which in turn predicted more depressive symptoms, which in turn predicted suboptimal medication adherence."
CROI: Cognitive Complaints and Development of Falls among HIV-Infected and Uninfected Women - (03/06/17)...."Cognitive complaints (self-reported major problems with memory or concentration, confusion, or inability to perform routine mental tasks) by women were associated with increased odds of having a fall..,previously reported high prevalence of falls in WIHS, 18-19% had 1 or more falls in past 6 months"
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