Midlife and older gay men in the United States have lived through a remarkable period of crisis and change. On the heels of the burgeoning gay rights movement in the 1970s, the AIDS epidemic robbed these men of many of their friends and partners beginning in the 1980s.
For all of the social progress in recent years, this group has endured discrimination throughout their lives, with many feeling the need to conceal an important aspect of their identities. And now they have reached a time in their lives that many men, regardless of their sexual orientation, find stressful.
Richard Wight, a researcher in the Department of Community Health Sciences in the UCLA Fielding School of Public Health, has recently studied mental health trajectories of midlife and older gay men against the backdrop of these societal shifts.
Wight and his colleagues, including professor Carol Aneshensel in the Department of Community Health Sciences, have drawn from an invaluable resource—the Los Angeles site of the ongoing Multicenter AIDS Cohort Study(MACS), one of the world’s largest and longest-running studies examining the natural history of HIV/AIDS. Led at UCLA by Dr. Roger Detels, professor of epidemiology at the Fielding school, the study has followed the lives of nearly 5,000 HIV-positive and HIV-negative gay and bisexual men at four U.S. sites since 1984 through twice-annual assessments.
“It dawned on me that we have three decades’ worth of data,” says Wight. “This was an opportunity to see how the historic societal changes affecting gay men have intersected with the natural aging process.”
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The proportion of HIV-positive patients receiving care in the United States who accessed antiretroviral therapy (ART) and achieved viral suppression increased substantially between 2009 and 2013, according to research published in the online edition of AIDS.
There was a 6% overall increase in the proportion of patients prescribed antiretrovirals, whereas the proportion of individuals with viral suppression and sustained viral suppression increased by 11% and 17%, respectively. The increases were most pronounced in young people aged 18-29 and blacks.
“This analysis demonstrates consistent increases in ART prescription and viral suppression among persons in HIV clinical care in the United States, overall and in nearly every demographic sub-group examined,” comment the investigators. “However, there is still a significant gap between the percentage of patients who are prescribed ART and who have sustained viral suppression.”
In 2012, the United States Department of Health and Human Services issued updated guidelines recommending that all people with HIV should receive antiretroviral therapy. One of the key goals of the US National HIV/AIDS Strategy (NHAS) is to increase access to care and improve outcomes for people with HIV. An undetectable viral load is a key marker for HIV outcomes as it is associated with a low risk of disease progression and transmission to sexual partners.
A team of researchers from the Centers for Disease Control and Prevention analysed data collected between 2009 and 2013 to estimate trends in ART prescription and viral suppression among patients in HIV care.
Data were obtained from the Medical Monitoring Project, a nationally representative sample of HIV-positive adult patients receiving medical care.
The authors calculated the percentage of patients prescribed ART (new and continuing prescriptions), with viral suppression (viral load below 200 copies/ml at last monitoring) and with sustained viral suppression (viral load below 200 copies/ml in all tests conducted in a twelve-month period).
Results were encouraging for all three outcomes.
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