Chapter 7: Living Well with HIV

1. Aging with HIV

At the start of the epidemic more than 30 years ago, people who were diagnosed with HIV or 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 today, thanks to improvements in the effectiveness of treatment with HIV medicine (called antiretroviral therapy or ART), people with HIV who are diagnosed early in their infection, and who get and stay on ART, can keep the virus suppressed and live long and healthy lives. For this reason, nearly half of people living with diagnosed HIV in the United States are aged 50 and older. Many of them have been living with HIV for years; others are recently infected or diagnosed. According to the Centers for Disease Control and Prevention (CDC), people aged 50 and older accounted for 17% of the 39,782 new HIV diagnoses in 2016 in the United States.

Complications Associated with Aging

So the good news is that people with HIV are living longer, healthier lives if they are on treatment and achieve and maintain a suppressed viral load. However, with this longer life expectancy, individuals living with long-term HIV infection exhibit many clinical characteristics commonly observed in aging: multiple chronic diseases or conditions, the use of multiple medications, changes in physical and cognitive abilities, and increased vulnerability to stressors.

Complications Associated with Long-term HIV Infection

While effective HIV treatments have decreased the likelihood of AIDS-defining illnesses among people aging with HIV, HIV-associated non-AIDS conditions are more common in individuals with long-standing HIV infection. These conditions include cardiovascular disease, lung disease, certain cancers, HIV-Associated Neurocognitive Disorders (HAND), and liver disease (including hepatitis B and hepatitis C), among others.

In addition, HIV appears to increase the risk for several age-associated diseases, as well as to cause chronic inflammation throughout the body. Chronic inflammation is associated with a number of health conditions, including cardiovascular disease, lymphoma, and type 2 diabetes. Researchers are working to better understand what causes chronic inflammation, even when people are being treated with ART for their HIV disease.

HIV and its treatment can also have profound effects on the brain. Although AIDS-related dementia, once relatively common among people with HIV, is now rare, researchers estimate that more than 50 percent of people with HIV have HAND, which may include deficits in attention, language, motor skills, memory, and other aspects of cognitive function that may significantly affect a person's quality of life. People who have HAND may also experience depression or psychological distress. Researchers are studying how HIV and its treatment affect the brain, including the effects on older people living with HIV.

For more information, see the National Institute on Aging's Aging with HIV: Responding to an Emerging Challenge.

Late HIV Diagnosis

Older Americans are more likely than younger Americans to be diagnosed with HIV infection late in the course of their disease, meaning they get a late start to treatment and possibly more damage to their immune system. This can lead to poorer prognoses and shorter survival after an HIV diagnosis. Late diagnoses can occur because health care providers may not always test older people for HIV infection, and older people may mistake HIV symptoms for those of normal aging and don't consider HIV as a cause.

According to CDC, in 2016, 35% of people aged 50 and older already had late-stage infection (AIDS) when they received an HIV diagnosis (i.e., they received a diagnosis late in the course of their disease). But that percentage has declined since 2011, when 42% already had late stage infection.

The Importance of Support Services

Living with HIV presents certain challenges, no matter what your age. But older people with HIV may face different issues than their younger counterparts, including greater social isolation and loneliness. Stigma is also a particular concern among older people with HIV. Stigma negatively affects people's quality of life, self-image, and behaviors, and may prevent them disclosing their HIV status or seeking HIV care. Therefore, it is important for older people with HIV to get linked to HIV care and have access to mental health and other support services to help them stay healthy and remain engaged in HIV care. You can find support services through your health care provider, your local community center, or an HIV service organization. Or use the HIV Services Locator to find services near you.

Content Source: HIV.gov

Date last updated: September 13, 2019

2. Employment and Health

Working with HIV

With proper care and treatment, many people living with HIV lead normal, healthy lives, including having a job. Most people living with HIV can continue working at their current jobs or look for a new job in their chosen field. Your overall well-being and financial health can be more stable when you are gainfully employed.

