Author: Gloria Crowell
The client population receiving services through the Ryan White HIV/AIDS Program is rapidly aging, reflecting a significant shift in the demographics of people living with HIV (PLWH) in both the United States and locally in Alameda County. Currently, more than half of all PLWH are 50 or older, and this proportion is projected to increase to 70% by 2030. In 2016 alone, 45% of Ryan White HIV/AIDS Program clients were age 50 and older, highlighting a critical and growing need for age-specific care and services. Within this demographic, approximately 72% are male, 28% are female, and less than 1% are transgender, underscoring the necessity for a nuanced understanding of gender-specific needs, as well.
These statistics underscore the urgent need for medical case managers to be well-equipped with specialized knowledge and resources tailored to the unique challenges of aging with HIV. This includes comprehensive care coordination that integrates Ryan White and medical waiver services with other available resources across the City of Oakland, County of Alameda, and various non-profit agencies. With an aging population that faces higher risks of comorbidities, social isolation, and compounded stigma, it is vital for medical case managers to adopt a proactive and holistic approach. Ensuring access to age-appropriate care, mental health services, social support networks, and community-based programs will be essential to improving the quality of life and health outcomes for this growing demographic of older adults living with HIV.
Practical Focus Areas
People aging with HIV share many of the same health concerns as the general population age 50 years and older. However, people aging with HIV also experience unique health needs as a result of chronic HIV-related conditions that require medical treatment. The providers caring for people aging with HIV may lack specialized training in health issues specific to aging patients. In addition, people aging with HIV—many of whom identify as lesbian, gay, bisexual, transgender, or queer—have unique social needs compared with the general aging population. People aging with HIV would benefit from having a multidisciplinary health care team that knows about community resources available to the aging population, as well as the nuances of healthcare financing and coverage.
Social Challenges Of People Aging With HIV
Social isolation is a profound and growing concern for people aging with HIV, especially for those who have endured the loss of close friends and partners to HIV over the past four decades, or those lacking robust family support systems. This isolation can worsen mental health issues such as depression and anxiety, creating a cycle of vulnerability that affects overall health and well-being. Moreover, the challenge of disclosing medical information becomes more pronounced as individuals age. Many people aging with HIV must navigate complex decisions about which aspects of their medical history to disclose—to healthcare providers, potential employers, or even to friends and family—while managing the stigma that still surrounds the virus.
Food and housing insecurity are also critical concerns, as many aging individuals face precarious financial situations that limit their access to nutritious food and stable housing. The complexity of financial management intensifies with age, particularly when it comes to navigating healthcare benefits like Medicare and Social Security. For people aging with HIV, these challenges are compounded by the high costs of essential medications and treatments for managing both HIV and comorbidities such as cardiovascular disease, diabetes, and osteoporosis. As a result, effective support must encompass not only medical care but also comprehensive assistance with financial planning, benefits management, and access to affordable, safe housing and nutrition to ensure stability and health for this vulnerable population.
What Medical Case Managers Must Prioritize
The aging population living with HIV requires immediate and focused care strategies. Achieving optimal health outcomes for this group hinges on a multidisciplinary approach that balances both medical necessity and quality of life. Addressing the unique and evolving needs of people aging with HIV is not just beneficial—it is essential. The psychosocial burdens that accompany aging with HIV, including depression, post-traumatic stress disorder, social isolation, and pervasive HIV stigma, must be urgently addressed. Without proper support and intervention, people aging with HIV who are isolated from family, community, and social support face devastating health consequences. Breaking this cycle starts with proactive steps: providing robust education to dismantle stigma and creating accessible community spaces for social interaction can dramatically improve their quality of life.
Examples/practical applications
Immediate Action Steps
- Implement coordinated care models: Seamless coordination between medical case managers, primary care providers, and other services is crucial. Fragmented care is not an option—integrated and well-coordinated approaches are essential to improving outcomes and quality of life for older adults living with HIV.
- Strengthen primary care integration: Enhancing integration between HIV-specific care and primary healthcare services is vital. A stronger, more unified primary care approach will better support the complex needs of people aging with HIV.
- Foster self-sufficiency and resilience: Introducing programs that encourage self-sufficiency—such as returning to work or volunteering—can help empower older adults with HIV. Preparing them for a future where financial and support structures, like Ryan White funding, may change, ensures long-term stability and well-being.
Important links/resources
- Optimizing HIV Care for People Aging with HIV: Putting Together the Best Health Care Team – HRSA’s Ryan White HIV/AIDS Program
- HealthHIV Pozitively Aging
- People with HIV are aging, and the challenges are piling up – NPR
- Rethinking HIV in an Aging Society – Council on Foreign Relations
Author
Throughout Gloria Crowell’s career, she has excelled in nonprofit leadership and public health, including her distinguished work with Allen Temple Health & Social Services. She has contributed to influential bodies such as the City of Oakland Redistricting Commission, the Alameda County Public Health Commission, and currently serves on the Alameda County Health Care for the Homeless Commission.
Her extensive career has allowed her to collaborate with thought leaders, deepen her expertise, and pioneer innovative solutions to the challenges facing underserved communities. In her current role as Program Administrator at the Y.A. Flunder Foundation, Gloria oversees Medical Case Management Services and Food & Wellness Services, ensuring vital support for vulnerable populations. Gloria Crowell’s remarkable dedication over the past 35 years exemplifies a lifelong commitment to advocacy, innovation, and transformative change for those most in need.