Ryan White, Aging and HIV

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TargetHIV

People with HIV in the U.S. are benefiting from treatment and living longer. For those getting care from HRSA's Ryan White HIV/AIDS Program (RWHAP), the data trend is dramatic. 

The proportion of RWHAP clients 50 and older was 32% In 2010, jumping to 44% in 2016, and ticking up again to 48.2% in 2022. The figure is projected to grow to 64% by 2030. (Read the 2019 HIV.gov blog HRSA Analyzes Growing Ryan White Client Population Over 50 Years Old).

Addressing Care Needs of Older Persons with HIV

In 2022, viral suppression rates were 92.9% for RWHAP clients ages 50 and over who were receiving medical care from the program. The rate is higher than the RWHAP overall average of 89.6%. (RWHAP Annual Client-Level Data Report, 2022, HRSA, 2023). 

Aging with HIV, however, has its challenges. In response, HRSA's HIV/AIDS Bureau (HAB) has devoted attention in recent years to the development of the following initiatives and resources to focus on HIV care needs of older individuals.

SPNS Aging with HIV Initiative

The SPNS Aging with HIV Initiative, formally entitled Emerging Strategies to Improve Health Outcomes for People Aging with HIV, started in 2022 and is identifying resources on improving the well-being of RWHAP clients ages 50 and older. There are 10 demonstration sites exploring interventions, with support from a network of evaluation and capacity building providers. Upcoming resources include: protocols,  tools, an evaluation toolkit, a pricing estimate template, and dozens of videos.

The initiative has two programs to support replication, available to anyone in the Ryan White Community: 

  • Speakers Bureau available to present on topics related to HIV and aging.
  • One-on-One Mentorship Program to provide expert guidance, and support in implementing an HIV & aging initiative.

Demonstration Sites: Aging with HIV Initiative

SPNS Aging with HIV Initiative

Foundation for the Aging Initiative

The basis for the Aging with HIV Initiative was established by multiple HRSA webinars and guides, including:

  • Optimizing HIV Care for People Aging with HIV: Incorporating New Elements of Care provides a summary of demographics on the increasing proportion of people with HIV in the U.S. who are over 50; common health challenges; gaps in medical management and tools to assess older patients; and social challenges often faced by older persons like social isolation.
  • Optimizing HIV Care for People Aging with HIV: Putting Together the Best Health Care Team, reviews the roles of the care team (e.g., nurses, case managers, pharmacists); staff training to provide, including how to conduct various patient assessments; and what to cover in undertaking an organizational assessment of a clinic's capacity to deliver care to its older patients. 
  • Addressing the Health Care and Social Support Needs of People Aging with HIV is a 2021, HRSA HAB Technical Expert Panel summarizing considerations and ideas for improving HIV care for older individuals.

See more tools on care for older persons with HIV in the TargetHIV Aging topic page and Adults Over 50 topic page on the AETC NCRC website.

Read the 2021 HIV.gov blog, I Am a Long-term Survivor of HIV.

Health Coverage and Medicare

As the HIV population ages, Medicare, the federal health insurance for older Americans, is taking on a larger role. HRSA's ACE TA Center has developed a number of tools to help RWHAP programs navigate Medicare coverage. See the Medicare Coverage collection.

Best Practices

There are 100+ evidence-based HIV interventions in the Best Practices Compilation, including Golden Compass. This San Francisco project out of the renowned Ward 86 clinic at San Francisco General Hospital provides an emphasis on co-morbidities associated with HIV and aging. 

Features include a weekly consultative geriatrics clinic; bimonthly consultative cardiology clinic; group classes; and health care coverage enrollment and other supports. Reported patient satisfaction rates are high. 

From the Field: Ryan White Conference Presentations

The 2024 National Ryan White Conference on HIV Care & Treatment featured an Aging and HIV Institute as well as sessions on Medicare. Those sessions will be available in the coming months. In the meantime, look for past conference sessions in our Conference Presentations database (filtered for Aging), including sessions from the Ryan White Clinical Conference, like the 2021 Ryan White Clinical Conference session on Managing Aging and HIV.