"I’m not an object, or an idea or an abstract lifestyle, or visible proof of a disease; or any other dehumanizing concept, yet that’s how everyone is summed up and evaluated."

I think I need to put this post in some sort of context, or else you’re going to get the wrong idea about me (more of that in a minute).

I’m sitting here in front of the laptop, with my back aching, feet pulsing, calves tingling, muscles full of lactic acid and neck hurting. I haven’t mentioned that the soles of my feet feel as though someone has dowsed them in petrol and set them on fire. As a matter of fact, there aren’t many parts of my body that aren’t screaming, ‘put an end to it; grab the f...ing pill box!’ You may think I’ve just got home from the gym, or been pounding the roads while training for a marathon, (if only!) but the fact is that these are my off-and-on, daily and nightly neuropathy symptoms. It’s the torture that almost turns me to religion because at least then I could understand I was being punished for my sins.

That said, life goes on and no, I’m not suicidal or particularly feeling sorry for myself (well sometimes maybe a little bit); it’s just the way it’s turned out for me in the same way that life’s slapped so many other people with unexpected wet fishes. Meh; it’s not heroism or stoicism either; you get on with it because you don’t have a choice! The trouble is that society won’t just let you get on with it. You have to be given a label and then be responded to accordingly; people get upset otherwise.

Christopher Plummer‘s got a lot to answer for; winning an Oscar for coming out joyously as a senior and then promptly and heroically popping his clogs. So now I can’t even be a grumpy old man any more, I’m now supposed to be thrilled to be sixty plus and living out my golden years as if there was no tomorrow. Well stuff that for a lark! As far as I’m concerned it’s just another label, another tag to hang around our necks which is supposed to determine how we live and justify our existence.

I’ve built up a lifetime full of labels... but not in the sense that Paul Smith or Armani rock my geriatric boat (can’t afford them sadly): I’m just plastered with labels that’s all and I hate it! I’m covered in damn sticky notes, each of which is carrying someone else’s description of who I am and I can’t even see myself under them anymore. Let me list a few and then maybe you’ll see what I mean.

According to who’s looking, I can be a gay man; unemployed; HIV-positive and with lung problems and arthritis. I’m a senior; daddy (silver or otherwise); bear (but only because of the unwanted extra kilos inaction has given me). I’m an ex-pat Englishman; ex-teacher; ex-tennis player; failed author (pretty much); enforced couch potato and blogger about neuropathy and HIV. Neuropathy, that came from either the medication or the virus or both, has dumped more labels on me, so that now I’m to all intents and purposes slowing down to a snail’s pace; with constant variable pain; can’t walk too far anymore and rapidly losing muscle strength. Tell me you haven’t already come to several conclusions as to who I am! Yet these are labels; not mine by choice but things people need to use to describe me. If I stood in front of you, smiled and didn’t say a word, half of them wouldn’t apply because they’re not really visible without further clues.

I’m not an object, or an idea or an abstract lifestyle, or visible proof of a disease; or any other dehumanizing concept, yet that’s how everyone is summed up and evaluated.

In an age where image is everything and your FaceBook profile determines the parameters of who and what you are; labels are pretty much essential keys to your fitting into society. Even if you don’t promote yourself with keyword descriptions, someone else will happily do it for you; so most people learn to put the best spin possible on themselves; in order to avoid stereotypes and pre-judgements from outside. I thank my lucky stars that I’m not a twenty-something gay person any more – those poor kids just have so much to live up to! The problem is that although the intensity and ensuing stress levels are off the chart in 2012, it was probably always the way and it’s not for nothing that people pin a label on you within twenty seconds of meeting. It’s probably an adrenalin-based survival technique. Animals have learned to evaluate a stranger pretty quickly to avoid becoming a quick snack. Unfortunately then, because it’s nature’s way, there’s not a damn thing you can do about it.

