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Thursday, September 18, 2014

Mental Health and Substance Abuse in Older HIV Infected Adults, Are we as a Community Prepared?


Aging: The New Challenge 


At the start of the epidemic, people who were diagnosed with HIV/AIDS could expect to live only 1-2 years after that diagnosis. This meant that the issues of aging were not a major focus for people with HIV disease.
But new medications and treatments have changed that. Life expectancy for people with HIV disease has increased dramatically—which means that they now have to face the challenges of aging with HIV/AIDS.
Normal aging is associated with risks for many different conditions, from osteoporosis to heart disease, but having HIV can increase those risks. Some illnesses or conditions which can be worsened by aging and HIV (or treatments for it) include:
  • Dementia
  • Depression
  • Insulin resistance
  • High cholesterol and triglycerides
  • Infections
  • Medication interactions
Mental Health and Substance Abuse in Older HIV Infected Adults, Are we as a Community Prepared?

What I'm not reading enough on or being talked about is mental health and substance abuse in older HIV infected adults.

 As a consumer on SSDI and living in a major metropolitan area my clinic Callen-Lorde has opened a new building to keep up with the demand for all with HIV/AIDS living with chronic mental health issues, I'm fortunate to have this, but as you get away from the bigger cities, these services are not readily available and if you find them many are not LGBT affirmative keeping many away from being properly diagnosed.  Thanks to local chapters of (NAMI) National Alliance on Mental Illness and (DBSA) Depression Bipolar Support Alliance the gap does have some resources.  In Brooklyn we are fortunate to have the only LGBT Outpatient facility in the nation called Rainbow Heights Club, we need a Rainbow Heights in each state, we need trained LGBT hospice care workers, our community at large to me has been dormant on the issue of mental illness in the gay community as a whole, so I'm hoping that the emphasis on HIV/AIDS and aging awareness now in it's 7th year, coupled by the Affordable Care Act and the Mental Health Parity Act we will see more long term mental health GLBT affirmative facilities in the existing AIDS service organizations pop up.

In the News today :

I did find one Op-Ed in the Advocate, a good read but with very little or should I say not once did I read the word mental illness, I did read, "Like other seniors, many older persons living with HIV also have other common diseases, such as heart disease and diabetes. Living with multiple health conditions can be very challenging both physically and emotionally."  And another mention, "When you couple that with the stigma that some older LGBT people face when they move into senior living communities, it can be a difficult psychological burden," for the entire article read here.

For more resources on  Mental Health and Substance Abuse in Older HIV Infected Adults:

HIV, Psychiatric Comorbidity, and Aging

Julia L. Skapik, BS, and Glenn J. Treisman, MD, PhD

Read complete article:

Psychosocial, mental health, and behavioral issues of aging with HIV

Psychosocial, mental health, and behavioral issues of aging with HIV  Rueda, Sergioa,b,c; Law, Stephanied; Rourke, Sean B.a,b,e,_mental_health,_and_behavioral_issues.7.aspx


Aging with HIV and AIDS: A growing social issue

June 25, 2014
St. Michael's Hospital

ASA, American Society on Aging (source)
Mental Health and Substance Abuse in Older HIV Infected Adults, by Lisa Cox

Wednesday, September 10, 2014

Health, Home, Purpose and Community. I have all of that yet still feel isolated from my Queer Community

Health, Home, Purpose and Community
So why do I still feel isolated from my Queer Community

From SAMHSA's: Leading Change A plan for SAMHSA's roles and Actions 2011 - 2014.

"Recovery is a unique journey for each individual, and each person in recovery must choose the range of services and supports ranging from clinical treatment to peer services.   To facilitate resilience, recovery, and social inclusion, persons with mental health and substance abuse use disorders will also need to receive treatment for their co-occurring health problems.  Access to services must be paired with shared decision-making process between people in recovery and providers to determine how best to select, structure, and delivers services.  Like other aspects of health care and unless adjudicated by courts of law, people have the right to choose and determine what services and treatments best meet their needs and preferences.  Self-determination is the foundation of person-centered and consumer-driven recovery supports and systems, including such approaches as person-centered planning, shared decision making , and peer-operated services.  People in recovery should be meaningfully involved in all aspects of behavioral health services, including planning, policy development, training, delivery, administration, and research."

A mouthful for sure, but me me as a person with mental health and substance abuse use disorders while receiving treatment for my being HIV+, while being disabled I often question is my recovery 100% or half way or held back do to being on social security disability insurance that keeps me feeling isolated from my own queer community after following the goal of recovery that is exemplified through a life that includes:
  • Health----Overcoming or managing one's disease(s) as well as living in a physically and emotionally healthy way;
  • Home----A stable and safe place to live that that supports recovery;
  • Purpose----Meaningful daily activities, such as a job, school, volunteerism, family, care taking, or creative endeavors, and the independence, income, and resources to participate in society; and
  •  Community----Relationships and social networks that provide support, friendship, love and hope. 
I've mastered all of these things, managing my health, through disability as both a bipolar and HIV+ aging gay man secured affordable housing.  Secured through volunteering a job in itself, to that of a part-time job thanks to social security who has a model that supports part-time employment  with hopes of full time employment, a joggling act in itself as you need the Medicare and Medicaid if you qualify to pay for health care expenses and medications that exceed some $56,000+ a year, most of that costly medications.  Then lastly as a gay man who's aging, soon to be 56 years old, shunned by my peers do to the combined multiple stigmas from within my own LGBT community who if I'm on disability, managing my health, have a home, then why is it so hard to find community, relationships, social networks, love and hope and friendship.

