Creating Inclusive Policy Reform for LGBT Older Adults with HIV


By Angela Perone

Angela Perone is a staff attorney at the National Center for Lesbian Rights, where she oversees the Elder Law Project. She also represents individuals living with HIV and AIDS through the AIDS Legal Referral Panel and serves on the Lesbian Gay Bisexual Transgender Advisory Committee, which provides advice and assistance to the San Francisco Human Rights Commission regarding issues in the LGBT community and for persons with HIV/AIDS. Perone graduated summa cum laude as a James Scholar from the University of Illinois and as a Public Interest Fellow and Moscone Scholar from the University of California, Hastings College of the Law.

Abstract:

Recent policies affecting lesbian, gay, bisexual, and transgender (LGBT) older adults and people living with HIV promise a new era of reform. From California Congresswoman Barbara Lee’s antidiscrimination HIV-related bills and the sweeping changes of the Affordable Care Act to U.S. Senator Michael Bennet’s LGBT Elder Americans Act and the federal administration’s recent regulations, guidance, and rules regarding hospitalization, housing, and social services for LGBT older adults, LGBT older adults and people living with HIV stand to gain an unprecedented recognition of rights. While these policy changes represent significant progress, policy makers and advocates must be mindful of how these various policies intersect and affect marginalized communities. Through inclusive policy reform, policy makers can ensure that their policies sufficiently address the needs of all LGBT elders.
This article begins by describing recent policies regarding stigma and resources regarding LGBT older adults and people living with HIV. It then provides context for such policy reform by exploring the demographics of LGBT older adults with HIV to highlight the immense importance of policies addressing some of the barriers for this community. It concludes by proposing several strategies for inclusive policy reform, including inclusive legislative drafting of bills, informal and formal rule making, increased research, mandatory cultural competency trainings for health care staff, and increased community education.

Text:

Lesbian, gay, bisexual, and transgender (LGBT) older adults face numerous obstacles with aging. Isolation, poverty, and discrimination can create barriers that many older adults already face in obtaining affordable housing, health care, and social services. LGBT seniors with HIV must navigate these obstacles while encountering stigma and ignorance about HIV transmission and treatment.
From 2010 to 2012, several important policy efforts raised attention to issues pertaining to HIV and LGBT seniors. In July 2012, U.S. Congresswoman Barbara Lee introduced a bill—Ending the HIV/AIDS Epidemic Act of 2012—to increase federal resources addressing HIV and to expand efforts to end stigma and discrimination against people with HIV (H.R. 6138 2012). Lee had introduced a similar bill in 2011—the Repeal HIV Discrimination Act—to create incentives and support for states to reform their HIV-specific laws that criminalize people with HIV (H.R. 3053 2011). Additional policy reforms to bring greater funding and resources for HIV prevention, treatment, and research in the United States have further buttressed Lee’s HIV-related bills.

The Patient Protection and Affordable Care Act, which will become fully effective in 2014, brings additional policy reform for persons with HIV, including antidiscrimination provisions, prohibitions on higher insurance rates based on preexisting conditions (Carroll 2012), and prohibitions on insurers from placing dollar limits on one’s benefits (Hyman 2012).
In July 2012, the Institute on Aging issued guidance to service providers to consider sexual orientation and gender identity when assessing which populations have the greatest social need for services and funding. This guidance followed the announcement in 2010 by U.S. Department of Health and Human Services Secretary Kathleen Sebelius to award $900,000 to establish the National Resource Center on LGBT Aging through 2013. In August 2012, the Centers for Medicare & Medicaid Services (CMS) announced plans to review federal nursing home regulations to improve quality and safety standards for residents. In September 2012, U.S. Senator Michael Bennet also introduced a bill—the LGBT Elder Americans Act of 2012—to amend the Older Americans Act of 1965 to recognize the unique needs of LGBT older adults. This bill would have provided national, state, and local organizations with information and technical assistance to effectively serve LGBT seniors and would have increased funding for research about and services to LGBT elders by explicitly defining LGBT older adults as a population of greatest social need. While the bill died in committee, it is expected to be reintroduced in the 113th Congress.
These important legislative and administrative efforts represent significant political changes, moving issues for people with HIV and LGBT older adults in a positive direction. However, any such efforts addressing HIV and/or LGBT older adults must be mindful of how these two areas intersect and affect marginalized communities.