Getting a New Job or Returning to Work

Working will affect a lot of your life: your medical status, your finances, your social life, the way you spend your time, and perhaps even your housing or transportation needs. Before taking action on getting a new job or returning to work, you may want to get information and perspectives from:

• Your HIV case manager or counselor, if you have one
• Benefits counselors at an HIV service organization or other community organization
• The Social Security Administrations Work Incentives Planning and Assistance Program (WIPA)
• Other people living with HIV who are working, or have returned to work
• Providers of any of your housing, medical, or financial benefits
• Public and non-profit employment and training service providers

Here are some questions to discuss with them:

• What are my goals for employment?
• What kind of work do I want to do?
• What are the resources that can help me set and achieve a new career goal?
• Are there state or local laws that further strengthen anti-discrimination protections in the American Disabilities Act (ADA)?
• How do I access training or education that will help me achieve my goals?
• How can I plan to take care of my health if I go to work?
• How will my going to work impact the benefits I am receiving?

Requesting Reasonable Accommodations

Qualified individuals with disabilities, including people living with HIV, have the right to request reasonable accommodations in the workplace. A reasonable accommodation is any modification or adjustment to a job or work environment that enables a qualified person with a disability to apply for or perform a job. An accommodation may be tangible (for example, a certain type of chair) or non-tangible (for example, a modified work schedule for someone with a medical condition requiring regular appointments with a health care provider). You are qualified if you are able to perform the essential functions of the job, with or without reasonable accommodation.

Your supervisor may not be trained in reasonable accommodations or know how to negotiate them. For that reason, often its best to go directly to the person responsible for human resources at your employer, even if that person works in a different location. In a small business, that person may well be the owner.

When you request an accommodation, state clearly what you need (for example, time off for a clinic visit every third Tuesday of the month, a certain type of chair, or a change in your work hours) and be ready to supply a doctors note supporting your request. The initial note need not contain your diagnosis, but it should verify that you are under that doctors care and that he/she believes you need the accommodation to maintain your health or to be able to fulfill essential functions of your job.

Many people living with HIV do not want to give a lot of details about their health. If you prefer not to provide a lot of information, you may want to limit the medical information you initially give to your employer. However, if your need for accommodation is not obvious, your employer may require that you provide medical documentation to establish that you have a disability as defined by the ADA, to show that the employee needs the requested accommodation, and to help determine effective accommodation options. This can, but often does not, include disclosing your specific medical condition.

Be aware that not all people with HIV or AIDS will need accommodations to perform their jobs and many others may only need a few or simple accommodations. The U.S. Department of Labors (DOL) Job Accommodation Network (JAN) provides free, expert, and confidential technical assistance to both employees and employers on workplace accommodations and disability employment issues, which includes resources for employees living with HIV or AIDS. See AskJAN.org , or call 800-526-7234 (voice) or 877-781-9403 (TTY) for one-on-one guidance.

Content Source: HIV.gov, and
Office of Disability Employment Policy U.S. Department of Labor

Date last updated: May 15, 2017

3. Exercise and Physical Activity

Should People Living with HIV Exercise?

Yes! Being HIV-positive is no different from being HIV-negative when it comes to exercise. Regular physical activity and exercise are part of a healthy lifestyle for everyone, including people living with HIV.

What Are the Benefits of Physical Activity?

Physical activity has many important benefits. It can

• Boost your mood
• Sharpen your focus
• Reduce your stress
• Improve your sleep

Health.gov/Move Your Way: What's Your Move

Physical activity can also help you reduce your risk of developing cardiovascular disease, high blood pressure, type 2 diabetes, and several types of cancer. These are all health conditions that can affect people living with HIV.

How Much Activity Should You Do?

According to the evidence-based Physical Activity Guidelines (2018), adults need at least 150 to 300 minutes per week of moderate-intensity aerobic activity, like biking, brisk walking, or fast dancing. Adults also need muscle-strengthening activity, like lifting weights or doing push-ups, at least 2 days per week.



