Age is just a number

The AIDS pandemic, now over four decades long, presents complex challenges to our understanding of the process of ageing. The disease itself surely existed before its accepted inception in 1981, and it will continue to plague populations well beyond another 40 years. AIDS has a recorded worldwide death toll of approximately 32 million and currently ranks as one of the longest-lasting plagues, after smallpox (1877–1977; Public Health Online, 2021). Metaphorically, as well, the pandemic has ‘grown up’ through our understanding of its biological intricacy and our ability to limit its lethal capacity through a series of antiretroviral treatments (ARTs) that have turned what in the 1980s brought an early frost to young men who contracted it into a chronic condition that keeps opportunistic infections at bay through protease, integrase and transcriptase inhibitors (Weiss, 2003).

‘You are in the middle of your life and you may be at the end of your life at the same time’, the Jungian Robert Bosnak remarked to his AIDS patient in his account of their therapeutic journey (1989, p 47). In many ways, the ageing of the pandemic captures the sense of this paradox, but what a pharmacological success story overlooks or, more pessimistically instantiates, is the nature of the life that has emerged for HIV long-term survivors (HIVLTS). Without a cure or vaccine, but with a daily drug regimen and its side effects, 21st-century AIDS has created a generation of HIV survivors who, I argue, suffer from early-onset ageing – physically, socially, even psychologically. Certainly, the switch from death sentence to one-pill-a-day undetectability (Olson and Goldstein, 2020) has for certain HIV populations meant a kind of resurrection, but the trauma of diagnosis and the temporary staving off of conditions like herpes, hepatitis and tuberculosis has taken its toll on the best of souls, many of whom must cope with continuing chronic medical conditions. Cardiovascular, osteopathic, neurocognitive, metabolic – such are the kinds of physical comorbidities that face the long-term survivor, whether she is 28 or 68. Immunosenescence in HIVLTS has become a field of medical research (Meir-Shafrir and Pollack, 2012; Tsoukas, 2014).