 

HIV and Aging: A Demographic Story for LGBT Persons

Few population studies collect data regarding sexual orientation and/or gender identity. However, current data estimates that LGB people aged sixty-five and older number 1.5 million and will double to three million by 2030 (SAGE and MAP 2010, 2). Another publication estimates that the population of LGBT elders in the United States will balloon to a range between two million and seven million people by 2030 (Grant 2010, 26).
Based on current HIV transmission information, by 2015, approximately 50 percent of all Americans living with HIV will be aged fifty and older (Fredriksen-Goldsen et al. 2011, 41). Many newly diagnosed people aged fifty and older are “late testers,” meaning they likely had HIV for years before their diagnosis (National Institute on Aging n.d.). One national study by the Gay Men’s Health Crisis (2010, 5) found that adults over the age of fifty at risk for HIV were 80 percent less likely to be tested for HIV than at-risk adults twenty to thirty years of age, which may provide some explanation for the late testing. Because of advances in HIV-related medication and treatment, people with HIV and AIDS are living longer, too. Now the number of individuals living with AIDS who are older than fifty is double the number of individuals with AIDS under age twenty-four (SAGE and MAP 2010, 31). These statistics highlight the large number of older adults living with HIV. Because of the immense stigma still attached to HIV, however, many people remain unaware of the startling numbers of older adults living with HIV.
Since LGBT communities of color and transgender women face even higher rates of HIV transmission than the general population, older transgender adults and LGBT people of color are more likely to have HIV than their white cisgender peers. For example, older African-Americans are twelve times as likely and Latinos are five times as likely as their white peers to have HIV (Gay Men’s Health Crisis 2010, 3). While 35 percent of transgender women respondents to a San Francisco study had HIV, 65 percent of those who were also African-American had HIV (Gay Men’s Health Crisis 2010, 6). Ronald Johnson, an African-American gay man with HIV, noted in an interview for the Graying of AIDS that “the racial disparities in health care . . . make the ability to take advantage of the medications an issue of race” and added that societal disparities “continue to play out in the AIDS epidemic” (Heinemann and Schlegloff n.d., 19). Yet, many policies ignore this reality. Racism, sexism, homophobia, and transphobia in the medical and legal community combine with ageism to create a dangerous reality for many elder LGBT persons of color and transgender women living with HIV.
While HIV impacts individuals’ health, it also leaves many people in a state of poverty. A 2011 study of LGBT older adults in Chicago, Illinois, reported that LGBT older adults with HIV were more likely to access Medicaid and food stamps (49 percent and 41 percent, respectively) compared to LGBT older adults without HIV (16 percent and 18 percent) (Brennan-Ing et al. 2011, 8). A similar study from 2010 found that LGBT older adult respondents with household incomes at or below two hundred percent of the federal poverty level reported higher rates of HIV than those above two hundred percent of the poverty level (Fredriksen-Goldsen et al. 2011, 44). These statistics highlight how LGBT older adults with HIV are more likely to require financial assistance for health care and basic necessities.
A majority of older LGBT also adults live alone (Brennan-Ing et al. 2011, 18). LGBT older adults have higher rates of social isolation and feel more unwelcome in health care and community settings than do the wider population (SAGE and MAP 2010, iii). A majority of LGBT older adults with HIV who responded to a 2011 survey reported being single, and they also reported relationships that were significantly shorter than those of respondents without HIV (Brennan-Ing et al. 2011, 17).

These relationship differences become even more significant as LGBT persons age. Biological families provide approximately 80 percent of long-term care in the United States, and more than two-thirds of adults who receive long-term care at home depend on biological family members as their only source of assistance (SAGE and MAP 2010, ii). However, nearly two-thirds of LGBT older adult respondents to a 2010 survey reported that they consider their friends “chosen family” (MetLife 2010, 3). LGBT elders are four times as likely to depend on a friend as a caregiver (MetLife 2010, 3). Depending on friends for caregiving support creates problems as friends age and also require caregiving assistance (Brennan-Ing et al. 2011, 11). LGBT older adults, however, who are more likely to be single, live alone, and rely on single-generation friends or “families of choice” for caregiving will be more likely to require institutional long-term care (SAGE and MAP 2010, ii).