That’s one of the reasons why you still can’t really spin being HIV-positive as being a good thing. I would argue that even many young gay people see being HIV positive is the 21^st century equivalent of having leprosy and God help you if you run into a Santorum sycophant or a Mullah Mary! Thirty years on, HIV is still largely in the closet, just behind the LGBT kids who are terrified of sticking their heads above the barricades. ‘It Gets Better’ is a noble concept and great inspiration for coming out but much easier said than achieved. Have you seen that silly computer game ‘Whack a Mole Gopher Bash’!

Polarisation in society increases exponentially with economic crisis and during those times, being publicly different is not always a safe option. What really shocks me as an older gay man (plus labels) is the attitude of young gay people to both their elders and to people who are HIV+. You only need to look at gay social network forums, to see how viciously judgemental and harsh ‘our own’ kids can be.

For example; a couple of years ago there was a scandal in the Netherlands concerning sex parties with positive guys who drugged some of their guests and then injected them with contaminated blood. Labels were attached before anybody knew details of the case. On the face of it, looking at the bare facts, nobody could justify that sort of behaviour in any possible way and the media had a field day. However, a couple of months later, the men were given prison sentences and the always pragmatic Dutch shrugged their shoulders and moved on to other news stories. The rest of the population had also been shocked at the details but nobody had actually died and yes, there are bad people in the world but in a country where ten years is a reasonably severe sentence for murder, the fourteen years the chief culprit got was seen as an appropriate punishment. That wasn’t the reaction of the gay youth on the forums though. At least three quarters wanted the guilty men hanged, shot, or at best chemically castrated and many responses were so violent and video-game aggressive, it was truly shocking. Across the gay forums it continued for months, merciless demands for the death penalty or worse. This was a general reaction from gay people under thirty, not just a few extremists. You could call it ignorance, or a lack of perspective or maybe a sense of guilt that this had happened within their own social group but it’s a sign of the times.

I’m not justifying what went on in that case, far from it but if only we waited until we knew more before pinning the label on the donkey! No wonder politicians can wrap us around their little fingers...they live for labels! Being gay clearly does not necessarily make you tolerant. When extremists, both political and religious, on the right wing of American politics; or religious fanatics in Africa, or Islamic Sharia law promoting imams, or Russian state-backed, city mayors, actively encourage this sort of polarisation of society to gain votes, you get a funny feeling about how gay people with HIV may well be viewed in the near future. ‘Gay’ plus ‘HIV’...if you’re neither, the labels are loaded enough!

I’m probably doing much the same thing with this article. For every label there’s a counter-label so my generalisations may appear to be equally clichéd. I should really only talk from my own position and my own labels.

As an LGBT person, I think that how you view being gay and HIV positive in the western world in 2012 very much depends how old you are. The older man or woman will often say that things were better in ‘the old days’, because they were better for them! They were younger, they could still turn heads and their bodies still defied gravity. I look at the gay scene now and wonder if I have any connection to it at all, but that’s because it’s time for new generations to have their days in the sun. However, I can’t say I like the gay nation very much sometimes. It rejects its old and infirm far too easily, expecting them to fade away quietly and not clog up the passageways in the saunas or appear ghost like in the woods at night.

His first experience of a contemptuous look is a marking point in a man’s life! It’s also so easy to claim the moral high ground by protesting that we’re the HIV generation; we’ve watched our friends suffer then die; we’ve seen the bars empty of a whole host of the most wonderful men and we’ve survived! ‘So what!’ seems to be the current answer from many of the newly emerged butterflies on the street who begin to wonder if the conspiracy theories are true and if it ever really happened. Don’t they realise? No, of course they don’t and the truth is they have to find out for themselves because the generation gap is as strong a divide in gay society as amongst heterosexuals.

