Canada’s health system unprepared for elderly HIV patients: charity

A growing number of older adults are living with human immunodeficiency virus (HIV) in Canada. But according to a Toronto-based charity, current healthcare systems are unwilling to care for the increasing number of older Canadians who are HIV-positive.

Toronto-based HIV/AIDS charity Realize says long-term care homes and care facilities across Canada are not equipped to treat elderly patients with HIV, who are more likely to have a chronic disease.

“They are more likely to develop cardiovascular disease, diabetes and other chronic diseases that they have to manage in addition to their HIV,” Kate Murzin, national program manager for Realize, told in a phone interview Wednesday. “They are now experiencing the overlap between HIV and aging, and it causes a lot of complexity in both their health, physical health, but also in terms of other social factors, for example financial security in old age.”

HIV is a sexually transmitted blood-borne pathogen. The World Health Organization (WHO) says HIV is an infection that attacks the body’s immune system, specifically the white blood cells. If the virus manages to destroy these cells, a person’s immune system is weakened. This can lead to other serious infections, including tuberculosis, cancer of the mouth, lung and liver, and fungal infections.

People living with HIV are at greater risk for disabilities, mobility problems and cognitive problems, Murzin said. These challenges affect their quality of life and without help or proper care, the mental and physical health of people living with HIV can deteriorate as a result, Murzin said.

In an email sent Wednesday, Ken Miller, executive director of the Canadian AIDS Society, told that there is “anxiety” among people dealing with HIV and the type of care they receive.

β€œIn general, medical staff are not well trained in the complexities of caring for people living with HIV, and health care providers tend to be even less trained,” Miller said.

In 1997, Canada introduced antiretroviral therapy (ART) for HIV, allowing people to live with the virus. A previous study published in 2015 explained that Canadians who underwent ART increased their lifespan to 65 years. This is an increase of 16 years since 2000.

With more HIV patients getting older, caring for those who are aging with HIV is generally not a focus during training, Miller said.

HIV can be spread through sexual activity or by sharing needles or syringes. At an advanced stage, HIV can lead to acquired immunodeficiency syndrome (AIDS), which severely damages the immune system. Since the 1980s, when HIV/AIDS was declared an epidemic, millions of people worldwide have died from AIDS-related diseases, according to UNAIDS.

According to Statistics Canada, there were an estimated 62,050 people living with HIV in 2018. There were 1,639 newly diagnosed cases in 2020, a 21 percent decrease from 2019, when 2,122 new cases were reported.

The longer lifespan of people with HIV means that the infection can continue to be transmitted. Murzin says streamlining both HIV treatment and aging in one place would help limit HIV transmission.

“Right now, people often get their HIV care from their primary care physician, or usually from an infectious disease specialist,” she said. “But an infectious disease specialist is in no way trained or prepared to provide care for all of the chronic illnesses that people face as they age.”

By educating employees about the added complexities people living with HIV face along with aging, Murzin says other issues can be alleviated as well.

“Before 1996, the treatment options for HIV were very limited, so make a diagnosis one at a time [when]… you were actually told to get your act together because you weren’t going to survive more than six months or a year was extremely traumatic,” she said.

Not only did HIV patients have to worry about their health, but disclosing their status to others was usually filled with judgment, Miller said.

“Stigma remains one of the biggest drivers of HIV transmission,” Miller said. “If someone is concerned about a positive result, this may deter them from reaching out. This is one of the factors that the new [HIV testing] initiatives more important.”

Realize and other organizations from around the world have gathered to create 10 calls to action to improve the quality of life of older adults living with HIV. With Dec. 1 being World AIDS Day, these organizations say they want to raise awareness of the challenges people living with HIV face, along with the emotions and complexities of getting older.

Some spearheads are low-threshold access to care, healthy living conditions, targeted research and empowerment, a place at the decision-making table, combating age discrimination and considering sexual health as part of overall health.

“Quality of life is much better than previous years, but there is always room for improvement,” Miller said in the email. “Starting with creating a system that supports individuals who change incomes later in life and provides at least the basics to any individual who needs it. Dental, physical, psychosocial and housing support.”

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