Research also shows a correlation between social isolation and higher depression, poverty, rehospitalization, delayed care-seeking, poor nutrition, and premature mortality (SAGE and MAP 2010, iii).
LGBT older adults are also more likely to suffer from chronic health conditions and poor health compared to their heterosexual peers. For example, gay and bisexual male respondents to California Health Interview Surveys from 2003 to 2007 reported higher rates of hypertension, diabetes, psychological distress, and physical disability than their heterosexual peers (Wallace et al. 2011, 3).

Older lesbian and bisexual women also had higher rates of psychological distress symptoms and physical disability than similar aging heterosexual peers (Wallace et al. 2011, 4). A recent study examining the mental and physical health of transgender older adults found that transgender older adults have a significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared to non-transgender participants (Fredriksen-Goldsen et al. 2013, 1). A study by the National Center for Transgender Equality (NCTE) also reported that between 33 and 39 percent of older transgender adults responding to a national survey had attempted suicide (Grant et al. 2011, 82). A SAGE (Services and Advocacy for GLBT Elders) and NCTE study reported the figure much higher—at 71 percent (SAGE and NCTE 2012, 18). The same report also found that older transgender adults were twice as likely to have experienced physical or verbal domestic violence than LGB peers (SAGE and NCTE 2012, 9). Transgender persons, especially older adults, are also less likely to seek medical intervention or assistance from caregivers (Knauer 2009, 15). For example, when famous jazz musician and transman Billy Tipton died from a bleeding ulcer in 1989, reports surfaced that he had not seen a doctor in fifty years, presumably because an examination would have revealed his trans status (Knauer 2009, 15).
LGBT older adults with HIV have unique health care needs that account for multiple chronic illnesses—such as cardiac disease, diabetes, and arthritis—in addition to HIV. Older LGBT adults with HIV are also more likely to suffer from depression; one study reports that they suffer twice the rate of depression as their peers (Brennan-Ing et al. 2011, 24). According to the Centers for Disease Control and Prevention (2010), men who have sex with men have a higher risk of HIV, especially in communities of color. Another study found that over 25 percent of transgender women tested positive for HIV/AIDS, with even higher rates among African-American transgender women (Grant 2010, 74). Because doctors are less likely to assume older adults are at risk of HIV, they are less likely to test them for the virus, and thus HIV is often detected later in older adults (Grant 2010, 74). Research suggests that LGBT older adults with HIV, particularly individuals without intergenerational informal caregiving, will encounter numerous obstacles navigating health care as they age (Brennan-Ing et al. 2011, 11).
Years of discrimination, criminalization, and immense stigma compound these health problems by dissuading many LGBT older adults from disclosing their sexual orientation and/or gender identity beyond a very tight circle of friends, if at all. Many LGBT elders grew up during the Lavender Scare in the 1950s (Redman 2012, 444), an era in which same-sex attraction could result in involuntary commitment to a mental hospital with electroshock therapy and perhaps even a lobotomy, employment termination, loss of parental rights, police harassment, and possible jail time (Knauer 2012, 290). Fear of inadequate health care in long-term facilities further prompts many LGBT elders who were “out” to return to the closet upon entering a facility (Persinger 2010, 141).
Stigma about sexual orientation and gender identity often adds to stigma against HIV to create immense barriers for LGBT older adults with HIV. For example, reports of health aides in long-term care facilities wearing gloves when opening doors or when making the beds of LGBT elders without HIV, due to an erroneous fear of contracting HIV, highlight the reality experienced by many LGBT older adults with HIV or those perceived to have HIV (Hovey 2009, 110). Approximately 20 percent of people with HIV who responded to the AIDS Community Research Initiative reported that HIV stigma made them feel that “staff didn’t like people like them” (Brennan-Ing et al. 2011, 8). Such fears are not unfounded. For example, when a long-term care facility in Little Rock, Arkansas, learned that Dr. Robert Franke, a seventy-five-year-old retired university provost and minister, had HIV, the facility promptly evicted him (Franke v. Parkstone Living Center 2009). According to court documents, nursing staff threatened that the facility would turn him over to Adult Protective Services if he had not moved out of the nursing home “by the end of the day” (Franke v. Parkstone Living Center 2009). Older LGBT participants with HIV who responded to the Aging and Health Report confirmed that Dr. Franke’s experience was not unique, reporting higher rates of denial of health care access or inferior care (Fredriksen-Goldsen et al. 2011, 43).
Many persons with HIV internalize stigma through feelings of shame, guilt, anger, fear, and self-loathing (Gay Men’s Health Crisis 2010, 23). In a University of Washington study of older adults living with HIV, 96 percent of respondents reported an experience with HIV stigma, and 71 percent reported stigma based on both age and HIV status (Gay Men’s Health Crisis 2010, 23). Stigma prevents many LGBT older adults with HIV from communicating their diagnosis to others. One study reported that more than half of the people between fifty and sixty-five years of age with HIV practiced “protective silence,” or refused to tell other people about their HIV diagnosis to protect themselves against HIV-related stigma (Heinemann and Schlegloff n.d., 22). A 2006 study of older adults with HIV found that many participants failed to disclose their HIV status to all of their sexual partners, including 16 percent who failed to disclose their status to any of their sexual partners (Karpiak et al. 2006, 29). The immense stigma attached to HIV, especially among LGBT older adults, prompts many individuals to fear negative repercussions and further social isolation from disclosure.