The tragedy is that from now on everybody will be judged by their labels whether self-attached or stamped on their foreheads; the 140 characters of their Tweet, or their profile updates and friends on FaceBook. It’s going to become harder to ‘find yourself’ (forgive the cliché, I’m an old hippy), establish your true identity and be satisfied with the person you are because you’ll eventually and inevitably end up disappointing yourself and others because you can’t live up to the ridiculously high expectation labels any more.

Sometimes, I’m glad I don’t have my whole life stretched out before me any more...I could never, ever be David Beckham and can he even live up to the size of his Armani label! Maybe my labels do define me and maybe I need to accept that other people are going to judge me according to my illnesses, or my age, or my social status but I don’t like it and I never will!

Editor’s note:  The most eye-catching piece of information here – and this is new - is the statement that if you’re living with HIV, over 50 years of age and haven’t yet started antiretroviral (ARV) therapy, the U.S. Department of Health and Human Services now recommend HIV treatment, regardless of your CD4 cell count.

PositiveLite.com discussed the guidelines relating to the general  HIV-positive population here. Today we focus specifically on the section relating to HIV and aging.

The complete text of that section is here. Note that while its primary intended audience is the medical profession, it’s written in language reasonably intelligible to all.  Whether these US guidelines will be taken up outside the US was discussed in our previous article, referred to above.

Key Considerations When Caring for Older HIV-Infected Patients

Summary

Antiretroviral therapy (ART) is recommended in patients over 50 years of age, regardless of CD4 cell count, because the risk of non-AIDS related complications may increase and the immunologic response to ART may be reduced in older HIV-infected patients.

 • ART-associated adverse events may occur more frequently in older HIV-infected adults than in younger HIV-infected individuals. Therefore, the bone, kidney, metabolic, cardiovascular, and liver health of older HIV-infected adults should be monitored closely.

• The increased risk of drug-drug interactions between antiretroviral (ARV) drugs and other medications commonly used in older HIV-infected patients should be assessed regularly, especially when starting or switching ART and concomitant medications.

• HIV experts and primary care providers should work together to optimize the medical care of older HIV-infected patients with complex comorbidities.

 • Counseling to prevent secondary transmission of HIV remains an important aspect of the care of the older HIV-infected patient.

The Background

Effective antiretroviral therapy (ART) has increased survival in HIV-infected individuals, resulting in an increasing number of older individuals living with HIV infection. In the United States, approximately 30% of people currently living with HIV/AIDS are age 50 years or older and trends suggest that the proportion of older persons living with HIV/AIDS will increase steadily. Care of HIV-infected patients increasingly will involve adults 60 to 80 years of age, a population for which data from clinical trials or pharmacokinetic studies are very limited.

There are several distinct areas of concern regarding the association between age and HIV disease. First, older HIV-infected patients may suffer from aging-related comorbid illnesses that can complicate the management of HIV infection, as outlined in detail below. Second, HIV disease may affect the biology of aging, possibly resulting in early manifestations of many clinical syndromes generally associated with advanced age. Third, reduced mucosal and immunologic defenses (such as post-menopausal atrophic vaginitis) and changes in risk behaviors (for example, decrease in condom use because of less concern about pregnancy and increased use of erectile dysfunction drugs) in older adults could lead to increased risk of acquisition and transmission of HIV. Finally, because older adults generally are perceived to be at low risk of HIV infection, screening for HIV in this population remains low. For these reasons, HIV infection in many older adults may not be diagnosed until late in the disease process. This section focuses on HIV diagnosis and treatment considerations in the older HIV-infected patient.

 HIV Diagnosis and Prevention

Even though many older individuals are engaged in risk behaviors associated with acquisition of HIV, they may be perceived to be at low risk of infection and, as a result, they are less likely to be tested for HIV than younger persons . According to one U.S. survey, 71% of men and 51% of women age 60 years and older continue to be sexually active, with less concern about the possibility of pregnancy contributing to less condom use. Another national survey reported that among individuals age 50 years or older, condoms were not used during most recent intercourse with 91% of casual partners or 70% of new partners]. In addition, results from a CDC survey show that in 2008 only 35% of adults age 45 to 64 years had ever been tested for HIV infection despite the 2006 CDC recommendation that individuals age 13 to 64 years be tested at least once and more often if sexually active.

