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HIV Does Not Care About Age

February 21, 2018

 

  

Human Immunodeficiency Virus, HIV, is by no means a new topic of concern but it is a topic that should remain central to the health of the older adult population. Largely, older adults with HIV or at risk for HIV infection is an under-served and overlooked population although statistics show an increasing number of older adults are living with HIV.

 

 

EPIDEMIOLOGY

 

We must confront the epidemiology of HIV infection among older adults – the distribution of the disease – specifically which older adults are affected; what factors contribute to them being at risk, and what should be done to control the spread of this health problem.

 

It is known that:

  • People 50 years and older account for an estimated 45% of people living with diagnosed HIV.

  • People 50 years and older accounted for 17% of HIV diagnoses in 2015.

  • Among people aged 50 and older, 49% of new HIV diagnoses in 2015 were among gay and bisexual men, 23% were among heterosexual women, 15% were among heterosexual men, and 12% were among persons who inject drugs.

  • Annual HIV infections among gay and bisexual men aged 55 and over increased 18% from 2010 to 2014.

  • Among people aged 50 and older, African Americans accounted for 43% of all new HIV diagnoses in 2015 while Whites accounted for 36%, and Hispanics/Latinos accounted for 17%.

  • From 2010 to 2014, HIV diagnoses among all people aged 50 and over decreased by 10%.   

 

 

COMMON RISK FACTORS

 

Growing older – aging - is not a risk factor for HIV infection. In fact, the risk factors are the same for younger adults.

 

  • Vaginal or anal sex without protection with someone who is HIV positive or with someone whose HIV status is unknown

  • Illegal drug use – sharing needles, syringes, rinse water or other drug equipment

 

While a person’s age is not a risk factor, there are changes in the body of aging adults as well as behaviors that increase their risk. Namely, for older women, the thinning and dryness of the vagina can cause cuts and tears and make them more susceptible to HIV infection during sex without a condom with a partner who is infected. For older men, the use of penile enhancing drugs to counteract declining sexual functions supports their ability to continue sexual activity. In terms of behaviors, older adults who change partners for reasons related to separation, divorce or death and who begin dating again, may not use condoms for protection or may not know of the new partner’s HIV status.

 

 

CHALLENGES

 

Some of the challenges relative to HIV risk factors and older adults are that:

  • older adults do not perceive themselves as being at risk. Largely, they do not believe they are at risk of pregnancy or STI infection and as a result, fail to protect themselves.

  • healthcare providers fail to discuss HIV risk factors, sexual behaviors and substance abuse with their older patients.

  • older adults may not know they are infected with HIV and mistake the symptoms for those of normal aging or other diseases associated with aging  

  • older adults are less likely than younger adults to test for HIV infection.

 

Certainly, these challenges can lead to new cases of HIV infection and even the older adult being diagnosed in the late stages of HIV infection or with AIDS. According to the Centers for Disease Control and Prevention, CDC, in 2014, 40% of people aged 55 and older had late stage infection (AIDS) at the time of HIV diagnosis (i.e., diagnosed late in the course of the infection).

 

 

CALL TO ACTION

 

HIV education and prevention services and opportunities for HIV testing must be a part of the continuum of care that the aging population receives. Agencies and institutions that serve older adults must continually evaluate HIV support services that older adults receive.   

 

Health care providers treating older adults must take charge of the conversation and

  • discuss substance abuse

  • discuss sexual activity

  • discuss ways of reducing their risk of transmission

  • discuss HIV testing

  • discuss symptoms of HIV infection which are sometimes mistaken for age-related conditions.

 

Health care providers are checking the blood pressure, cholesterol level, feet, breast and prostate of older adult patients but are they testing for HIV infection?

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