1. Ageism, Aging and HIV: A Call to Action
Ageism, Global Health Care Policy,
And Chronic Disease Management
July 20, 2016
Robert Reinhard
Community Liaison
Canadian HIV Cure Enterprise
&
NIH MDC BELIEVE Cure Collaboratory

2. Financial Disclosures/COI
I have no financial disclosures
No COI
My disclaimer of representativeness-personal perspective- others also important

3. Overview of Talk
Global Differences in Age, Aging and Life Expectancy in the context of HIV
Comparing Burdens of Disease: HIV, Infectious Disease and NonCommunicable Disease
The Wisdom of Bette Davis: What is Aging With HIV Really Like?
What People Need Where They Live

4. 1. Life Expectancy: What’s Behind the Results?
Figure
Trends in life expectancy for individuals initiating antiretroviral therapy at age 35 years
Life expectancy estimates from Rwanda,1 South Africa,9 the UK,6 and high-income countries in North America and Europe7 are plotted at the midpoint of the calendar periods for which they are reported.
I’m showing this not to discuss disparity- which we all know- but because in my experience LE is useful to start talking with communities about how research relates biologically and socially to the present not just the future. HIV LE does not mean HIV cause mortality. Rather LE is a marker of all cause SDOH and medical cause mortality risk across the lifespan-including HIV: economics, IDU, co=infection, health system, adherence, stigma, ART initiation, late diagnosis, ethnicity, genomics, pathogenesis, trauma, accident-It’s a picture not only of how long you lived but also a picture that (behind the slopes) shows a symbol of how you lived all those years that you were alive and compared to people without HIV or who live somewhere else.
And it’s my view that Life as lived is the medical remission research challenge to answer it’s not the research barrier
Copyright © 2015 Egger et al. Open Access article distributed under the terms of CC BY-NC-ND Terms and Conditions
The Lancet Global Health 2015 3, e122-e123DOI: ( /S X(14) )

5. HIV LE Percentage compared to general population= also w/in countries great disparity BC Indigenous People with HIVat 20 years have LE only to 40- so advocacy-and cure strategy around “aging” is relative
We cant show cause and effect for LE mortality sans HIV, althoughLE rises in highly endemic countries with ART rollout- but we can look at who needs to be engaged and what research must address for them
Trends in life expectancy of HIV-positive adults on antiretroviral therapy Wandeler, Gilles; Johnson, Leigh F.; Egger, Matthias.Curr. Opinion HIV/AIDS. epub May 31, 2016

6. 2. Comparing BOD
Of course having HIV contributed to other deaths when it is present but more people die of a broken heart
This is somewhat out of date-last year TB deaths surpassed HIV/aids
WHO Fact Sheets:

7. WHO Fact Sheets:http://www.who.int/mediacentre/factsheets/fs310/en/

8. But Where You Live Matters
Aging with HIV is not what happens after ART or after it’s “manageable” Manageable is word that is highly over and mis-used

9. 3.The Wisdom of Bette Davis
Getting older is not for sissies- esp if you have HIV

10. 4.What People Need Where They Live
Integrated (and differentiated) healthcare for all health across lifespan
Removing global disparity in HIV and NCD services
Functional Life*
Good Life
Research for new treatment and cure
*Is Sepo Study an answer? Rehabilitation program in Zambia lab/sepo-2/

11. Great Thanks Sagacity Consultants University of Toronto Kate Murzin
Ron Rosenes
Darien Taylor
ACRIA
Steve Karpiak
Mark Brennan-Ing
University of Toronto
Kate Murzin
Stephanie Nixon
Kelly O’Brien
Rupert Kaul
Connie Kim
Colin Kovacs
George Washington University
BELIEVE Collaboratory
Doug Nixon
Rosanne Lamplough
Anna-Laura Ross