Clinicians must be attuned to the possibility of HIV infection in older patients, including those older than 64 years of age who, based on CDC recommendations, would not be screened for HIV. Furthermore, sexual history taking, risk-reduction counseling, and screening for sexually transmitted diseases (STDs) (if indicated), are important components of general health care for HIV-infected and -uninfected older patients.

Failure to consider a diagnosis of HIV in older persons likely contributes to later disease presentation and initiation of ART. One surveillance report showed that the proportion of patients who progressed to AIDS within 1 year of diagnosis was greater among patients >60 years of age (52%) than among patients younger than 25 years (16%). When individuals >50 years of age present with severe illnesses, AIDS-related opportunistic infections (OIs) need to be considered in the differential diagnosis of the illness.

 Initiating Antiretroviral Therapy

Concerns about decreased immune recovery and increased risk of serious non-AIDS events are factors that favor initiating ART in patients >50 years of age regardless of CD4 cell count. (See Initiating Antiretroviral Therapy in Treatment-Naive Patients. ) Data that would favor use of any one of the Panel’s recommended initial ART regimens (see What to Start) on the basis of age are not available. The choice of regimen should be informed by a comprehensive review of the patient’s other medical conditions and medications.

A noteworthy limitation of currently available information is lack of data on the long-term safety of specific antiretroviral (ARV) drugs in older patients, such as use of tenofovir disoproxil fumarate (TDF) in older patients with declining renal function. The recommendations on how frequently to monitor parameters of ART effectiveness and safety for adults age >50 years are similar to those for the general HIV-infected population; however, the recommendations for older adults focus particularly on the adverse events of ART pertaining to renal, liver, cardiovascular, metabolic, and bone health .

HIV, Aging, and Antiretroviral Therapy

The efficacy, pharmacokinetics, adverse effects, and drug interaction potentials of ART in the older adult have not been studied systematically. There is no evidence that the virologic response to ART is different in older patients than in younger patients. However, CD4 T-cell recovery after starting ART generally is less robust in older patients than in younger patients. This observation suggests that starting ART at a younger age will result in better immunologic and possibly clinical outcomes.

Hepatic metabolism and renal elimination are the major routes of drug clearance, including the clearance of ARV drugs. Both liver and kidney function may decrease with age, which may result in impaired drug elimination and drug accumulation. Current ARV drug doses are based on pharmacokinetic and pharmacodynamic data derived from studies conducted in subjects with normal organ function. Most clinical trials include only a small proportion of study participants >50 years of age. Whether drug accumulation in the older patient may lead to greater incidence and severity of adverse effects than seen in younger patients is unknown.

HIV-infected patients with aging-associated comorbidities may require additional pharmacologic intervention, making therapeutic management increasingly complex. In addition to taking medications to manage HIV infection and comorbid conditions, many older HIV-infected patients also are taking medications to ameliorate discomfort (e.g., pain medications, sedatives) or to manage adverse effects of medications (e.g., anti-emetics). They also may self-medicate with over-the-counter medicines or supplements. In the HIV-negative population, polypharmacy is a major cause of iatrogenic problems in geriatric patients. This may be the result of medication errors (by prescribers or patients), nonadherence, additive drug toxicities, and drug-drug interactions. Older HIV-infected patients probably are at an even greater risk of polypharmacy and its attendant adverse consequences than younger HIV-infected or similarly aged HIV-uninfected patients.

Drug-drug interactions are common with ART and easily can be overlooked by prescribers. The available drug interaction information on ARV agents is derived primarily from pharmacokinetic studies performed in a small number of relatively young, HIV-uninfected subjects with normal organ function. Data from these studies provide clinicians with a basis to assess whether a significant interaction may exist. However, the magnitude of the interaction may be different in older HIV-infected patients than in younger HIV-infected patients.