Health.gov/Move Your Way: What's Your Move

If you're living with HIV or have another chronic health condition, talk to your health care provider or a physical activity specialist to make sure these guidelines are right for you.

The most important thing is to move more and sit less!

What Types of Activity Are Right for People Living with HIV?

People living with HIV can do the same types of physical activity and exercise as individuals who do not have HIV.

Physical activity is any body movement that works your muscles and requires more energy than resting. Brisk walking, running, biking, dancing, jumping rope, and swimming are a few examples of physical activity.

Exercise is a type of physical activity that's planned and structured with the goal of improving your health or fitness. Taking an aerobics class and playing on a sports team are examples of exercise.

Both are part of living healthy.

Take time to find a fitness routine that you enjoy. You may consider taking part in a group activity that allows you to engage with others. Make it fun, and commit to being physically active regularly.

Content Source: HIV.gov

Date last updated: January 02, 2019

4. Food Safety and Nutrition

Why Is a Good Diet Important for People with HIV?

Good nutrition is important to all people—whether or not they are living with HIV. But some conditions related to treating HIV or AIDS (including wasting, diarrhea, and lipid abnormalities) mean that proper nutrition is really important to people with HIV. Eating well is key to maintaining strength, energy, and a healthy immune system. In addition, because HIV can lead to immune suppression, food safety and proper hygiene are concerns when it comes to preventing infections.

For more information, see the Department of Veterans Affairs' HIV/AIDS: Diet and Nutrition

A healthy diet is essential to maintaining good health across your lifespan. The U.S. Food and Drug Administration (FDA) defines a healthy diet as one that: provides enough of each essential nutrient; contains a variety of foods from all of the basic food groups; provides adequate energy to maintain a healthy weight; and does not contain excess fat, sugar, salt, or alcohol. There are six essential nutrients:

• Protein builds muscles and a strong immune system.
• Carbohydrates (including starches and sugars) give you energy.
• Fat gives you extra energy.
• Vitamins regulate body processes.
• Minerals regulate body processes and also make up body tissues.
• Water gives cells shape and acts as a medium in which body processes can occur.

For more information about healthy eating, see FDA's Smart Nutrition 101: FAQs.

Before you make major changes in your diet, however, contact your primary care provider, or a registered dietician who specializes in HIV care, to get a better assessment of your nutritional needs.
What Do You Need to Know About Food Safety?

Because HIV affects your immune system, you may be at greater risk for food-borne illness. So in addition to eating well, you need to eat safely. By following a few basic safety rules when you prepare and eat your meals, you can protect yourself from food-related illness:

• Avoid eating raw eggs, meats, or seafood (including sushi and oysters/shellfish).
• Wash fruits and vegetables thoroughly.
• Use a separate cutting board for raw meats.
• Wash hands, utensils, and cutting boards with soap and water after each use.
• Water safety is extremely important, as water can carry a variety of parasites, bacteria, and viruses. To protect yourself against these infections, here are some helpful hints:
  
  • Do not drink water from lakes, ponds, rivers, or streams.
  • You may choose to use a store-bought water filter at home for your drinking water.
  • You can significantly reduce your risk of water-borne illness by using only boiled water for drinking and cooking.
  • When traveling abroad in areas where sanitation is poor or water safety is questionable, drink only bottled water and avoid ice or unpasteurized juices and drinks.

Content Source: HIV.gov

Date last updated: May 15, 2017

5. Housing and Health

Why Do People with HIV Need Stable Housing?

Stable housing is closely linked to successful HIV outcomes. With safe, decent, and affordable housing, people with HIV are better able to access medical care and supportive services, get on HIV treatment, take their HIV medication consistently, and see their health care provider regularly. In short: the more stable your living situation, the better you do in care.

Individuals with HIV who are homeless or lack stable housing, on the other hand, are more likely to delay HIV care and less likely to access care consistently or to adhere to their HIV treatment.

Throughout many communities, people with HIV risk losing their housing due to such factors as stigma and discrimination, increased medical costs and limited incomes or reduced ability to keep working due to HIV-related illnesses.

