As the number of people 50 years of age and older living with HIV in San Francisco continues to increase, AIDS agencies have teamed with aging providers to assess what services are needed for this unique segment of the city's senior population.
According to the Department of Public Health's most recent HIV Semi-Annual Surveillance Report, with data through December 2014, 58.4 percent of the 14,711 men living with HIV in the city are aged 50 and older. Among the 902 women living with HIV, 54.2 percent are 50 years of age or older.
Acria, a New York-based agency that runs the Center on HIV and Aging, is working with local leaders on the assessment of what services are needed for people as they age with HIV. Since January, Acria has been conducting informal interviews with HIV providers as well as aging providers.
It has also convened a focus group of people who have lived with HIV longer than 10 years and has teamed with the group Let's Kick Ass (AIDS Survivor Syndrome), which advocates on behalf of long-term survivors of HIV and AIDS.
Last week the agency held a two-day training for representatives from various HIV and aging providers to identify gaps in their services and to develop action plans for each. The city's Department of Aging and Adult Services and the Independent Living Resource Center of San Francisco co-hosted the gathering.
"One of the big ones is aging providers are not prepared or not well equipped to deal with a situation where someone in the cohort age group 50 or older comes out about their HIV status. They don't know where to refer them for services in general," said Hanna Tessema, Acria's HIV older adults technical assistance manager. "Also, aging providers' LGBT cultural competency is lacking."
In November the city's Long Term Care Coordinating Council reconvened an HIV and Aging workgroup to provide it with guidance on the needs of seniors living with HIV and AIDS. The workgroup's members plan to assist with the needs assessment Acria is helping to oversee.
"I think it is needed in San Francisco, bringing together aging providers and HIV providers," said Vince Crisostomo, who co-chairs the workgroup and oversees the San Francisco AIDS Foundation's 50 Plus Network for gay, bisexual, and trans men over the age of 50.
Since launching over a year ago, the agency's 50 Plus group now attracts upwards of 40 people to its weekly discussion sessions and its mailing list now numbers 400 men. As the numbers increase, the AIDS foundation is looking at how it can increase the services it offers to older HIV positive men.
SFAF was awarded grant funding from the State Office of AIDS and the Centers for Disease Control and Prevention to launch a health navigation program for people living with HIV. The program, which should soft launch in August, will be housed at the agency's new gay men's health center it is opening in the Castro this fall.
"It will help folks from soup to nuts in navigating the medical bureaucracy, from getting insurance referrals to other care," said Tim Patriarca, the foundation's executive director of gay men's health and wellness. "It will really enable us to put more attention in that area."
Another new offering being considered is providing clients at the health center with general wellness coaching, said Patriarca.
"There will be a whole host of other support groups and services at the center which 50 Plus participants can engage in as well," he said.
Need for more support groups
One need that has been identified already is for smaller, facilitator-led support groups for those aging with HIV or AIDS. The lack of such services, not just for HIV-positive men but for women and transgender people as well, has come up during the trainings Acria has been holding.
"It seems there aren't enough services around support groups for older adults with HIV," said Tessema. "Other people, rather than a support group to talk about HIV, want to find ways to socialize and integrate themselves into society, whether informally or formally, to get themselves out of isolation."
For months Jon-Edmond Abraham, 64, a long-term survivor of HIV, has been advocating for various agencies to begin offering facilitator-led support groups specifically designated for seniors living with HIV. Although a participant of the 50 Plus Network, Abraham said he would benefit from more than just a social support group.
"We would be well served by a bit of attention and focus by having a support group for us and our demographic," said Abraham, who so far has been unsuccessful in joining one of the few support groups that are being offered. "It is the sort of situation where nobody seems to be concerned about us on that level. It is just not easy to swallow at all."
Crisostomo said that SFAF is looking at providing smaller support groups, limited to eight to 12 people, for older men with HIV.
"We hope to launch something around that in late summer or early September. The details are still being worked out," he said.
One of the agencies Abraham had applied with was Openhouse, the nonprofit that focuses on LGBT seniors and offers a weekly support group for HIV-positive older men. Seth Kilbourn, the agency's executive director, told the Bay Area Reporter he could not comment about a specific individual.
But he did say the agency had purposefully capped the number of men who could participate in the group to no more than 15. And he stressed it is not meant to function as a therapy group.
"It is designed to help those folks to get together and talk about whatever issues they want to that week. They can confront whatever issues they are confronting, on HIV but not always," he said. "I do think there is a need for more programs and more activities and resources for long-term survivors. It is something we are definitely looking at."
Another agency Abraham has been unable to access a support group at is UCSF's Alliance Health Project. It currently offers seven peer-facilitated support groups for people with HIV, but none are currently designated specifically for seniors living with HIV.
AHP director Lori Thoemmes, speaking in general terms, said everyone who applies to join one of the agency's support groups is assessed to see if they would be successful in such a setting or should be referred to individual therapy.
"Some people are fine to be in a peer facilitated group. Lots of them aren't," she said.
At one point AHP had offered a support group specifically for long-term survivors of HIV and AIDS. But it disbanded it when the staff facilitator was let go by the agency amid a round of layoffs last year, and the agency does not have resources to revive it.
"We continue to be challenged with flat funding," said Thoemmes. "What do you stop doing if you want to start something new?"
Kilbourn said Openhouse also does not have the funding to provide all of the programs it would like.
"There are not enough resources at Openhouse and elsewhere for people to get what they need," he said. "We really have to look at what kinds of activities, support groups, and social group services folks are really going to want."
Acria's assessment of what services are needed for seniors aging with HIV is not expected to be complete until later this year or in early 2016.
"This is a call to duty for anyone working in HIV and aging to be involved. Because the numbers continue to rise," said Tessema. "A lot of people are committed to this and we can definitely do more."