Nonadherence is the most common cause of treatment failure. Complex dosing requirements, high pill burden, inability to access medications because of cost or availability, limited health literacy including lack of numeracy skills, misunderstanding of instructions, depression, and neurocognitive impairment are among the key reasons for nonadherence. Although many of these factors likely will be more prevalent in an aging HIV-infected population, some data suggest that older HIV-infected patients may be more adherent to ART than younger HIV-infected patients.

Clinicians should assess adherence regularly to identify any factors, such as neurocognitive deficits, that may make adherence a challenge. One or more interventions such as discontinuation of unnecessary medications; regimen simplification; or use of adherence tools, including pillboxes, daily calendars, and evidence-based behavioral approaches may be necessary to facilitate medication adherence. (See Adherence to Antiretroviral Therapy.)

Non-AIDS HIV-Related Complications and other Comorbidities

With the reduction in AIDS-related morbidity and mortality observed with effective use of ART, non-AIDS conditions constitute an increasing proportion of serious illnesses in ART-treated HIV-infected populations. Heart disease and cancer are the leading causes of death in older Americans. Similarly, for HIV-infected patients on ART, non-AIDS events such as heart disease, liver disease, and cancer have emerged as major causes of morbidity and mortality. Neurocognitive impairment, already a major health problem in aging patients, may be exacerbated by the effect of HIV infection on the brain. That the presence of multiple non-AIDS comorbidities coupled with the immunologic effects of HIV infection could add to the disease burden of an aging HIV-infected person is a concern. At present, primary care recommendations are the same for HIV-infected and HIV-uninfected adults and focus on identifying and managing risks of conditions such as heart, liver, and renal disease; cancer; and bone demineralization.

Discontinuing Antiretroviral  Therapy in Older Patients

Important issues to discuss with aging HIV-infected patients are living wills, advance directives, and long-term care planning including financial concerns. Health care cost sharing (e.g., co-pays, out-of-pocket costs), loss of employment, and other financial-related factors can cause interruptions in treatment. Clinic systems can minimize loss of treatment by helping patients maintain access to insurance.

For the severely debilitated or terminally ill HIV-infected patient, adding palliative care medications, while perhaps beneficial, further increases the complexity and risk of negative drug interactions. For such patients, a balanced consideration of both the expected benefits of ART and the toxicities and negative quality-of-life effects of ART is needed.

Few data exist on the use of ART in severely debilitated patients with chronic, severe, or non-AIDS terminal conditions. Withdrawal of ART usually results in rebound viremia and a decline in CD4 cell count. Acute retroviral syndrome after abrupt discontinuation of ART has been reported. In very debilitated patients, if there are no significant adverse reactions to ART, most clinicians would continue therapy. In cases where ART negatively affects quality of life, the decision to continue therapy should be made together with the patient and/or family members after a discussion on the risks and benefits of continuing or withdrawing ART.

Conclusion

HIV infection may increase the risk of many major health conditions experienced by aging adults and possibly accelerate the aging process. As HIV-infected adults age, their health problems become increasingly complex, placing additional demands on the health care system. This adds to the concern that outpatient clinics providing HIV care in the United States share the same financial problems as other chronic disease and primary care clinics and that reimbursement for care is not sufficient to maintain care at a sustainable level . Continued involvement of HIV experts in the care of older HIV-infected patients is warranted. However, given that the current shortage of primary care providers and geriatricians is projected to continue, current HIV providers will need to adapt to the shifting need for expertise in geriatrics through continuing education and ongoing assessment of the evolving health needs of aging HIV-infected patients. The aging of the HIV-infected population also signals a need for more information on long-term safety and efficacy of ARV drugs in older patients.

Please refer to the guidelines themselves, for a complete list of references.

