The HIV population in the United States is aging. This can be seen as a sign of success as people with HIV are living longer because they are engaged in care and benefiting from effective treatments. Consider these data from the HRSA Ryan White HIV/AIDS Program (RWHAP) fact sheet, Older Adult Clients: Ryan White HIV/AIDS Program, 2018
46.1% of individuals getting RWHAP care are over 50 years old, similar to the age demographics of all Americans diagnosed with HIV
91.5% of those aged over 50 are virally suppressed, exceeding the RWHAP average of 87%.
The aging trend has been underway for many years and is projected to continue. In 2018, RWHAP clients aged 55 and older accounted for 31% of all clients, up significantly from 16.6% in 2010. A large proportion of RWHAP clients (45-54 years old) are on the cusp of joining the 55+ age group.
In a letter to Robert Torres, Secretary of Aging Pennsylvania Department of Aging, representatives of the PA Commission on LGBT Affairs wrote:
In February, the Aging Workgroup of the Commission on LGBTQ Affairs developed a survey to hear from aging service providers and LGBTQ consumers across the Commonwealth. The survey was completed by over 400 individuals, representing both service providers and older Pennsylvanians. The Workgroup used this survey data to craft the recommendations […] LGBTQ older adult respondents expressed great concern over being able to access LGBTQ-friendly resources and services. A strong majority indicated they would more readily access these services if they knew providers had completed LGBTQ cultural competence training. Providers also identified the need for greater training within the aging network to develop the knowledge and skills needed to more effectively serve LGBTQ older adults and individuals living with HIV. They reported wanting more resources that they could share with co-workers to improve their agencies, and resources to share with clients to help them connect to LGBTQ-friendly services. Providers and consumers both identified the need for non-discrimination protections, improved data collection, and greater support for LGBTQ people in the long-term care system.
A formal document regarding recommendations to the Department of Aging, at the Pennsylvania Department of Health, include:
Expanding LGBTQ cultural competence within all levels of care providers
Develop training opportunities and resources on the topic of HIV & Aging
Support advocacy efforts for LGBTQ older Pennsylvanians
Establish mechanisms for collecting data on sexual orientation and gender identity
Provide training materials for aging services providers
Identify opportunities to partner and support LGBTQ affordable, inclusive housing initiatives
Develop and share resources related to LGBTQ aging with all levels of care providers
Develop programs that deal with social isolation, including training seniors on the use of social media technologies
You can find out more in the official document, with the full list of recommendations, submitted to the Department of Aging here. For more information about the Department of Aging, go here.
August “Buzz” Pusateri played an integral role in the Pitt Men’s Study, a confidential research study of the natural history of HIV and AIDS. Not only did he believe in the importance of recruiting volunteers to help further research, he was one of the project’s first volunteers. Twice a year, sometimes more, Pusateri visited the clinic to give blood and answer detailed questions about his life. He also participated in special studies.
“Buzz got it across to the community … that this had to be done for them to defeat this epidemic of AIDS,” said Charles Rinaldo, a scientist and investigator of the Pitt Men’s Study. “He was central to it. He was always there. He was a tough guy, too.”
August “Buzz” Pusateri
Pusateri, a long-term HIV survivor, died on Monday, according to a tribute on the Pitt Men’s Study website. He was 81. Pusateri was a well-known community activist, a founding member of the Pitt Men’s Study community advisory board, and a volunteer with Shepherd Wellness Community. He had been involved in the Pitt Men’s Study since recruitment began in 1984.
“It’s just a horrible loss,” Rinaldo said. “He was our go-to person as far as connecting with the community. He was number one in making sure the community understood.”
Pusateri tested positive for HIV more than 30 years ago. He told the Tribune-Review in 2015 “it’s been an up-and-down battle.”
“Really, with this HIV, you never know what’s going to happen to you,” Pusateri said in 2015.
The Pittsburgh resident was the longest serving chair of the community advisory board, the direct link between the researchers and LGBTQ community, Rinaldo said.
Despite having health problems in more recent years, Pusateri would still come to the board meetings, Rinaldo said.
“I called him the ‘Iron Man’ and he was,” Rinaldo said. “He had health issues, but that didn’t stop him.”
Close friend Richard Vinski said Pusateri was extremely inspirational and motivating.
“Any time something hit him or he ended up in the hospital … he’d say, ‘I’m going to beat this,’” Vinski said. “He just had a great outlook on life and he motivated people because of his strength.”
“If you looked at him he was a frail, small man toward the end of his life, but he was a big guy when it came to getting people moving and giving them the right point of view,” Vinski said.
Pusateri was proud to be a long-term HIV survivor, and shared his experiences publicly to combat stigma and prove that people living with HIV could have full and meaningful lives, officials with Shepherd Wellness Community said.
A pharmacist, Pusateri would often speak to center members about the need for careful adherence to their HIV/AIDS regimens. Shepherd Wellness Community is an AIDS Community center that helps people living with HIV/AIDS.
