It is clear that you value having a relationship with your physician not just an appointment now and then. It is essential for all patients to feel comfortable with their medical provider. Concealing my problems and more seriously concealing my entire identity does not allow for healing and growth physically or psychologically. My physician will only be able to superficially help me if I don't honestly present myself.
What specifically did you find essential for you in your former physician? You don't mention the doctor's gender; are you more comfortable with a male or female? Was it that you felt accepted as a gay man or that the doctor was lesbian or gay?; was the doctor an HIV specialist or a specialist in aging? What areas of your health were you and your doctor focusing on: aging or HIV?
It is evident that persons who are HIV positive are living longer but along with other afflictions or co-morbidities that arise with aging. A 2007 study published in the Journal of Gerontology showed that HIV positive men were more frail than HIV negative men. It noted that the longer an individual has HIV the more frail they become; a 55 year old HIV positive individual has similar fraility to a 65 year old HIV negative individual. After entering care and adhering to prescribed HIV medication regiments (HAART) life expectancy increases. Better adherence of older persons brings about better virological outcome. It is thought by many that the preservation of the immune system is relevant because it can reduce risk of non-AIDS co-morbidities. One study (DAD) showed that the rates of fatal non-AIDS defining malignancies is 5 times higher than rates for AIDS-defining malignancies among older HIV infected (65-69) and increases with age after 50 years.
I consulted with Dr. Larence Hitzeman, MD., an HIV provider at the Village Care of New York Health Center in Manhattan. He noted that all HIV providers can handle HIV related problems in the older adult as does he. The provider needs to have awareness of co-morbidities that are along for the ride with the HIV positive individual who is also aging: heart disease, kidney disease, brain function, Diabetes, Hypertension, bone disease.
The medical professional that you choose needs to be a specialist in HIV and knowledgeable regarding treatment strategies for HIV drug resistance and with new HIV drugs for patients with resistance.
Where do you begin your search for a provider with whom you can work?
First ask your former provider to recommend someone with her/his qualities.
If you are interested in researching via computer, several web sites offer helpful guidance:
http://www.gayhealth.com
http://www.gmhc.org
GRIOT (Gay Reunion in Our Time) Circle which is a grass roots organization for older LGBT citizens and associated with Gay Mens Health Crisis (GMHC).
http://www.acria.org
ACRIA offers extensive research and materials on HIV and aging.
http://www.nyahof.org
New York Association of HIV Over Fifty.
Wishing you long, happy and fulfilling years,
Ken
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