I recently attended a meeting which was part of a series by the University of BC and was funded by the Canadian Institute of Health Research.  The meeting was to report back to the community on research that had been done regarding family caregivers and their role in palliative care.  The topic covered a survey of how caregivers felt about looking after loved ones at end of life stages.  There was a good mix of hospice nurses in attendance and the general public; about 100 people were present.

The presentation commenced by revealing that in surveys many family members felt that they wanted to look after another family member who was dying because they wanted them to be able to die at home.  They had often made promises to the family member.  As time went on, they realized that this was much more than they had originally envisioned but felt that they had to stick by their promise, even though it compromised their own health and well-being.  Some set up baby monitors so that they could do a chore and still hear how their family member/patient was doing.

Most of the time, the deciding factor of whether or not the family member went into a home was largely dependent on their incontinence - especially among men caregivers, who found it very hard to deal with.

The team also looked at rural situations and these were particularly difficult when a family member might have to drive hours with their father/mother, etc. to a hospital for various treatments and the caregiver was often exhausted, especially if they had young children to look after as well.

I well remember looking after my mother when she had just had a stroke and was starting to get dementia.  I was afraid of leaving her on her own since she had already left pots boiling dry on the stove, and I was very worried she would fall trying to negotiate stairs.  This was a common theme among survey participants, where the caregivers became hermits to look after family members.

I could relate to the incontinence factor too and remember one incident when my mother and I went shopping and she was unable to wait for us to reach a bathroom!  I had to take the truck to the car cleaner twice as a result.  It was a horrendous day when I eventually got her to a Canadian Tire bathroom and then ran across the road to buy baby wipes, diapers and new clothes and then race back to the bathroom to change her and throw away her soiled clothing, while cleaning her up too.  Already on anxiety pills, I was completely frazzled and ended up sending my mother home in a taxi while I took the truck in to the car detailers.

For someone who already has an illness, trying to look after a sick older relative is next to impossible but you can feel an enormous sense of obligation and guilt.  Eventually, you have to come to terms with the fact that you may not be giving them the best care and a nursing home is your only option.

I started the search for a nursing home and looked at many.  Unfortunately, when the day comes and your health authority calls you to tell you there is a vacancy, you have to make the decision whether or not to accept the allotted place and then be prepared to move your loved one within 24 hours.  I found this incredibly hard, since the home I wanted my mother in was not the one that they had offered and the thought of leaving her in a one room bedroom, when she had been used to a full apartment, made me extremely sad.  In addition, the pressure I received from my brother and sister (who lived in Spain and California) not to move her into a home and to take care of her myself, was enormous and made me feel very guilty; siblings and family members who are nowhere to be seen, don’t come and visit and yet feel it is their right to add their two cents worth, can only add confusion and misery to an already intolerable situation.

I moved my mother into the new digs and it was gut wrenching to hear her ask when I would be back and hear her saying “please, don’t leave me” - I felt like the lowest of the low... but I felt her safety was paramount and she needed to be in a place that had equipment and personnel 24/7 because she was now in the Alzheimer’s stage.

I put her on a waiting list for the home that I preferred and about six months later, I was once again given the option of moving her within 24 hours.  This was an easier choice because I felt the level of care was so superior at the other nursing home.  After moving my mother, I was glad to be proven right.  She was bathed more, her nurse gave my mother extraordinary personal care and before long, her hair was nice curled, she looked and smelled cleaner and she seemed more engaged with her new friends.

The previous home had put all the patients together but this home had more severe cases and violent people in a separate unit. I knew my mother was happy.  However, with her care finally at a level that I was content with, I could not help but think that this was not how my mother would have chosen to live.  She was a very neat and clean person and was proud of how she looked after her home.  She would have been mortified to think she was incontinent.   I really wonder why we don’t have living wills that give the option for all of us if we get Alzheimer’s and are unable to feed ourselves, are afraid every time a family member leaves the nursing home, only to forget they were even there a minute later or just wheel ourselves around hallways, not understanding the privacy of others’ bedrooms.