“Buzz volunteered in our kitchen for five years before joining our staff as chef from 1998-2006,” Shepherd Wellness Community officials said in a statement. “He delighted in planning menus and preparing meals that were high-quality, delicious and nutritious. He always beamed with joy when our community gathered to enjoy his sumptuous dinners.”
Pusateri also hosted movie nights at the center, sharing his love for classic cinema. Vinski said his friend was a collector of old movies.
August “Buzz” Pusateri passed away on Monday, May 4th. Buzz was a well-known community activist who dedicated much of his life to combating AIDS. He was a founding member of the Pitt Men’s Study community advisory board and volunteered for the Shepard Wellness Community. The Pittsburgh Post-Gazette wrote a feature about Buzz back in 2001, which you can find here.
Buzz will be missed but his contributions to the LGBTQ community will continue well into the future. Here are just a few tributes from friends and colleagues:
From Dr. Charles Rinaldo, principle investigator of the Pitt Men’s Study…
I am extremely saddened to inform you that long time founding member and chair of the Pitt Men’s Study Community Advisory Board, LGBTQ advocate and dear friend August “Buzz” Pusateri passed away overnight. We in the Pitt Men’s Study have known Buzz for 35+ years. He was always there for us. This is a terrible loss.
From Dr. Larry Kingsley, co-investigator of the Pitt Men’s Study…
Buzz was the best of the rest of us. I remember him since 1984 when he was gracious enough to pilot test the first MACS questionnaire, which I administered. He never flinched. He gave far more to us than we could return. Buzz is on my mensch list, which is short.
From the Shepherd Wellness Community…
Buzz volunteered in our kitchen for five years before joining our staff as chef from 1998-2006. He delighted in planning menus and preparing meals that were high-quality, delicious and nutritious. He always beamed with joy when our community gathered to enjoy his sumptuous dinners.
A longtime advocate for HIV/AIDS, Buzz was proud to be a long-term survivor. He shared this experience publically to combat stigma and proclaim that people living with HIV can have full and meaningful lives. Buzz also had a career as a pharmacist and would often speak to our members about the need for careful adherence to their HIV/AIDS regimens.
A man of many interests, Buzz loved classic cinema and he delighted in hosting movie nights at our center where he presented the background of each film, accompanied by his review. We remember Buzz for being deeply spiritual and a devoted and active member of St. Paul Cathedral.
From the Delta Foundation…
Buzz’s community contributions are long: He was on the board of the Lambda Foundation, was a founding member of Community Advisory Board at the Pitt Men’s Study, founded Dignity Pittsburgh (and was their the longest serving treasurer and secretary), was a long-time supporter of Shepherd Wellness Community, and was a founder of the Pittsburgh Coffeehouse. He was also a proud member of the Board of Directors for the Delta Foundation and was recently named an Emeritus member. Buzz was out and proud at a time when the LGBTQ community was invisible and was always advocating against the stigma that still remains to this day as a person living with AIDS.
From Persad Center…
Buzz was a man that set the bar for dedication and compassion among LGBTQ advocates in the Pittsburgh area for the last few decades. He is fondly remembered by so many for his loyalty and drive to help those living with HIV. He was an inspirational human being, and often helped folks find their place when it came to helping others in the LGBTQ community. He was a joy to work with and be around and helped so many people. He will be missed.
A memorial will be scheduled at a later date. Details to follow.
The Pitt Men’s Study would like to remind our volunteers and the community at large that protecting yourself from getting COVID-19 is not only a way to safeguard your own health but also important in protecting everyone you come in contact with.
Wash your hands with soap and water, for 20 seconds
Hand sanitizer must contain at least 60% alcohol
Avoid touching your eyes, nose or mouth
Avoid close contact with people who are sick.
Put distance between yourself and others.
Stay home if you are not feeling well.
Cover coughs and sneezes with a tissue
Throw used tissue in the trash
Immediately wash your hands or use hand sanitizer
Clean and disinfect frequently touched surfaces daily
Wear a mask ONLY if you are sick or caring for someone who is sick
Remember, older adults and people with underlying chronic illness are at higher risk for serious complications from COVID-19 illness. Please call your healthcare provider if you have any of the following symptoms: Cough, fever, shortness of breath.
Both relationship-specific and structural factors influence whether coupled gay men living in New York City choose to use pre- and post-exposure prophylaxis (PrEP/PEP) for HIV prevention. Some men – particularly those in monogamous relationships – felt that discussing PrEP and PEP in the context of a relationship could threaten the relationship by raising issues of trust, while others felt that it had the potential to enhance sexual health and satisfaction.
Stigma from the gay community and healthcare providers around promiscuity also presented barriers to PrEP uptake. This qualitative research was conducted by Stephen Bosco, Dr Tyrel Starks and colleagues at City University New York and published in the Journal of Homosexuality.