Strategies for Inclusive Policy Reform for LGBT Older Adults with HIV

Several efforts could help ensure that LGBT seniors, including elders of color and transgender older adults, are included in policy reform. First, lawmakers must recognize the importance of intersecting identities when developing policies regarding LGBT elders  and people living with HIV. Laws must not only reflect the needs of our diverse communities but also be responsive in providing funding and support for communities that are often left invisible from policy reform—especially communities of color and transgender older adults.

Second, administrative agencies can issue guidance and engage in formal rule-making procedures to provide inclusive protections for LGBT older adults, including LGBT older adults with HIV. Third, increased research can focus on the intersecting needs of LGBT older adults with HIV. Fourth, policy reforms can include efforts to mandate inclusive cultural competency training for health care staff—and provide important funding to implement these requirements. Finally, increased community education within the LGBT community and the general population about the needs of LGBT older adults, including the needs of LGBT older adults with HIV, will help increase awareness and a deeper understanding as to why inclusive policy reform is necessary.

Legislative Reform

Legislators and policy makers must consider intersecting identities when drafting and revising current legislation. For example, while Congresswoman Lee’s HIV-related legislation provides important support for people with HIV and represents one of the first attempts to eradicate criminal laws that penalize people based on their HIV-status, neither bill addressed how HIV affects older adults. For example, Ending the HIV/AIDS Epidemic Act of 2012 notes that HIV rates increase among young people between the ages of thirteen and twenty-nine, especially young men of color who have sex with men, but fails to acknowledge HIV transmission rates for older people, let alone older LGBT people (H.R. 6138 2012). With increasing technologies allowing persons with HIV to live longer and newer cases of HIV diagnoses among older adults, policy reform addressing HIV should include provisions addressing HIV among older adults, including LGBT elders.
Senator Bennet’s LGBT Elder Americans Act of 2012 provided another possibility for policy reform for LGBT older adults. The bill would have codified guidance by the Administration on Aging (AoA) issued in July 2012 to consider LGBT older adults as a population of “greatest social need.” This step would have created new funding sources for services to LGBT seniors. The bill would also have provided for data collection regarding discrimination against LGBT older adults and increased resources for LGBT elders, caregivers, families, and service providers through the permanent creation of the National Resource Center on LGBT Aging (S. 3575 2012).
However, similar to Lee’s HIV-related legislation, Bennet’s LGBT Elder Americans Act of 2012 failed to include any reference to HIV and how LGBT older adults with HIV have specific unmet needs. Senator Bennet, and possibly other lawmakers, will likely reintroduce the LGBT Elder Americans Act in the 113th Congress; if they do, the bill would benefit not only from mentioning how HIV affects LGBT older adults but also from including some kind of educational and programmatic revisions that address HIV-related stigma that older adults, particularly LGBT older adults, experience. The language included in the LGBT Elder Americans Act of 2012 may have been sufficiently broad to include such revisions; however, a more specific amendment would better achieve this goal and help provide even stronger justification as to why LGBT older adults are indeed a population of greatest social and economic need.
Because many LGBT older adults with HIV represent racial and ethnic minorities, implementation of the recent policies must provide both visibility and resources to the diverse communities of LGBT older adults living with HIV. Thus, some portion of funding stemming from bills like Lee’s HIV-related legislation or Bennet’s LGBT Elder Americans Act, or some similar legislation in the future, should address the needs of LGBT elders of color living with HIV. Given the extraordinarily high rates of HIV among older transgender women of color, such a focused priority is critical. Similarly, as portions of the Affordable Care Act become effective through 2014, policy makers, service providers, and advocates must remain mindful of how this complex set of health care reforms provides new services to many LGBT older adults, particularly from marginalized communities of intersecting identities.

