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aids comes of age Research by Social Work professor Charles Emlet and a student may ultimately help older AIDS patients get the care they need. By Jill Carnell Danseco Charles Emlet studies seniors who face all the ailments that come with age. Arthritis. Osteoperosis. Stroke. Not to mention joint pain, high cholesterol and hearing loss. They also have AIDS. Tell a stranger you’re a senior with AIDS, the UW Tacoma Social Work professor says, and you’re likely to hear the response one of his research subjects did: “You’re awfully old to have this disease.” A gerontologist with more than two decades of experience working with and studying HIV and AIDS patients, Emlet was one of the first scholars in the nation to examine the care of older people with the disease. His groundbreaking work has led to changes in the way older HIV/AIDS patients are treated and a heightened level of international awareness of the issue in the health-care field and among the public. This year, with the help of a student research assistant, Emlet has embarked upon an ambitious plan to survey the state’s aging centers on their understanding of, and preparation for, the treatment of older residents with HIV and AIDS. He hopes the project will ultimately lead to policy changes that help seniors with HIV/AIDS connect with improved health care and social services. “If we can find out just what they know about HIV/AIDS in older people, we may be able to develop a training program that would help them increase the level of care.” * * *
Emlet grew up in Fresno, Calif., the son and grandson of farmers. Expecting to one day run his grandparents’ farm, he began studying agriculture at Reedley College. His life changed when he stumbled into a class led by a faculty member with a Master of Social Work degree. “I was enthralled by how he worked with people,” Emlet says. He had found a new path in life, and he followed it. Specializing in gerontology and research, Emlet earned his own MSW at California State University, Fresno. In the 1980s, with the HIV epidemic reaching critical proportions in the Bay Area, he began working with HIV and AIDS patients as a home-care worker while teaching in the Gerontology Program at American River College in Sacramento. Emlet’s research assistant, Amanda Hudson has never lived in a world where AIDS didn’t exist. She was born in 1983, while Emlet was just beginning his study of the disease. At the time, conventional wisdom held that AIDS was a young person’s disease, contracted by doing the reckless things young people do—unprotected sex, sharing drug needles—and once you had it, you died young. But, as Emlet quickly learned in the late 80s, conventional wisdom was wrong. “To my surprise, I began to see older patients, people in their 50s, 60s, even 70s and older,” he said. “They didn’t want the same treatment we were giving to the younger patients. The gerontologist in me went, ‘Whoa.’” Approaching older HIV/AIDS patients in the same way as the younger ones just didn’t work, Emlet said. They rejected the idea of joining support groups. And when Emlet turned to research to find better methods of serving these older patients, he discovered that there was only one book available on the subject. With his patients dying—nearly half of his caseload passed away within a six-month period, Emlet said—he resolved to find new ways to help this unique population. He began to discover that very few experts in the field thought HIV/AIDS in older people was worth much thought. Even the faculty adviser in his Ph.D. program at Case Western Reserve University rejected the idea at first. “He told me, ‘It’s not an issue. I don’t get it,’” Emlet said. But Emlet pushed forward with the goal of learning how HIV/AIDS affects older people and helping to create a standard of care for these patients. He began to learn that many adults over 50 had a perception that they were immune to the lethal disease. “Baby-boomers grew up in the sexual revolution of the 1960s and ‘70s,” he said. “They never had a sense of HIV and AIDS. They were more sexually active than their parents, but they didn’t think HIV pertained to them.” According to studies, even today, older adults are less knowledgeable about HIV/AIDS than their younger counterparts, and people over 50 who engage in high-risk sexual behavior are less likely to use condoms and be tested for HIV. “HIV and AIDS should be on their radar screen, but it isn’t,” Emlet said. “Look at the commercials for Viagra and other sexual-enhancement drugs. They assume monogamy and heterosexuality, but that isn’t necessarily the case. And there are no condom commercials for older people and no safe sex messages.” With more seniors putting themselves at risk, it’s no surprise that, according to the Center for Disease Control and Prevention, the number of adults over 50 living with AIDS increased by 80% from 2001 to 2005. And it’s not only new AIDS cases. With new anti-viral drugs extending the lifetimes of HIV/AIDS patients, more are living into old age. “When I started in this business, the only way to be an older person living with HIV was to become infected older,” he said. “Now, people can grow old with HIV. That’s the good news. But there are a lot of other issues balancing HIV with other age-related conditions. You can grow old and have a meaningful life, but the disease impacts all of the things that people already have to deal with as they age.” Social services haven’t kept up with the changing demographics in HIV/AIDS patients, assuming that existing care networks can handle the load, Emlet says. But it’s not easy to shoehorn seniors into a system designed for younger people. Older HIV/AIDS patients are usually unwilling to seek help from these traditional support networks, believing they won’t fit in. One older woman with HIV complained to Emlet that the women in her support group wanted to talk about childcare – while she wanted to discuss menopause and arthritis. However, they’re often embarrassed to ask for services from support networks designed for typical senior citizens. They feel alienated by both groups at once, Emlet said. “What’s lacking is recognition that the older population’s needs are different.” He said. “There is very little programming specifically for this population.” Emlet came to UW Tacoma’s Social Work program in 1999. He teaches classes on social work practice and gerontological social work, all the while building his international reputation as a leader in the research on HIV and aging. Hudson, his research assistant, first learned about the issue in Emlet’s class on aging. “It opened my eyes to how much older people are neglected,” she said. Another student recommended to Emlet that he consider hiring her as an assistant on this project. Even though he didn’t have funding for the study at the time, she was interested in the idea and agreed to work with him, whether she got paid or not. “I love research,” she said. Together, they successfully applied for a grant from the UW Center for AIDS Research. Their project is a pilot study of the Aging and Disability Resource Centers in Washington. Conceived as “one-stop shops” offering a variety of services for older Washington residents, the Resource Centers might be a good way to deliver HIV/AIDS services. “Older adults are eligible for services from both the HIV system of care and the network of services for seniors,” Emlet said. “But I’ve found that older HIV-infected adults are less likely to know about services available to them though the aging network. They don’t seem to be utilizing the aging resources much, and they could be missing out on a lot.” Emlet and Hudson have developed a survey to examine in detail what each of the 13 Resource Centers in Washington knows about HIV in older people, what experience they have serving this population and what they think they need to learn in order to serve them more effectively. Eventually, they hope to take the study national. “There’s never been a national survey like this,” he said. “I’m very excited about it.” In the end, the results could lead to better care for seniors with HIV and AIDS. “Perhaps there’s a need for these agencies to increase their knowledge of how HIV impacts older people. That could have a ripple effect that might ultimately enhance how accessible their services are to older people with HIV.” As the AIDS epidemic has grown, the health-care field is finally beginning to understand that older people can, and do, contract the disease, and that they may require different care than younger patients. With Emlet leading the way, other scholars have begun to examine the effects of HIV/AIDS on this population. “When I go to aging conferences now, instead of one or two papers related to aging and HIV, there are seven to 10 papers, and that’s heartening,” he said. The public, too, is more aware of HIV in seniors. But, Emlet said, there’s still a long way to go in overcoming the myth that older people don’t engage in risky behavior that can lead to infection. “People ask me how older people could get HIV,” he said. “Well, duh—they have unprotected sex or shoot drugs, just like younger people.”
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