By Drew Filipski, thebuckeyeflame.com

Neighborhood Family Practice steps up for LGBTQ+ elders.

Aging as an LGBTQ+ person comes with challenges, and living with HIV adds another layer of difficulty.

Discrimination, isolation and roadblocks to accessing care can turn everyday life into an uphill battle. On National HIV/AIDS and Aging Awareness Day (September 18) – and every day – Cleveland’s Neighborhood Family Practice (NFP) wants the community to know there’s a place where they can get the care they deserve—without judgment.

‘There’s still stigma’

“LGBTQ+ elders are twice as likely to live alone and four times less likely to have children compared to their heterosexual peers,” says Brittani Flory, HIV prevention nurse at NFP. “The lack of traditional support networks often leads to isolation, making it harder to access care.” LGBTQ+ older adults are also much less likely to use services like senior centers or meal programs because they fear discrimination, according to a report by SAGE, a national organization addressing issues related to LGBTQ+ aging.

Yet they need those services.  Nearly one-third of LGBTQ+ elders live at or below the federal poverty line, often without the financial safety net of Social Security or a pension. “Many have faced discrimination their whole lives, including with healthcare, so they’re understandably hesitant,” Flory adds.

Affirming care from the start

NFP focuses on creating a welcoming and affirming space. “One of the biggest barriers is the fear of discrimination,” Flory says. “A lot of older LGBTQ+ folks have experienced healthcare discrimination before, so they’re understandably hesitant to trust new providers.” “From the moment someone steps into our practice, they should feel safe and respected,” says Rae Onders, HIV prevention coordinator. “We make sure everyone on our staff is trained to create an inclusive environment—whether it’s using correct pronouns or just recognizing that not all families look the same.”

Comprehensive HIV care through the Ryan White Program

For older LGBTQ+ adults living with HIV, the Ryan White HIV/AIDS Program is a lifeline. “Ryan White is an absolute game-changer,” says Onders. “It covers everything from HIV medication and mental health support to transportation and case management. For older patients, especially those who have mobility issues or live on a fixed income, it’s essential.”

As more people live longer with HIV, the need for tailored care becomes critical. “HIV is a chronic condition now, not a death sentence,” says Dr. Lisa Navracruz, an HIV specialist at NFP. “But people living with HIV often deal with aging-related issues earlier, so integrating HIV care with their overall health is really important.”

At NFP, HIV care is fully integrated into primary care services. This means patients don’t just see their doctor for HIV—they can get treatment for everything from diabetes to hypertension. “We’re treating the whole person, not just managing HIV,” says Navracruz. “It’s all about keeping people healthy as they age.”

Preventing late-stage HIV diagnoses

iLate-stage HIV diagnoses are still a problem for older adults. Many don’t think they’re at risk, which delays testing. In fact, 17% of new HIV diagnoses in 2018 were among people ages 50 and older​, according to a report by SAGE.

“We routinely offer HIV screening to all patients, regardless of age,” Flory explains. “We normalize conversations about sexual health, so our older patients feel comfortable talking about it. Once we open that door, it makes all the difference.”

NFP also offers PrEP and other preventive tools to help older adults take control of their health. Education about preventive tools like PrEP and barrier methods, such as condoms, is important to include in the patient conversation. “For some older adults, PrEP or condoms may be unfamiliar or carry stigma, so we take the time to explain their benefits and make sure they feel comfortable,” Flory adds.

Mental health: tackling isolation and cognitive decline

Long-term survivors of HIV often face more than just medical challenges. Mental health issues such  as depression and cognitive decline are common “Social isolation is a big problem for older LGBTQ+ folks,” says Onders. “When you’re already isolated, it’s easy to feel forgotten” and lose hope.

According to a SAGE report, 59% of LGBTQ+ older adults report feeling isolated. Research shows that social isolation can have the same negative impact on health as smoking 15 cigarettes a day​. NFP provides a dedicated Ryan White therapist for HIV-positive patients, working closely with the HIV care team. “We have social workers, case managers, and therapists all working together,” says Onders. “It’s about treating the whole person—physical and mental health go hand in hand.”

Reaching LGBTQ+ elders directly

NFP knows that sometimes, healthcare has to meet people where they are. “We do a lot of outreach,” says Onders. “Every month, we offer testing at the LGBT Center in Cleveland, expanding their hours to offer these services on Saturdays. We also conduct outreach directly with seniors at events like we did at the Annual Health Fair at the Barton Senior Center on Sept 12.”

The goal? To make sure LGBTQ+ elders know that care is available—and that it’s for them. “So many older adults feel invisible in the healthcare system,” says Flory. “We’re working hard to change that.”

Looking ahead: evolving care for LGBTQ+ elders

As the population of older adults living with HIV grows, NFP is committed to evolving its care model to meet their needs. “Our family medicine approach allows us to care for patients throughout their entire lifespan,” says Dr. Navracruz. “From managing HIV to addressing age-related health issues, we’re here to help at every stage.”

For LGBTQ+ elders, feeling seen and supported is crucial. “Whether it’s using the right pronouns or understanding the unique challenges LGBTQ+ elders face, our goal is to create a space where everyone feels safe.”

On National HIV/AIDS and Aging Awareness Day, NFP is sending a clear message: Cleveland’s LGBTQ+ elders deserve care, support and respect.

IGNITE ACTION

• Read all about the NFP’s HIV & Prevention Care/Services by visiting their site here. On the site, you can schedule an appointment for a health screening and learn more about services including testing and PrEP.