Administrative Reform

While inclusive legislative reform represents an important strategy to ensure better protection for LGBT older adults with HIV, other avenues can lead to policy reform—including change through executive departments and administrative agencies. For example, the AoA (or another appropriate entity) could issue guidance or engage in formal rule making to codify language in the Code of Federal Regulations recognizing that LGBT older adults, including those from racial and ethnic minority communities and/or transgender communities and those living with HIV, comprise a population of “greatest social need.”
The CMS similarly could engage in formal rule making (or encourage guidance) after any review of the federal nursing home regulations to expressly acknowledge that LGBT older adults enjoy the same resident rights outlined through the 1987 Federal Nursing Home Reform Act (Centers for Medicare & Medicaid Services 1987). Additionally, CMS could propose an antidiscrimination provision that includes both sexual orientation and gender identity and requires nursing aides to participate in cultural competency trainings.
Moreover, CMS could strengthen the current regulations by providing an inclusive definition of “family” throughout the regulations. While other administrative regulations have broadened the definition of family in hospital contexts (and thus could potentially be applied in other contexts including nursing homes), current nursing home regulations do not include an inclusive definition of family and may leave many LGBT older adults without anyone legally allowed to provide support and guidance to the nursing home on their behalf. Because LGBT older adults, particularly transgender residents, persons of color, and persons living with HIV, often bear the brunt of multiple forms of prejudices, regulations that expressly recognize the applicability of these rights to LGBT persons should acknowledge the diversity of residents that may identify as LGBT. Such recognition will not only create more visibility for communities with intersecting identities, it will increase awareness that will hopefully lead to better and more culturally competent research and care.

Research

More research on the needs of LGBT seniors, including the complex social, health, housing, and social service needs of LGBT seniors of color, would tremendously buttress any legislative and administrative endeavors addressing LGBT older adults by providing empirical data. Very little research currently exists on LGBT seniors. In fact, a 2011 report by the Institute of Medicine concluded that “researchers still have a great deal to learn” (Institute of Medicine 2011, 1). The report found that researchers have failed to adequately address the needs of LGBT elders, bisexuals, transgender persons, and racial and ethnic minorities in the LGBT community (Institute of Medicine 2011, 1).
In late March 2013, a group of researchers released a study in the Gerontologist that represented one of the first studies to address transgender older adults’ physical and mental health, but noted in the study’s conclusion the need for longitudinal studies “to better understand the health trajectories of transgender older adults over time” (Fredriksen-Goldsen et al. 2013, 12).

A handful of studies and surveys are currently underway regarding LGBT seniors, including a study of LGBT seniors in San Francisco by the LGBT Senior Task Force and a national study on the health of LGBT older adults by researchers from the University of Washington (Espinoza 2011, 2). Still, more local, state, and national studies exploring the needs of all LGBT seniors would strengthen any LGBT-inclusive policy efforts by providing the necessary data to justify increased funding and resources for this intersectional population of greatest social need.

Cultural Competency Trainings

Increased cultural competency of nursing facility staff could dramatically decrease the instances of harassment, discrimination, and maltreatment by residents based on their intersecting identities. Seth Kilbourne, executive director of Openhouse, noted in an interview that “mainstream service providers often say they do not serve any LGBT elders and therefore have no problems related to cultural competency around LGBT issues” (SAGE and MAP 2010, 34).

However, because many LGBT older adults fear disclosure of their sexual orientation and/or gender identity, staff are often unaware of their LGBT residents’ needs and are unprepared to address harassment as it arises. A national 2010 survey further confirms that few service providers for older adults are prepared (or even recognize the needs) of LGBT seniors. Fewer than 8 percent of three hundred and twenty area agencies and state units on aging surveyed offered services targeted to LGBT older adults and a mere 12 percent even conducted outreach to this population (Knochel et al. 2010).

Staff lacking the training or sensitivity to respond to harassment may increase social isolation by improperly targeting or separating an LGBT resident who is the victim of harassment. For example, in response to frequent harassment by other residents and their family members, staff moved an openly gay man to a floor for patients with severe disabilities and/or dementia, and he subsequently hanged himself (SAGE and MAP 2010, 36).
Mandatory cultural competency trainings could ensure that staff have the proper tools to respond to harassment. In 2008, California passed a bill mandating LGBT cultural competency training for licensed health professionals who have constant interaction with seniors in nursing homes and senior care facilities (Equality California 2008). A lack of funding and oversight has resulted in somewhat of a hollow victory for this bill, as many service providers are unaware of this mandate or unwilling to spend the time and resources to train their staff (Meyer 2012, 516).