What Federal Housing Assistance Programs Are Available for People with HIV?



To help take care of the housing needs of low-income people living with HIV and their families, the U.S. Department of Housing and Urban Development's (HUD) Office of HIV/AIDS Housing manages the Housing Opportunities for Persons With AIDS (HOPWA) program. The HOPWA program is the only Federal program dedicated to addressing the housing needs of people living with HIV. Under the HOPWA Program, HUD makes grants to local communities, States, and nonprofit organizations for projects that benefit low-income people living with HIV and their families. (View grantee eligibility requirements.)

Many local HOPWA programs and projects provide short-term and long-term rental assistance, operate community residences, or provide other supportive housing facilities that have been created to address the needs of people with HIV.

Find a HOPWA Grantee or Local Program: Search HIV.gov's HIV Services Locator to search for housing assistance near you.

Are People with HIV Eligible for Other HUD Programs?

In addition to the HOPWA program, people living with HIV are eligible for any HUD program for which they might otherwise qualify (such as by being low-income or homeless). Programs include public housing, the Section 8 Housing Choice Voucher Program, housing opportunities supported by Community Development Block Grants, the HOME Investment Partnerships Program, and the Continuum of Care Homeless Assistance Program.

Find Housing Assistance: If you are homeless, at risk of becoming homeless, or know someone who is, help is available. Use HUD's Resource Locator to find housing assistance programs near you.

Access Other Housing Information: Find resources for homeless persons , including, youth , veterans , and the chronically homeless , as well as rental, homebuyer, and homeowner assistance.

This page was developed in collaboration with HUD's Office of HIV/AIDS Housing.

Content Source: HIV.gov

Date last updated: August 21, 2019

6. Traveling Outside the U.S.

Can I Travel Abroad with HIV?

With proper treatment, people with HIV can lead healthy and active lives, including traveling for business and pleasure. However, traveling to other countries, particularly developing countries, may require some advance preparation and special precautions.

Before You Travel

See your health care provider or travel medicine specialist to discuss the medical risks you might face and what you should do to prepare for safe and healthy travel. Ideally, this conversation should take place at least 4-6 weeks before your scheduled departure.

Talk to your provider about the places you plan to visit. He or she may:

• Recommend certain travel vaccines. Most travel vaccines are made from killed bacteria or viruses and can be given safely to people with HIV and others with weakened immune systems. However, they may be less effective than in people with strong immune systems, and may not provide full protection. Your doctor may recommend blood tests to confirm that a vaccine was effective, or recommend additional precautions to keep you safe. Some vaccines are made from live viruses and many people with weakened immune systems should not take them. However, depending on the circumstances, the benefits of protection may outweigh the risks. Talk to your health care provider about what is recommended for you.
• Recommend you pack a supply of medicine like antibiotics to treat travelers' diarrhea, which can affect people with weakened immune systems.
• Provide you with the name(s) of health care providers or clinics that treat people with HIV infection in the region you plan to visit.
• Advise you on how to minimize the risk of malaria and other insect-borne diseases such as dengue and yellow fever, depending on your destination. People who have weakened immune systems can get seriously ill from malaria, so it's important to closely follow your doctor's instructions for taking the preventative medicine, which may include taking it for several weeks before and after the trip. You should also take steps to avoid bug bites: wear insect repellent, wear long pants and sleeves, and sleep under a net if your rooms are exposed to the outdoors.

Also, educate yourself about your insurance policies:

• Review your medical insurance to see what coverage it provides when you are away from home. You may purchase supplemental traveler's insurance to cover the cost of emergency medical evacuation by air and the cost of in-country care, if these costs may are not covered by your regular insurance. View the U.S. State Department's information on insurance for overseas travel.
• Take proof of insurance, such as a photocopy or scan your policy and send the image to an e-mail address you can access both in the United States and abroad. Leave a copy at home and tell your friends or family where it is located.