It's my GLBT community that causes me to struggle as I don't meet their expectations of someone who's not just housed and has purpose, but in their eyes living in poverty as the model keeps you in poverty to have all of these things and be fully recovered is where I'm at soon to be 56 years of age.

Much is written on disparities and poverty, low income and I will pick up on this topic  and look at what's being done for the Lesbian, Gay, Bisexual and Transgender community over all health and those of us living in the commmunity living with both substance abuse and behavioral health care and co-occurring  HIV+ diagnoses, all three each a hurdle in itself, combined I'm often told when out speaking, sharing my story what are you doing as a consumer of all of the above to survive.

If this is you, if you feel have followed an excellent model, one that I advocate for as well as advocate for treatment for both, and are aging and feeling isolated, I'd love to hear from you.

I also want to share with you a story that happened recently.  I ran into a friend, fellow HIV/AIDS cyclist from years ago, we exchanged our hello's and quick catching up when an articulate panhandler approached, this was on ninth avenue in Manhattan, 10:30 AM.  He showed us a $1 and said he was short $.50 cents of which both myself and my friend each had a quarter and gave to him.  He said thank you and then added, what' the best nation in the Country, I said not the United States, can it be France...his response was a donation.  That was both funny and for the short time this individual was talking to two others, he felt socially connected (social inclusion), not social exclusion.

Moral of this story, be safe, I know it's hard, but if you don't have change a simple hello, or acknowledgement that there is a person asking you will go a far way in his or her day.  And if you do, even a quarter or dime will help. Social inclusion, not social exclusion has to start somewhere.

Tuesday, August 26, 2014

August 2014 HIV and Mental Healh in the News

With a Mandate for Change, a Longtime HIV/AIDS Leader Steps Up as Chief Officer for NYC's Massive Human Service Agency by (Julie "JD" Davids, August 25, 2014)

Read More:

"Tasked with managing all that HRA's 14,000 staff members do to provide direct services to New Yorkers, Tietz now oversees a broad range of programs, including Adult Protective Services; the HIV/AIDS Services Administration; Domestic Violence; Shelters and Services; Disaster Assistance and Crisis Management and Customized Assistance Services for public assistance recipients."


Opinion: Shining a light on mental illness (Robert T. Foster, Edmonton Journal

Read More::

 "Almost five per cent of admissions to hospitals are related to mental health issues, including anxiety, bipolar disorders, major depressive disorders, low-grade depression, schizophrenia, personality disorders, obsessive-compulsive disorders (OCD), impulse control, eating disorders, substance abuse and suicidal behaviour. Such disorders comprise the second highest cost of running a hospital in Canada."

"Suicide is responsible for about 25 per cent of all deaths among 15- to 24-year-olds and 16 per cent among 25- to 44-year-olds. It’s one of the leading causes of death from adolescence to middle age"

With advances in HIV care, survivors face other disease risks  Contact: Connie Hughes
646-674-6348 Wolters Kluwer Health 

Read More: 

"Research and Planning to Meet Health Needs of People Living with HIV"

"Large-scale HIV treatment and prevention programs have substantially lowered the rates of HIV infection and deaths from HIV/AIDS. Dr Narayan and coauthors write, "Today, with over 35 million people living (and aging) with HIV and over two million becoming infected every year, we are faced with a new challenge: addressing morbidity and mortality from NCDs—heart disease, stroke, diabetes and metabolic complications, renal disease, cancers, liver disease, and mental illness—that increase with age and may be related to HIV and its treatment."






Sunday, August 24, 2014

Writing Relaxes Me, Helps me focus when feeling Manic

You would think someone with one website up 2twenty years that focused on writing letters lobbying for city services in Boston and a short Freelance writing gig with AOL-Digital City Boston, and then finally my other website up ten years this year, with blog posts 66 in two years would mean I am a perfect speller. I'm not, editing is for editors ....I miss having one, but I learned more important is if your content is right on, then that's all that matter and lastly -- Just write.

 Writing relaxes me, helps me focus when I'm manic.

I first started writing when I was 34 years old, in twenty two years I never hit spell check and got this pop-up seen in photo I snapped above.

The little things that make your day, the photo, the ease of pulling a topic together, it truly made my day as I try to keep to a blog post schedule.  The above was from an email I wrote, how cool is it when something good comes from something you were doing anyway.

Share your little thing here either today or this week after reading mine and share via the comment button.