As a result, California Senator Christine Kehoe introduced a broader bill in 2011 that would have mandated regulatory boards that license or certify health care professionals to require continuing education on LGBT cultural competency in health care (Equality California 2011). While the governor subsequently vetoed the bill after it passed the Senate (Bill Analysis 2011), both bills represent policy efforts and increased dialogue to include cultural competency trainings for health care providers.
Any policy efforts to increase cultural competency among health care staff should include language recognizing that LGBT older adults straddle many communities, and thus any cultural competency training program should address how to respond to the needs of all LGBT seniors, including older LGBT adults with HIV. Similarly, any cultural competency trainings must recognize the complex ways in which intersecting identities interact to create multiple forms of oppression. An elderly African-American transsexual with HIV may experience discrimination because of age, race, gender identity, and HIV status. Health care providers must be prepared to acknowledge the needs of all LGBT seniors.

Community Education

Inclusive legislative policy, administrative reform, research, and cultural competency trainings would undoubtedly help improve support, services, and protections for LGBT older adults with HIV. Still, another important piece for ensuring inclusive policy for LGBT older adults with HIV is to encourage and engage in inclusive community education. Community advocacy provides not only the kindling but often the spark that ignites policy reform. Organizations like SAGE and FORGE Transgender Aging Network are engaging in important policy and community education to improve the lives of LGBT older adults. Community education is important for changing the hearts and minds of the LGBT community and the larger general population. By increasing awareness about the “demographic story” for many LGBT older adults, especially LGBT older adults with HIV, advocates will be better armed with the knowledge to persuade policy makers to implement inclusive policies about LGBT older adults with HIV.

Conclusion

 

LGBT older adults and people living with HIV face immense stigma, discrimination, and lack of resources.     New policies, regulations, and guidance signal the dawn of a new era of dialogue, action, and recognition of the needs of LGBT older adults and people living with HIV, including resources and policies addressing stigma and discrimination based on sexual orientation, gender identity, age, and HIV status. To be truly effective, any policy reform must acknowledge how HIV-related policies and policies regarding LGBT older adults intersect and address specific needs for LGBT older adults with HIV, a growing population in the United States. Effective policy reform must also recognize and address how marginalized communities, including people of color and transgender women, are uniquely affected by policies regarding LGBT aging and HIV. Very little research exists regarding LGBT older adults, and even less research exists regarding the intersecting identities of LGBT older adults with HIV. While much work lies ahead on the road to full and equal recognition for LGBT older adults with HIV, recent policy efforts suggest significant change in the ways in which mainstream society, policy makers, and even the LGBT community views the needs. Such change must be accompanied by inclusive policy reform addressing the diverse needs of this community to yield the best results for equal access and justice for all LGBT older adults living with HIV.
References

Bill Analysis. 2011. SB 747

Brennan-Ing, Mark, Stephen E. Karpiak, and Liz Seidel. 2011. Health and psychosocial needs of LGBT older adults. Washington DC: AIDS Community Research Initiative of America. 19 September.

Carroll, Marisa. 2012. What the Affordable Care Act means for transgender people. Nation, 14 August.

Centers for Disease Control and Prevention (CDC). 2010. HIV and AIDS among gay and bisexual men. CDC Fact Sheet, June.

Centers for Medicare & Medicaid Services, Department of Health and Human Services, Code of Federal Regulations. Title 42, Resident Rights. 1987.

Equality California. 2008. Governor signs senior care bill. Press release, 29 September.

———. 2011. State assembly passes bill requiring LGBT cultural competency training for healthcare providers. Press release, 1 September.

Espinoza, Robert. 2011. A timetable round up of recent LGBT research. Aging Today, July-August.

Franke v. Parkstone Living Center, Inc. 2009. Complaint. No. 4:09-cv-00341-GTE, 12 May (E.D. Ark.).

Fredriksen-Goldsen et al. 2011. The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults.

——— et al. 2013. Physical and mental health of transgender older adults: An at-risk and underserved population. Gerontologist, 27 March.