At the end of the meeting, I asked the researchers if they had considered what nursing homes would be available for gay or lesbians in the future and whether people were looking after loved ones at homes because the choices in nursing homes was so pathetic.  There were no answers and I found that disturbing because with an ageing baby boomer population, there will soon be a time when many, many more nursing homes will be needed.

At the end of the day, I felt that what "caring for caregivers" really means is helping them care for their loved ones, affording caregivers to get time off and care for themselves - rather like providing the oxygen mask on airplanes to the caregivers first so that they can help those they are with.

Last week, the Senior Pride Network (SPN) held its fourth conference on aging within the LGBTQ community at The 519 Community Centre in Toronto. The SPN is an association of individuals, organizations and community groups that share an interest in and a commitment to expanding positive and appropriate programs and services for older queer people.

The conference was well-attended. Although seniors were in the majority, a surprising number of the delegates were far from their retirement years. I found this encouraging, as one of the themes that emerged from the conference was how do we, young and old, learn from one another. What does aging mean for a generation of LGBTQ people whose activism was central to our current rights reality? How does it complicate issues related to sex, sexuality and our abilities to live open, out lives?

As an oldster myself, I think queer seniors have a lot of knowledge and experience to pass on to a younger generation. But I also think older people like me can benefit from experiences of younger members of the community. They may have different insights than I. We need to be inspired by each other.

This was the theme that was powerfully taken up by Dr Rinaldo Walcott (below, right)  in his keynote presentation. Walcott is an associate professor at the Ontario Institute for Studies in Education (OISE) at the University of Toronto, where he’s also chair of OISE”s sociology and equity studies department. That’s his formal title, but when I asked him how he would self-describe himself, he said he was “a black gay professor who’s interested in communicating the research I do in the university to the larger community”.

Although he talked mostly about gay men, he gave all of us a lot to think about. I’m going to paraphrase Walcott here but these were the themes he raised.

In Canada, we live in an aging society. In heterosexual life, aging often brings respect, whereas in gay life, it’s to be feared. As straight men age, they gain respect and authority. For gay men, it goes the other way. So much of gay male culture is about youth so a gay old age is to be feared. “Old faggot” is an insult, not a term of respect.

What’s particularly poignant is that the generation of gay men that’s now old is the first that lived out of the closet, the first to fight against homophobia and heterosexism, against criminalization of our sexuality, against AIDS in the face of fear or indifference from the public at large. It’s the generation that, in Walcott’s words, were the foot soldiers who made it possible for younger generations to live openly and in freedom. Yet, despite younger men benefiting from the activism of this older generation of gay men, those older men are not always valued.

Walcott told his listeners that our unique lives as elders need to be seen as much more than our health, even though the overwhelming focus of aging today is based on a medical model. But aging is more than that. It’s also about financial security and adequate housing. It’s about support networks. And it’s also about sex and sexuality. As aging gay men, can we be old and still have sex? Can we be sexual in a long-term care home? As he reminded us, our queer social and cultural lives are important, and queer culture demands cultural excess. Does that all disappear when we become old men?

For Walcott, the question that can’t be avoided is, what does an uncloseted aging gay life look like? Because aging in the closet is not an option. (That question might already have been answered, had we not lost a whole generation of gay men to AIDS.)

So what does it mean for society as a whole cohort of gay men all age together? Is society ready for a large group of men without conventional families and children and who may not even be partnered? Are the unique needs of queer people even part of planning for an older demographic?

These were the challenges that Walcott posed and for which we’ll need to find answers. Part of the solution, he said, is to engage younger people in the issue of aging because we’re all going to get old eventually. But it’s also a time for a renewed activism on the part of older people ourselves because the need for activism doesn’t stop with achieving “Freedom 55”, as the old financial services ad would have it. And as Lali Mohamed, a youth member of a panel discussion that followed Walcott’s presentation reminded us, in creating a space for such shared activism we need to create a bigger kitchen table at which everybody is invited to sit - including those of different racial and ethnic backgrounds, trans people and those who don’t often see themselves reflected in the mainstream queer media.