When You Travel Abroad

Food and water in developing countries may contain germs that could make you sick.

Do not:

• eat raw fruit or vegetables that you do not peel yourself;
• eat raw or undercooked seafood or meat;
• eat unpasteurized dairy products;
• eat anything from a street vendor;
• drink tap water (in developing countries some hotels may purify their own water but it is safer to avoid it), drinks made with tap water, or ice made from tap water.

Do eat and drink:

• hot foods;
• hot coffee or tea;
• bottled water and drinks (make sure the seals are original and have not been tampered with);
• water that you bring to a rolling boil for one full minute then cool in a covered and clean vessel;
• fruits that you peel;
• wine, beer and other alcoholic beverages are also safe.

Be aware:

• Tuberculosis is very common worldwide, and can be severe in people with HIV. Avoid hospitals and clinics where coughing TB patients are treated. See your doctor upon your return to discuss whether you should be tested for TB.
• Animal wastes, such as fecal droppings in soil or on sidewalks, can pose hazards to individuals with weakened immune systems. Physical barriers, such as shoes, can protect you from direct contact. Likewise, towels can protect you from direct contact when lying on a beach or in parks. If you are in physical contact with animals, wash your hands thoroughly afterwards with soap and water.
• Take all your medications on schedule, as usual.
• Stick to your special diet, if you are on one.
• Take the same precautions that you take at home to prevent transmitting HIV to others.

Are There Restrictions on Traveling Abroad?

Some countries restrict visitors with HIV from entering their borders or staying for long periods of time. Others permit discrimination on the basis of sexual orientation or gender identification. According to the State Department, more than 70 countries consider consensual same-sex relations a crime, sometimes carrying severe punishment. Before you travel internationally, be aware of the laws, policies, and practices in the country or countries you plan to visit. This information is usually available from the consular offices of each country or in the State Department's country information summaries, along with information about entry and exit requirements.

Traveling to the U.S. from Other Countries

As of January 2010, travelers with HIV or AIDS are allowed entrance into the U.S.

What Travelers' Health Resources Are Available?

CDC's Yellow Book, a guide to health information for international travelers is an excellent resource for anyone traveling overseas. The section on Immunocompromised Travelers has extensive information for people with HIV. CDC's Travelers' Health website contains find information on:

• travelers' health for people with weakened immune systems
• travel health notices for destinations
• recommended vaccinations and precautions for destinations

Additionally, the Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV contain information about immunization against malaria and other infections that may be useful.

Content on this page was adapted from the Centers for Disease Control and Prevention.

Content Source: HIV.gov

Date last updated: August 19, 2019

1. Civil Rights

Laws Protect People Living with HIV and AIDS

If you are living with HIV or AIDS, you are protected against discrimination on the basis of your HIV under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA). Under these laws, discrimination means that you are not allowed to participate in a service that is offered to others, or you are denied a benefit, because of your HIV disease.

For more information, see the Department of Justice's website.

For more information in the health care context, see the Office of Civil Rights' Civil Rights: HIV/AIDS.

Federal Law

Both Section 504 and the ADA prohibit discrimination against qualified persons, including those with HIV/AIDS.

The ADA prohibits discrimination by employers, places of public accommodation, and state and local government entities. Section 504 prohibits health and human service providers or organizations that get Federal funds or assistance from discriminating against you because you are living with HIV/AIDS. Examples of entities that may be covered by the ADA and/or Section 504 include hospitals, clinics, social services agencies, drug treatment centers, nursing homes, doctors' offices, dentists' offices, daycares, public pools, and fitness gyms. Again, under these laws, discrimination means that you are not allowed to participate in a service that is offered to others, or you are denied a benefit, because of your HIV disease. The ADA also protects your family and friends from discrimination because of YOUR HIV status, based on their association with you. For more information, see OCR's Your Rights Under Section 504 and the Americans With Disabilities Act.

