Feb 28, 2022 - News

D.C.’s HIV+ population is aging. Doctors say that’s a good sign.

Illustration of a person with a cane that has a red HIV awareness ribbon on it.

Illustration: Aïda Amer/Axios

More than half of people in D.C. living with HIV are 50 years and older, which is a positive sign, according to the health care providers who treat them.

Why it matters: D.C. has aggressive goals to slash new HIV transmissions and ensure that 95% of Washingtonians with HIV know their status, are in treatment, and have reached viral suppression by 2030.

  • “HIV is seen as a chronic disease at this point,” says Clover Barnes, senior deputy director of DC Health’s HIV/AIDS, Hepatitis, STD, and TB administration. “We are excited that people are living longer … despite having HIV.”

In its latest HIV surveillance report, D.C. showed slowed declines towards its goals of reducing HIV transmission in the District. Still, the city has seen a significant drop in new infections and a significant increase in viral suppression since its peak in cases in 2007.

  • That same report also showed that D.C.’s HIV positive population is aging.

By the numbers: In 2020, 4,864 people 55 and older knew they were HIV positive, with 32 new cases in 2020.

  • Among those newly diagnosed, 1 in 4 were men having sex with other men, 2 in 5 are women, and 4 in 5 are Black.

D.C.’s older population also has a relatively high rate of treatment and is more often virally suppressed than younger age groups.

Zoom out: D.C.’s aging HIV positive population is in line with national trends, says Jen Kates, senior vice president and director of global health and HIV policy at the Kaiser Family Foundation. "This was a trend predicted several years ago," she adds.

  • And that’s because of "almost all positive factors," she says. Access to care and treatment is better, for example.

The big picture: Providers at Whitman Walker and Unity Health Care, which both treat many of the city’s HIV patients, have similarly observed this trend, they tell Axios.

Both Whitman Walker and Unity Health Care say the majority of their HIV positive patients are Black, and at Whitman Walker, the average age of a patient is 50, if not older. At Unity Health Care, 57% of patients are over the age of 50.

What they’re saying: Whitman Walker chief health officer Sarah Henn says HIV has become a chronic illness as people live and age with it.

  • That means providers are spending more of their time treating their HIV positive patients for conditions faced by many older Americans: hypertension, pre-diabetes, diabetes and and high cholesterol.
  • Henn also notes that there are long-term side effects associated with the use of antivirals, which are the medications used for viral suppression, that providers must watch for.

Unity Health Care infectious disease director Gebeyehu Teferi says patients at Unity often receive a team of providers, which might include an infectious disease specialist to treat HIV as well as a primary care provider who can monitor other vitals.

As the world enters the next phase of the coronavirus pandemic, loosening mask and vaccine restrictions, and a decline in cases after the Omicron surge, providers everywhere are trying to get people back in for regular care.

  • “I think my biggest concerns are what’s gone undiagnosed. So in our patients who have been chronically living with HIV, those are, you know, delayed diagnosis for cancer, our heart disease, and other things,” Henn says.

What’s next: The D.C. health care system must continue to be versatile, however, to both treat an aging population but also address a challenge present in the latest surveillance report: Most new infections in 2020 were among young people.

D.C. this year is working on innovating its Ryan White HIV/AIDS Part B program, which offers grants to states to improve HIV care.

  • Barnes says this will look like a “no wrong door approach,” meaning people who both have HIV or are at-risk of getting HIV can access services in the same place.
  • And, if they are diagnosed with HIV, Barnes says, it means they’ve already been connected with a trusted provider.
  • D.C. will begin the grant program for local providers starting April 1 to implement these programs.

“Our hope is that you can stay with that same case manager moving into dealing with your HIV diagnosis or prevent you from getting there in the first place,” Barnes says.

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and the Silver Century Foundation.


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