How to Calm a Manic Episode 

Monday, August 18, 2014

Project Hope Exchange All in 30 Seconds

I'm committee Chair for HIV/AIDS fellow consumer/peers/friend.  My goal is to ask 20 + HIV+ men or women to leave a 30 second message of hope.  It's by first name only. 
Please help me by participating and sharing this post.

Thank You

More about Project Hope Exchange

At the core of Project Hope Exchange are two key components: a PHE Hope Line
(855-975-4673), through which adversity survivors can leave 30-second messages of
hope; and a searchable online repository of recorded messages at  

“We believe something especially powerful happens
when a survivor of a particular adversity speaks directly to someone currently battling
that same adversity,” said A2A Alliance founder and PHE co-creator Jeff Bell, “and
we’ve attempted to build an interactive, multimedia platform that makes that process as
easy as possible.”

Tuesday, August 5, 2014

I Just Wish Everyone on SSDI Is Eligible for Both, Many Are Not!

Excellent  post Mathew, thank you.  "On being broke but- not poor" (source Huffington Post) August 4, 2014"   You are not alone on your dual diagnoses of HIV and mental health.   "Dr. Glenn J. Treisman, MD, Ph.D., who is Director of the AIDS Psychiatry services at John Hopkins Hospital estimates that at any given time 1 in 5 HIVers is suffering from a major depression and require psychiatric treatment."

I applaud the promotion of "Medi/Medi,” I just wish everyone on SSDI is eligible for both, many are not, I'm not and the affordable care act doesn't apply to me either as I’m at 141% of the Federal Poverty Level.

“The CDC predicts that 50 percent of those living with HIV in the U.S. will be over 50 years of age by 2015.”  “And by 2020, more then 70 percent of Americans with HIV are expected to be age 50 and older, source: (the Diverse Elders Coalition).  In 2015 I will be 56 years old.

In the article being broke but not poor, Mr. Ebert says, "I believe in Medicare,"  I couldn't agree more. Without Medicare I wouldn't be able to cover the 80% of the estimated $56,000 a year being paid for my mental health treatment, HIV labs, HIV and psychotropic medications.   

I'm also thankful for receiving all my services at a clinic where services are on a sliding scale based on income.  What's starting to happen is I'm aging, and I'm needing care of specialist, many who don't bill based on a sliding scale, so I'm being hit with co-pays as with Medicare only I have to cover 20%.

 ACRIA, Center on HIV and Aging  in 2013 held a one day conference on HIV and Aging
From that conference came the following, “ since many of these older adults with HIV have the triple diagnoses of HIV, depression and substance abuse.  These health factors are exacerbated by the impact of HIV stigma, ageism, racism and poverty, which contribute to social isolation. Consequently many adults with HIV will lack informal supports as they age and will increasingly rely on costly health and social services.”

Give up Medicare, would mean losing my SSDI.  Losing that means losing my housing and being able to afford the high costs associated with HIV and bipolar disorder as mentioned above. Take away those and substance use may come back taking down all that I've struggled with in on my bumpy road to recovery


Mental Health Problems Effect many of Us

AIDS (Dot) Gov

Diverse Elders Coalition

Growing Older With HIV/AIDS

2014 Federal Poverty Guidlines

Tuesday, July 29, 2014

Why is Positive Mental Health Important for People Living with HIV?

Many a day I put the kettle on to make tea and forget.  You see I'm using my Grandmothers old coffee pot as tea kettle and there's no whistle.   After yesterday's near melt that I started to smell metal ..two things happened.   One, this post and two, a tea kettle with a whistle.

Why is positive mental health important for consumers who are dual diagnosed HIV and with a mental illness, besides keeping your mind sharp, check out:

Source: AIDS.GOV Mental Health
"Your mental health is just as important as your physical health. When you have positive mental health, you generally are able to:
  • function better at work, at school, and in relationships.
  • cope more effectively with life’s difficulties, such as the death of a loved one, ending a relationship, job stress, health issues, and family or financial problems.
  • take better care of yourself physically.
  • provide better care for your children or other family members.
But mental health problems can affect the way you think, feel, and behave, and can change how well you function at work and at home. If you are living with HIV, mental health problems can affect your physical health by:
  • making it harder for you to take all your HIV medicines on time.
  • making it harder for you to keep your health appointments or take advantage of your support network.
  • interfering with your healthy behaviors, such as getting enough sleep and exercise and avoiding risk behaviors such as having unprotected sex.
  • impairing your ability to cope with the stresses of daily life.
Mental health problems are very common among all Americans, not just those living with HIV. In fact, in 2012, about:
  • One in five American adults experienced a diagnosable mental illness.
  • Nearly one in 10 young people experienced a period of major depression.
  • Four percent of American adults lived with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.
As a person living with HIV, it is important for you to be aware that you have an increased risk for developing mood, anxiety, and cognitive disorders. These conditions are treatable. People who experience mental health problems can get better and many recover completely. You can better manage your overall health and well-being if you know how having HIV can affect your mental health and what resources are available to help you if you need it."

I've taken to brain games, it helps me.  Give it a try.


Free Brain Games on AARP