Privacy

The Office for Civil Rights (OCR) also enforces the Privacy Rule under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which protects the privacy of your health information and gives you the right to review and make corrections to your medical records. For more information, see OCR's Health Information Privacy, Protecting the Civil Rights and Health Information Privacy Rights of People Living with HIV, or How to File a Complaint.

Content Source: HIV.gov

Date last updated: November 10, 2017

2. Workplace Rights

HIV, Employment Discrimination, and the Law

The Americans with Disabilities Act of 1990 (ADA) prohibits employment discrimination on the basis of disability. The ADA, which covers employers of 15 or more people, applies to employment decisions at all stages. Court decisions have found that an individual with even asymptomatic HIV is protected under this law.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses some of the barriers to healthcare facing people with HIV, as well as other vulnerable populations. HIPAA gives people with group coverage new protections from discriminatory treatment, makes it easier for small groups (such as businesses with a small number of employees) to obtain and keep health insurance coverage, and gives those losing/leaving group coverage new options for obtaining individual coverage.

The Family Medical Leave Act of 1993 (FMLA) applies to private-sector employers with 50 or more employees within 75 miles of the work site. Eligible employees may take leave for serious medical conditions or to provide care for an immediate family member with a serious medical condition, including HIV/AIDS. Eligible employees are entitled to a total of 12 weeks of job-protected, unpaid leave during any 12-month period.

The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) allows employees to continue their health insurance coverage at their own expense for a period of time after their employment ends. For most employees ceasing work for health reasons, the period of time to which benefits may be extended ranges from 18 to 36 months.

Filing a Charge of Employment Discrimination

Any individual who believes that his or her employment rights have been violated may file a charge of discrimination with the Federal Equal Employment Opportunity Commission (EEOC). In addition, an individual, an organization, or an agency may file a charge on behalf of another person in order to protect the aggrieved person's identity.

For more information, see EEOC's The ADA: Your Employment Rights as an Individual With a Disability.

Content Source: HIV.gov

Date last updated: May 15, 2017

3. Limits on Confidentiality

HIV Disclosure Policies and Procedures

If your HIV test is positive, the clinic or other testing site will report the results to your state health department. They do this so that public health officials can monitor what's happening with the HIV epidemic in your city and state. (It's important for them to know this, because Federal and state funding for HIV services is often targeted to areas where the epidemic is strongest.)

Your state health department will then remove all of your personal information (name, address, etc.) from your test results and send the information to the U.S. Centers for Disease Control and Prevention (CDC). CDC is the Federal agency responsible for tracking national public health trends. CDC does not share this information with anyone else, including insurance companies. For more information, see CDC's HIV Testing Basics: Privacy.

Many states and some cities have partner-notification laws—meaning that, if you test positive for HIV, you (or your healthcare provider) may be legally obligated to tell your sex or needle-sharing partner(s). In some states, if you are HIV-positive and don't tell your partner(s), you can be charged with a crime. Some health departments require healthcare providers to report the name of your sex and needle-sharing partner(s) if they know that information–even if you refuse to report that information yourself.

Some states also have laws that require clinic staff to notify a “third party” if they know that person has a significant risk for exposure to HIV from a patient the staff member knows is infected with HIV. This is called “duty to warn.” The Ryan White HIV/AIDS Program requires that health departments receiving money from the Ryan White program show “good faith” efforts to notify the marriage partners of a patient with HIV.

Disclosure Policies in Correctional Facilities

Any individual who believes that his or her employment rights have been violated may file a charge of discrimination with the Federal Equal Employment Opportunity Commission (EEOC). In addition, an individual, an organization, or an agency may file a charge on behalf of another person in order to protect the aggrieved person's identity.

For more information, see EEOC's The ADA: Your Employment Rights as an Individual With a Disability.

Content Source: HIV.gov

Date last updated: May 15, 2017

Chapter VIII is entirely derived and adapted from the Institutes of Health's National Library of Medicine, National Center for Biotechnology Information, SAMHSA/CSAT, Treatment Improvement Protocols.https://www.ncbi.nlm.nih.gov/books/NBK64930/