Gender & Sexuality

Thriving Not Just Surviving: A Promising New Care Model for Patients Aging with HIV

January 23, 2025

By Sandra Larson

HIVE Clinic WP Hero Image

HIV-Endurance (HIVE) Clinic

HIV-Endurance (HIVE) Clinic received the “Flame of HIV/AIDS Activism” award during the Getting to Zero Reception, hosted by Getting to Zero Massachusetts, an initiative of Fenway Health.

BMC's award-winning HIV-Endurance (HIVE) Clinic integrates multiple specialties to meet the unique needs of older HIV patients.

In the early days of the AIDS epidemic patients diagnosed with HIV, or human immunodeficiency virus, which was identified by virologists in 1983, could expect to survive only one or two years because there were no effective HIV treatment options in the 1980s. Over the past few decades, however, remarkable progress in the development of antiretroviral drug therapies has transformed HIV from a death sentence into a manageable chronic condition.  

Today, people with HIV who receive early and consistent antiretroviral therapy can live long and healthy lives. Nationally, more than half of the 1.1 million people living with diagnosed HIV in 2022 were 50 or older, according to the Centers for Disease Control and Prevention, whose recent report had a new age category for 75 and older.  

In 2022, the U.S. Health Resources & Services Administration (HRSA) selected Boston Medical Center (BMC) as one of the 10 sites nationwide selected to receive a three-year grant to develop strategies to improve care for people aging with HIV. With the funding, in 2023, BMC launched the HIV-Endurance (HIVE) Clinic.  Archana Asundi, MD, an infectious diseases physician-scientist who specializes in HIV, is the Principal Investigator of the grant and Director of the HIVE clinic.  Commonly, HIV care is provided under the umbrella of infectious disease care. Where the HIVE Clinic stands out is that it provides aging HIV patients with specialized, interdisciplinary care from Geriatrics, Infectious Diseases, and Specialty Pharmacy in one hub, or “hive.” This multi-specialty partnership between reflects BMC’s ongoing effort to transform HIV care for a growing population in need. 

A population with unique needs 

Asundi says her team cares for some 1,840 people living with HIV, and 59% —around 1,000—are 50 or older. 

Aging HIV patients, like most older people, face a host of age-related health concerns, from chronic conditions to changes in physical and cognitive abilities—but they also experience unique challenges related to their HIV diagnosis, Asundi notes. For reasons ranging from chronic inflammation, toxicity from medications, and health disparities in the population of people living with HIV, she explains, some aging-related conditions may have a more severe effect. 

“People that are aging with HIV face what we call accelerated and accentuated aging,” she says. “Not only do they face comorbidities earlier than the general population, but they also have a higher burden. So we’re seeing this cascading effect, where higher comorbidities lead to increased geriatric syndromes.” 

These comorbidities, she explains, include heart disease and chronic liver, lung, and kidney disease, as well as heightened burden of malignancies like cancers. Geriatric syndromes include polypharmacy (the receipt of five or more medications), higher frailty, and higher fall risk. 

In addition, the LGBTQ+ population is heavily represented among people with HIV, and they often face additional burdens of loneliness and isolation, marginalized identity, and survivor’s guilt after losing friends and significant others, Asundi says. 

How BMC’s HIVE Clinic works

HIVE offers a one-stop shopping opportunity for HIV patients. Referred by their Infectious Diseases or Geriatrics provider, they come in for a multi-part visit during which they are seen by a geriatrician, a geriatric nurse, an infectious diseases pharmacist, a case manager and an infectious disease clinician. The HIVE Clinic team discusses findings and recommendations, and, with the patient’s permission, coordinates next steps with the patient’s care team.  

The clinic has received about 65 referrals and has served about half so far, Asundi says. Patient ages have ranged from 55 to 87. 

One retired patient recently was struggling with multiple medical issues, frailty, and isolation, and they had providers spread across multiple health systems. As a first step, the HIVE Clinic team started a dialogue with her cardiologist at another hospital to better coordinate care.  

The team also referred her to an adult day health program where older individuals can find activities, meals, and social interaction. When she saw the patient later, Asundi says, “She was beyond delighted. She said, ‘I go and I dance, I do Zumba, and they feed me, and I have all these friends there now.’ So we were able to not only address medical needs, but also brought her joy in terms of a needed social piece, too.” 

Jennifer Sergile, RN, the HIVE team’s geriatric nurse, says HIVE has assisted patients with a wide variety of other useful services.  

“We order a lot of assistive equipment for them. Now that they’re older, they may need a walker or a wheelchair or a rollator,” Sergile says. “We set up visiting nurse services, where a nurse can go out to the home and assist them with their medications. We refer for physical therapy and occupational therapy services. We’ve set up Meals on Wheels delivery for patients who didn’t have enough food.” 

She mentions a patient with hearing loss who was unable to hear an auditory phone alarm. The HIVE Clinic equipped her with a MedMinder automated pill dispenser featuring flashing lights to alert her at medication time. 

Positive recognition and feedback 

The HIVE Clinic was honored recently with a 2024 Flame of HIV/AIDS Activism Award from the Massachusetts Getting to Zero Coalition, a statewide consortium working to reduce HIV infections, stigma, and deaths. The December 6 awards event was held at Fenway Health, a longstanding Boston provider of care for HIV/AIDS patients that also works to address the needs of aging patients through a program of its Fenway Institute, the LGBTQIA+ Aging Project. Fenway Health notes the honor is bestowed on “organizations that have demonstrated unwavering commitment and made significant contributions toward ending the HIV epidemic in Massachusetts.” 

Patient feedback has been positive, too, Sergile says. 

“What I hear mostly is that they feel heard, and that everything is so comprehensive,” she says. “It’s hard to describe, but for someone who feels that they’ve never been heard or always been overlooked, to be able to sit down for 90 minutes to divulge everything that’s going on with them—it feels like very intense, in-depth attention. They’re getting services that they often feel they’ve needed for a while, but didn’t know where to turn.” 

Looking ahead 

Asundi’s focus right now is on increasing the HIVE Clinic’s capacity by increasing workflow efficiency and increasing the involvement of medical trainees, such as HIV Pathway residents and fellows in Geriatrics and Infectious Diseases. 

“We’ve had very high demand in our first year and a half, and we only foresee that’s going to snowball. There are patients that are 50 and 60 now, who 10 years from now are going to be 60 and 70, so we anticipate that demand will only continue to grow.” 

The HIVE team has been presenting the clinic model at local, regional and national forums, and Asundi has been working with the Massachusetts Executive Office of Elder Affairs to incorporate people living with HIV into their next iteration of the State Action Plan for Aging.  

In all these efforts, she emphasizes the necessity of including people with lived experience in planning and growing the clinic. 

“I think a lot of the strength of what we do comes from the voices of people with lived experience,” Asundi says. “I hope that this and other similar programs can really engage people who have been living with this for 10, 20, 30 years, to ensure that what we develop really addresses what they consider priorities, whether they be healthcare-related, medical, social, or whatever their care priorities are.” 

As a broad vision, she adds, “My dream is to take the lessons that we’ve learned and make sure that as a city and as a state we’re doing the best job we can supporting the population that’s growing older with HIV.” 

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