Gay and bisexual men accounted for 66% of all new HIV diagnoses in the US in 2017. It is estimated that 35-68% of these infections happen within the context of a long-term relationship. This indicates that coupled gay men have the potential to benefit significantly from biomedical prevention strategies, such as PrEP (taken on an ongoing basis) and PEP (taken shortly after a suspected infection). However, only 7% of the potential 1.1 million gay and bisexual men who could benefit from PrEP were prescribed it in 2016. Black and minority men in the US remain most at-risk for HIV infection, while also having the lowest rates of PrEP uptake.
As they have for more than three decades, the Pitt Men’s Study leaders gathered with about four dozen men and women. They remembered those who have died and gave thanks for the 1,743 men who have participated in the nation’s longest-running HIV/AIDS research project.
Charles Rinaldo, a Ph.D. scientist who has led the effort since the virus surfaced here in 1981, walked solemnly down the center aisle with a group of clergy.
“So here we are again to honor our participants,” the soft-spoken Rinaldo said, welcoming the sparse group. “For 35 years now, you have supported our study for HIV/AIDS. … We can’t thank you enough. Without you, there is no study.”
Every six months, year after year, participants have trekked to Oakland to offer blood and bodily fluids. Their alms have become the foundation of hundreds of research projects.
The Pitt study, conducted in the halls of the university where Jonas Salk developed the world’s first polio vaccine, began before the affliction that has killed an estimated 32 million people worldwide even had a name: human immunodeficiency virus. Or simply, HIV.
Neither the virus nor its final, deadly stage — acquired immunodeficiency syndrome, or AIDS — dominates the news and national fears as they did decades ago. Yet around the world, about 38 million people remain infected. Many are living longer lives thanks to lifesaving, though expensive, medical treatments. But there is no cure — yet.
Worldwide, an estimated 1.7 million people became infected with HIV last year. Another 770,000 died from AIDS-related illnesses.
In the United States, just more than 1 million people are believed to be living with HIV. Although the number of new infections has declined dramatically, nearly 40,000 in the U.S. still contract HIV every year. And about 16,000 people died from AIDS in the United States in 2016.
Because of that, work on the Pitt Men’s Study continues.
Extensive evidence from HIV prevention research studies has firmly established that “Undetectable Equals Untransmittable,” or U=U. This means that people living with HIV who achieve and maintain an undetectable viral load — the amount of virus in their blood — by taking antiretroviral therapy (ART) as prescribed do not sexually transmit HIV to others. The U.S. Centers for Disease Control and Prevention estimates this strategy is 100% effective against the sexual transmission of HIV.
Now, a new study of nearly 112,000 men who have sex with men in the United States has found increasing acceptance of the U=U message in this population. Overall, 54% of HIV-negative participants and 84% of participants with HIV correctly identified U=U as accurate. The study was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Study results were published online in the Journal of Acquired Immune Deficiency Syndromes.
“U=U has been validated repeatedly by numerous studies as a safe and effective means of preventing the sexual transmission of HIV,” said Anthony S. Fauci, M.D., NIAID Director. “The increased understanding and acceptance of U=U is encouraging because HIV treatment as prevention is a foundation of efforts to end the epidemic in the United States and around the world. This public health message has the power to reduce stigma, protect the health of people living with HIV and prevent sexual transmission of HIV to others.”
Researchers examined a representative sample of LGB people in the United States from three age groups—young ( 18-25 ), middle ( 34-41 ) and older ( 52-59 )—to understand the factors that influenced past utilization of LGBT-specific clinics and providers and interest in using them in the future.
“The discrepancy between past utilization and interest in future use of LGBT-specific providers suggests there is a disconnect between the type of healthcare many LGB people would like to have and what they have access to,” said lead author Alexander J. Martos, former Research Analyst at the Williams Institute. “Younger, Black LGB people and those with lower incomes reported the greatest interest in LGBT community-based healthcare.”
Ending the HIV Epidemic: A Plan for America aims to close this implementation gap. NIH-funded advances in effective HIV prevention, diagnosis, treatment and care are the foundation of this effort. In addition, expanded partnerships across HHS agencies, local community organizations, health departments, and other organizations will drive new research to determine optimal implementation of these advances. This type of research is called “implementation science,” and is essential to translate proven tools and techniques into strategies that can be adopted at the community level, particularly for communities most vulnerable to HIV.
Understanding what works to prevent and treat HIV at the community level is critical to the success of the Ending the HIV Epidemic plan. More than 50% of new HIV diagnoses in 2016 and 2017 occurred in just 50 geographic areas: 48 counties; Washington, D.C.; and San Juan, Puerto Rico. Seven states also have a disproportionate occurrence of HIV in rural areas. For its first five years, the new initiative will infuse new resources, expertise, and technology into communities in those key geographic areas.
However, communities are more than just geography. On World AIDS Day, we are reminded that Ending the HIV Epidemic must take place “Community by Community.” The people affected by HIV are a part of unique communities often shaped by differences in race, ethnicity, gender, culture, and socioeconomics. To reach people who have different needs, preferences, and choices, and ensure that HIV treatment and prevention tools can work in their lives, we must go beyond a “one-size-fits-all” approach.