This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

An HIV diagnosis is no longer the death sentence it once was, but those who live with HIV still face many challenges. They are at higher risk for cardiovascular disease, diabetes, dementia, osteoporosis, frailty, falls, and some cancers, and are also more prone to depression and addiction. That's why 75 Detroit- and Lansing-area residents have benefited greatly from a pilot program called Food and Friendship Connections, which offers meals, transportation, and community for older adults living with HIV.

Food and Friendship Connections participant Lenderrick Bridges says the program has helped him "tremendously."

"I've gotten to know my people, the same demographic of people, which I really didn't know existed," Bridges says. "It's helped me a lot. I've found a lot of information that I was seeking. And it's more relaxed, not so regimented as other groups I've been in."
Food and Friendship Connections participants create candles during a social outing to Wicksup Candle Co. in Oak Park.
In November 2019, the Detroit Area Agency on Aging (DAAA) and Tri-County Office of Aging (TCOA) joined forces with the Michigan Department of Health and Human Services’ Behavioral and Physical Health and Aging Services Administration and Bureau of HIV and STI Programs to launch Food and Friendship Connections. TCOA worked with those living in the Lansing area while DAAA focused on older adults in the Detroit metro area, a region that is home to one-third of all HIV cases in the state. Detroit's HIV rate is four times higher than the Michigan average – and it's spiking because of the opioid crisis.

"We at DAAA have had a long history of understanding the disparities and inequalities as related to health care services and populations in which we serve. This was an opportunity for us to get services to a population that's been underserved and to address what we see is a growing epidemic here in southeastern Michigan," says Ronald Taylor, DAAA president and CEO. "It fits right into our mission and our purpose of enhancing and improving the lives of individuals, especially older adults."
Ronald Taylor.
Launched in January 2020 with funding from the Michigan Health Endowment Fund, Food and Friendship Connections provided home-delivered meals and liquid nutrition, wellness checks, and transportation to health care appointments, the grocery store, and peer support group meetings and educational workshops, which were also offered virtually. The goal was to create a safety net for older adults who often found themselves isolated, ostracized, and diminished in health as aging and other coexisting chronic illnesses took their toll. Of 600 older adults identified for the project, 75 participated in it. Community partners in the project included Detroit Health Department, MiGen, Affirmations, Corktown Health Center, Matrix Human Services, Detroit Recovery Project, and Detroit Rescue Mission.

Food and Friendship Connections workshops featured DAAA staff who presented on topics like telehealth, diabetes management, and the DAAA Senior Community Services Employment Program. Outside presenters included a spiritual life coach who focuses on clients with HIV and a Detroit Health Department housing specialist. To help participants overcome the digital divide and attend virtual program events, each was given a Chromebook.
Food and Friendship Connections participant Waymond Barks creates a candle during a social outing.
Bridges actively took part in the peer support group and educational workshops, but did not sign up for the home-delivered meals made available by the DAAA’s Meals on Wheels program, an option for Food and Friendship participants.

"I got a lot of ideas from the peers on their eating habits and how I could fit [better eating] into my situation," Bridges says. "I would like to have more fresh or frozen fruits and vegetables, but I've gained ideas on how to better utilize what I do have."

Stigma stymies quality of health, quality of life

While HIV continues to disproportionately impact LGBTQ, Black, and Latinx populations and the main means of transmission remains sexual contact, those participating in antiretroviral therapy (ART) as prescribed can live long, healthy lives and will not transmit HIV through sex. ART also reduces the risk of blood-borne HIV transmission through intravenous drug use. However, stigma is "probably the most enduring issue for people living with HIV," according to Fredrick Thomas, Food and Friendship Connections peer support coordinator. 
Fredrick Thomas.
"Because [HIV] was initially identified as a gay disease, some saw it as God's punishment for deviant behavior. That stigma still kind of lingers," Thomas says. "This stigma causes a kind of PTSD for many folks that then becomes a barrier for people. People fear seeking treatment or disclosing their diagnosis with their families and friends. So they might not get the services and supports that they need."

According to HIV.gov, about 13% of people with HIV in the U.S. do not know they have it. Everyone between the ages of 13 and 64 should be tested at least once. 

"Oftentimes, even those who seek medical attention from doctors don't get tested for HIV because what they are experiencing is parallel with symptoms of other virus-type medical conditions," Thomas says. "Early detection and treatment is so important. The first six months are extremely important when it comes to treatment for HIV."

Having a supportive community of friends is equally important for quality of life. Thomas tells the story of an older woman living with HIV who chose to only attend the virtual Food and Friendship Connections peer support group. Even though she never showed her face during virtual meetings or met her newfound network of friends in person, they brought joy to her life.

"She told me that she just wanted to connect with people. She wanted to talk to people. She wanted to be part of a community. She specifically thanked me for creating that space for her. She found her community, and she was happy," Thomas says. "She recently passed away. Many of the peer support group members actually showed up for her funeral. A couple of them were even pallbearers."

The project is over, but the work has just begun.

While the Food and Friendship Connection program has wrapped up, DAAA is determined to continue providing resources and support for older adults living with HIV. Though formally disbanded, the peer support group continues to share resources with each other and organize quarterly social outings. All Food and Friendship participants who received meals or nutrition have been grandfathered into the DAAA Meals on Wheels program.
Food and Friendship Connections participants Waymond Barks and Stafford Sykes pick out scents for candles during a social outing to Wicksup Candle Co. in Oak Park.
"We're continuing to look at how we can repurpose some existing resources, along with integrating this program into other programs and services ... to meet the needs of the participants," Taylor says. "We have had conversations about what Food and Friendship Connections would look like moving forward. We would definitely like to seek funding opportunities, open the program up to new folks, and get the transportation program back up and running. That's hugely important."

While the number of people living with HIV decreases with age, those who are past 60 and have lived longest with the condition have few supports. They often outlive their pensions or savings, having spent that money years ago when they believed they would never see old age.

"This work is something that should be ongoing, regardless of any new funding," Taylor says. "You know, the longer that we're working in this [HIV] environment, the rest of the community will wrap their arms around the work that we're doing and send us more referrals. Focusing on older adults living with HIV is really important — it's kind of a new phenomenon."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

All photos by Steve Koss except Ronald Taylor photo by Nick Hagen.