Walcott’s challenges followed us as we engaged together during the two days of the conference in exploring how we can build a stronger, healthier community that older queer people will feel comfortable in. In my second report from the conference, I’ll be writing about one interesting workshop that focused on the experiences and lessons learned by several social service agencies that have already begun to provide older LGBTQ-inclusive programming.

 In the meantime, you can read more about aging in these articles recently published on PositiveLite.com:

HIV and aging

A senior’s moment or memory loss...again

Aging is gonna be the end of me someday   

One of the things that I’ve dreaded having to deal with is aging,  But I am going to get older and I will have to find a way to live with it.  Aging myself is in fact the worst. Many times I find myself wondering “am I too old to do this, too old to go there, too old for that guy?”  (I did the older guy/younger guy thing; it didn’t work but that’s another story).

I like it when these twenty-something kids try to put me down and call me “old man”. I tell them right away that I’m not old, I’m just “older”. It’s a hoot to hear them tell me to get a life. I tell them I’ve lived a life already; at least I made to this age, they haven’t yet. Being able to tell them that I had my job longer than they’ve been alive was enlightening for them, I’m sure. Hell, I had cowboy boots older than most of them.

The music of today drives me crazy. If they played some of this stuff back in my day, I’d be whacking the record player. It sounds like the needle got stuck. I swear some of that "Boom Boom Boom" throws my heartbeat out of whack and makes my whole body vibrate and not in a good way. If anyone were to catch me singing along to Justin Bieber's "Baby", they’d think I was in pain or constipated.

My Mom commented back when I was about 40 that I dress too young. What does that mean? My response was that when I'm looking to buy a shirt, if I find one that will fit me, I look at the price tag, and I don't see any age limit on it. I never ever thought I’d be caught dead in a cardigan like some 70-year old but, hey, they came back into style. So far I only have one. Next on the list is “suspenders”, I’ve noticed people wearing them again. Could it be they are making “older” the “new black”? Even the Buddy Holly glasses I wore at 14 years old are back in style, so I had to get a pair when it was time for a new pair.

I worked for a while with seniors and I remember a lot of the terminology that they use and it made me wonder what people my age would use when we got to be their age. Things like, “that’s some groovy shit. eh?”.  Or as the nurses go by, “is that a wiggle or is your ass chewing bubblegum?”

I am sitting on another panel this week dealing with one of my favourite topics, HIV and aging. so it’s been back on my mind. I’ll be answering questions about how old I was when I was diagnosed, what were my expectations in life at that time, what they are now, what are my fears. Other questions will deal with changes I’ve noticed in my body, if I think it’s the meds or just the aging process. It will conclude with each of us giving a final thought and because the symposium is aimed to the healthcare profession this is what I am going to say:

“Back in the early 1980s there was an epidemic that no one knew much about. It took the lives of millions of people before science caught up to it and learned how to control it. Scientists discovered new medications, advocates and survivors joined together to help stop the spread of the disease. People began living with the virus and many of the original people who were infected are still alive today, still fighting.

Today we are seeing an epidemic of another kind: people living with HIV are getting older just like everyone else. We are only the beginning, we are the new leaders. We know how much of strain  baby boomers will be on the medical community; people living with HIV are among them. Right now, long-term care facilities don’t understand HIV or us, they aren’t ready for us. As we remember those that came before us, let’s make it impossible for people to forget us as well. We won’t require any special treatment, we only want what anyone else receives, nothing more.”

Well, this was fun actually, I think I am on pace to be a classic “grumpy old man”. If that happens sooner for me than others, so be it, I’ll be dressed for it - and in style.