People living with HIV face specific hurdles beyond those that confront the general population as they enter the latter half of their lives. Living with HIV increases the risks of experiencing substance abuse, social discrimination, and stigma—which can lead to negative outcomes for those dealing with both HIV and comorbidities like cardiovascular disease, neurological issues, kidney problems, and cancer.
However, studies suggest that living with HIV may not be as disruptive to “successful aging” as we once had thought.
The Journal of Acquired Immune Deficiency Syndromes recently published results showing 82.5 percent of HIV-positive women aged 50-plus reported that they were aging well—compared with 83.7 percent of HIV-negative respondents. These results are particularly hopeful given that previous studies had been limited to white men and found greater disparities between poz and negative respondents—with 66 percent of poz men self-reporting successful aging versus 84 percent of HIV-negative men in a 2014 study.
Women living with HIV are known to have more negative health outcomes, with reduced access to care and quality of life, poorer adherence and viral suppression, and increased morbidity and mortality. Women living (and aging) with HIV are also disproportionately African-American and face wide-ranging health disparities and social inequalities.
Successful aging is generally defined as growing older while avoiding significant illness or disability. In a 2019 piece in the Journal of the Association of Nurses in AIDS Care, researcher David Vance reiterated what he considers the eight essential components of successful aging: length of life, biological health, mental health, cognitive efficiency (being able to learn and problem solve), social competence (ability to form and maintain close relationships), productivity, personal control, and life satisfaction.
Some people living with HIV have self-defined the concept differently. For many, physical fitness and even general health may be of less importance to their happiness and sense of aging successfully. Quality of life may reign over length of life, and continuing to engage in activities may have more value than one’s productivity in those activities.
A 2017 Canadian study found six themes that repeatedly came up when researchers spoke to people over the age of 50 who were living with HIV: accepting limitations, maintaining a positive outlook, fostering social support, taking responsibility for their health, adopting a healthy lifestyle, and engaging in meaningful activities.
Many of these themes are echoed in advice from the poz women’s group Well Project’s suggestions on how long-term survivors can age well by taking control of their health, finding support, speaking their truth, demanding a seat at the table, and committing to purposeful action.
Additionally, researchers from the Journal of Acquired Immune Deficiency Syndrome study found that spirituality was of particular importance to older Black poz women’s sense of wellbeing. It also found connections between aging well and higher levels of self-reported psychosocial attributes, such as optimism, resilience, and personal mastery. Those who reported experiencing anxiety, depression, loneliness, or a lifetime of discrimination, were less likely to report they were aging well. Addressing these mental health (and societal) issues could help combat those impacts.
The long-term survivors organization Let’s Kick ASS (AIDS Survivor Syndrome) suggests feedback loops, where stigma helps increase the isolation many older HIV-positive people face, which in turn adds to loneliness and depression, which can exasperate physical health problems. Therefore, even something like promoting the message that undetectable equals untransmittable (the consensus that shows when someone’s viral load has become undetectable, they are no longer able to transmit the virus to someone else) could improve the health of those living with HIV over 50 by reducing the stigma they may face in aging communities.
As the world changes, the future will undoubtably include new solutions and challenges to living well with HIV in the second half of one’s life. The ability to adapt to those changes or move to places with fewer challenges may play increasing roles in our experiences of aging.
Yet ultimately, what it takes to age well is a subjective evaluation that depends in part on what you value and prioritize. Is it a shorter life spent engaging in meaningful activities or stretching the goal post out longer, even if it comes with additional challenges? Either way there are some commonalities: it helps to have a support system and to stay as physically and mentally healthy as you can. And retaining control over decisions about your own life is essential. It helps to start now, at whatever age you are, to plan the future you’d like and to begin living well today.