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National HIV/AIDS and Aging Awareness Day: An Insider's Perspective

Tuesday Sep 18, 2018

By Hany Abdelaal

A year and a half ago, Gregory Brown, formerly homeless and long estranged from his 14 children, was suffering from such severe HIV, drug use and breathing problems that he was all skin and bones. He had little energy to move, and spent most of his time sleeping in the small bedroom of his single room occupancy housing (SRO).

What a difference a knock on the door can make.
"Now I'm 155 pounds, and I feel great," says Brown. Almost 60, he has gained 35 pounds and has an undetectable viral load -- a key measure of HIV control. He remains sober, has enough energy to ride his bike through Central Park, and regularly spends weekends with several of his children and grandchildren. "It's a lot of fun," he says about pushing his grandchildren on the swings and taking them to the pool. "I didn't do that too much when my own children were little; I didn't really raise them."

The turnaround began in March 2017 when outreach worker Peter Sorter, who is part of a VNSNY Select Health program funded by the New York state End the Epidemic (ETE) grant dedicated to reducing HIV statewide, knocked on the door to check in on a Mr. Gregory Brown, a high priority for follow up because his insurance records showed he had a high viral load and poor medication refill rate, and hadn't seen his doctor in quite some time. Alarmed by Brown's state during the visit, Sorter called in Dr. William LaRock, nurse practitioner and clinical director at VNSNY CHOICE SelectHealth, a Medicaid HIV Special Needs Plan (SNP).

Together, Sorter and Dr. LaRock represent the unique collaboration that is at the heart of the SelectHealth ETE grant -- an approach that includes skilled outreach workers from the Alliance for Positive Change, who accompany and navigate the way for plan members returning to care, along with medical oversight by the SelectHealth clinical director and a laser focus on having plan members return to treatment.

"Gregory, you need to go to a doctor," Dr. LaRock said, after an initial assessment.

"Take me, then," responded Brown. "It's time. I'm not well."

Soon after, Sorter accompanied him to St. Luke's Roosevelt Hospital Morningside Clinic on Manhattan's 110th Street. There, Gregory saw a doctor for his HIV; underwent a battery of tests on his heart, lungs and brain; had his medications assessed; was given an inhaler for shortness of breath and respiratory complications; and scheduled follow-up appointments as needed, knowing the care team would help him with transportation. He has enrolled in a pharmacy program that delivers medicines directly to his room, and takes his medications every day ("when I wake up; it's a habit now"). He is doing so well, in fact, that he has been moved out of the program's high-risk pool.

The main objective of the three-year grant was to increase the Viral Load Suppression rate by at least 20 percent in some 650-700 SelectHealth plan members who are flagged as no longer being in control of their HIV. By 2017, the program had more than met that goal with a 50 percent reduction in unsuppressed viral loads. Brown, with his undetectable viral load and a consistent record of regular clinic visits and medications refills, is living proof of the program's impact.

"They came into my life and changed my life all the way around," Brown said recently in a telephone interview. "I was very sick -- real sick. They came and got me, took me to the doctor, saw to it that I started on my medication, and got me back on my feet. And here I am today. If it wasn't for these people, I wouldn't be here."

HIV and Aging
In the United States, HIV is increasingly a disease of older people (National HIV/AIDS and Aging Awareness Day is September 18).

Statistics show that some 45 percent of Americans living with the diagnosed disease are age 50 or older. One reason for this is that people are living longer with the illness in check. Breakthroughs in medication and care delivery models have rendered HIV a manageable chronic illness in many cases, with a treatment regimen that's much less onerous than it was years ago.

At the same time, the health issues that can accompany aging -- including chronic illnesses such as diabetes, hypertension and cardiac disease, as well as isolation -- can amplify the effects of HIV in older people.

"The longer someone goes with untreated HIV, the higher the stress can be on the immune system, and the more at risk a person becomes for health concerns that result from being in a constant inflammatory state," says Dr. LaRock.

"Gregory's story is a great example of what is important to think about for someone who's been living with HIV for a long time and is now moving into their 50s and 60s," says Dr. LaRock. "The risk profile changes for everybody as they age, but particularly for people who have not been attentive to taking care of themselves. One of Gregory's motivations for getting back into care was the fact that he was feeling the weight of having had HIV for a number of years. He realized that if he was going to stay healthy, this was the moment for him to act."


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