Gay Men’s Health Crisis. 2010. Growing older with the epidemic: HIV and aging.

Grant, Jaime M. 2010. Outing age: Public policy issues affecting lesbian, gay, bisexual and transgender elders. Washington DC: National Gay and Lesbian Task Force.

——— et al. 2011. Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force.

Heinemann, Katja, and Naomi Schegloff. n.d. The graying of AIDS: Stories from an aging epidemic. The Graying of AIDS.

Hovey, Jaime E. 2009. Nursing wounds: Why LGBT elders need protection from discrimination and abuse based on sexual orientation and gender identity. Elder Law Journal 17: 95-123.

H.R. 3053, 112th Congress. 2011.

H.R. 6138, 112th Congress. 2012.

Institute of Medicine of the National Academies. 2011. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding.

Hyman, Wilton B. 2012. An explanation of the patient protection and affordable care act. Ohio Northern University Law Review 38: 579-638.

Karpiak, Stephen E., R. Andrew Shippy, and Marjorie Cantor. 2006. Research on older adults with HIV (ROAH). New York: AIDS Community Research Initiative of America.

Knauer, Nancy J. 2009. LGBT elder law: Toward equity in aging. Harvard Journal of Law & Gender 32: 1.

———. 2012. “Gen Silent”: Advocating for LGBT elders. Elder Law Journal 19(2): 289.

Knochel, Kelly Abel et al. 2010. Ready to serve? The aging network and LGB and T older adults.

MetLife. 2010. Still out, still aging: The MetLife study of lesbian, gay, bisexual, and transgender baby boomers. New York: MetLife Mature Market Institute.

Meyer, Hilary. 2012. Federal policy, activism, and LGBT older adults. Temple Political & Civil Rights Law Review 21: 511.

National Consumer Voice for Quality Long-Term Care. 2012. Advocates advancing quality for consumers: CMS focuses on improving resident quality and safety in nursing home regulations. 2 August.

National Institute on Aging. n.d. HIV, AIDS, and older people. National Institutes of Health. U.S. Department of Health and Human Services.

Persinger, Annick. 2010. Still pioneers: Special social and economic hardships for elderly gays and lesbians. Hastings Women’s Law Journal 21(1): 137, Winter.

Redman, Daniel. 2012. They stood up for us: Advocating for LGBT elders in long-term care. Temple Political & Civil Rights Law Review 21: 443.

S. 3575. 112th Congress. 2012.

SAGE (Services and Advocacy for GLBT Elders) and MAP (Movement Advancement Project). 2010. Improving the lives of LGBT older adults.

——— and National Center for Transgender Equality (NCTE). 2012. Improving the lives of transgender older adults.

Wallace, Steven P. et al. 2011. The health of aging lesbian, gay and bisexual adults in California. UCLA Center for Health Policy Research, March.

Pull quotes:
Racism, sexism, homophobia, and transphobia in the medical and legal community combine with ageism to create a dangerous reality for many elder LGBT persons of color and transgender women living with HIV.
Fear of inadequate health care in long-term facilities further prompts many LGBT elders who were “out” to return to the closet upon entering a facility.
Endnotes

In the rest of this journal, the acronym LGBTQ is used to incorporate a broad range of the sexuality spectrum, but this article uses the phrase “LGBT older adults” because this is the term used by practitioners who serve this population. The acronym “LGBT” refers to lesbian, gay, bisexual, and transgender individuals. However, it is important to note that some older adults do not identify with this label and instead prefer labels like “men who love men” and “women who love women,” among others.
Unless otherwise specified, this article uses the words “older,” “elder,” and “senior” interchangeably to represent a population of people fifty years or older. While the age groups represented in this category have varying needs, research has been extremely limited on LGBT older adults and older adults with HIV and has focused mostly on people fifty years or older.
Cisgender describes individuals whose gender identity matches the gender assigned at birth.

HIV and Aging for LGBT Older Adults:
What Policy Makers Should Know:
By 2013, the population of LGBT older adults will reach between two million and seven million people.
By 2015, approximately 50 percent of all Americans living with HIV will be aged fifty and older.
LGBT older adults with HIV are more likely to live alone and rely on nonbiological “families of choice” for caregiving.
LGBT older adults with HIV are more likely to suffer from depression.
Of LGBT older adult respondents to a University of Washington survey, 71 percent reported stigma based on both age and HIV status.

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