HIV/AIDS Among Persons Aged 50 years and Older


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HIV/AIDS among Persons aged 50 years and older
United States Population Boom
HIV/AIDS Risk Factors for Persons aged 50 years and older
Age-related Disparities in HIV/AIDS Prevention Barriers for Older Persons
Major Efforts to Address HIV/AIDS among Older Persons
Next Steps

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HIV/AIDS Among Persons Aged 50 years and Older

  1. 1. HIV/AIDS Among Persons Aged 50 Years and Older Karen Whiteman, PhD
  2. 2. Discussion Topics HIV/AIDS among Persons aged 50 years and older United States Population Boom HIV/AIDS Risk Factors for Persons aged 50 years and older Age-related Disparities in HIV/AIDS Prevention Barriers for Older Persons Major Efforts to Address HIV/AIDS among Older Persons Next Steps
  3. 3. HIV/AIDS in the United States On June 5, 1981, the Centers for Disease Control and Prevention reported the first cases of Acquired Immune Deficiency Syndrome (AIDS) in the United States (1981). AIDS, an unfamiliar disease, rapidly became an epidemic, infecting more than 130,000 persons annually (Hall, Song, Rhodes et al., 2008).
  4. 4. HIV/AIDS in the United States Since the first cases of AIDS reported, over 575,000 persons in the United States have died from AIDS (Hall, Song, Rhodes et al., 2008). Most recent estimates have projected that 1.7 million persons in the United States have had the Human Immunodeficiency Virus (HIV) infection (, 2012). An estimated 20% of persons are unaware of HIV infection (CDC, 2011).
  5. 5. Who contracts HIV/AIDS? Any person can contract HIV/AIDS… HIV disproportionately affects: Men who have sex with men (CDC, 2012) Blacks/African-Americans and Hispanics/Latinos (CDC, 2010) Persons residing in the South and Northeast regions of the United States (CDC, 2010) Persons with severe mental illnesses (Prince, Walkup, Akincigil et al., 2012) Homeless populations (CDC, 2008)
  6. 6. HIV/AIDS and Older Adults: Proportion of new HIV Cases Currently, persons over the age of 50 years represent 10.8% -11% incident infections in the general population (Prejean, Song, Hernandez et al., 2011; Brooks, Buchacz, Gebo et al., 2012). Historically, the incident infections rates of HIV among persons aged 50 years and older have remained between 10-11% (Prejean, Song, Hernandez et al., 2011).
  7. 7. HIV/AIDS and Older Adults: Incidence Rates Florida Newly reported HIV cases among persons age 50 and over increased by 6% from 2002 to 2011 (Florida Department of Health Bureau of HIV/AIDS, 2012). In comparison, newly HIV reported cases among persons age 13-39 and age 40-49 each decreased between 2002 and 2012 (Florida Department of Health Bureau of HIV/AIDS, 2012).
  8. 8. HIV/AIDS and Older Adults: AIDS cases Florida Newly reported AIDS cases among persons aged 50 and older increased by 9% from 2002 (19.8% of total) to 2011 (29% of total) (Florida Department of Health Bureau of HIV/AIDS, 2012). In comparison, newly reported AIDS cases among persons age 13-39 and age 40-49 have decreased from 2002 to 2011.
  9. 9. While new cases of HIV infection among persons aged 50 years and older do not comprise the largest proportion of new cases, currently, 31% of persons living with HIV are over the age of 50 (Administration on Aging, 2012a). Persons aged 50 years and older living with HIV infection are often male, African- American, men who have sex with men, and urban residents (Linley, Prejean, An et al., 2012). HIV/AIDS and Older Adults
  10. 10. Older Persons Living with HIV/AIDS More persons are living with HIV/AIDS now because of the 1995 advancement of HIV treatment through Highly Active Antiretroviral Therapy (HAART) (CDC, 1997) HAART has decreased morbidity and mortality of persons with AIDS by 50% (Moore & Chaisson 1999). The success of antiretroviral therapy has resulted in a group of persons aged 50 years and older who have aged with the HIV infection.
  11. 11. HIV/AIDS and Older Adults The percent of persons living with HIV/AIDS older than 50 years, in the year 2015 will be…. a. 20% b. 30% c. 40% d. 50% or more (Vance, McGuinness, Musgrove et al., 2011)
  12. 12. United States Population Boom In the United States, there is an imminent population increase of older persons as a result of the post-World War II “baby boom” that occurred between the years 1946 and 1964 (U.S. Census, 2010). In 2050, the number of persons in all 50 states and the District of Columbia aged 65 and older will reach an estimated 88.5 million, which is more than double the projected population of 40.2 million in 2010 (Vincent & Velkoff, 2010).
  13. 13. United States Population Boom As of 2010, Florida has the highest percentage of older adults (aged 65 and older) (17.3%), followed by West Virginia (16%), Maine (15.9%), and Pennsylvania (15.4%) (U.S. Census, 2001).
  14. 14. HIV/AIDS Risk Factors for Persons aged 50 years and older
  15. 15. Normal Aging
  16. 16. HIV/AIDS Risk Factors Any person, of any age, who is HIV-infected can transmit HIV through their blood, semen, vaginal secretions, and breast milk (CDC, 2010). To transmit HIV, these fluids must come in contact with a mucous membrane or damaged tissue or injected into a person’s bloodstream (CDC, 2010).
  17. 17. HIV is transmitted primarily by the following modes of transmission: 1) not using a condom when having sex with a person who has HIV; 2) having multiple sex partners or other sexually transmitted diseases can increase the risk of HIV infection during sex; 3) sharing needles, syringes, rinse water, or any other paraphernalia used for injection drugs; and 4) being born to a HIV-infected woman. (CDC, 2012) HIV/AIDS Risk Factors
  18. 18. Age-related HIV/AIDS Risk Factors Risky sexual behavior Adults who lived in the 1960s during the era of the sexual revolution, the social movement that challenged traditional behaviors related to sexuality (Allyn, 2000), are now aged 50 years and older. Many older persons remain sexually active into their 80s (Schick, Herbenick, Reece et al., 2010), and similar to younger persons, many older persons also have multiple sex partners (Foster, Clark, Holstad, & Burgess, 2012).
  19. 19. Age-related HIV/AIDS Risk Factors Few older persons use condoms to protect themselves from infection during sexual intercourse. According to the 2008 National Survey of Sexual Health and Behavior, persons aged 50 years or older did not use condoms during their most recent sexual intercourse with 91.5% of casual partners, 76% of friends, 69.6% of new acquaintances, and 33.3% of transactional sexual partners (Schick, Herbenick, Reece et al., 2010). Women who are postmenopausal and who no longer require birth control to prevent pregnancy may not consider the need for condoms (Kirk & Goetz, 2009).
  20. 20. Age-related HIV/AIDS Risk Factors Lack of knowledge of HIV/AIDS transmission Older persons may lack knowledge of HIV transmission and how to protect themselves (Foster, Clark, Holstad, & Burgess, 2012) because the risk factors for persons 50 years and older have changed since the 1980’s outbreak of epidemic. Prior to screening blood supply for HIV/AIDS, blood transfusion was the primary mode of transmission for this age group (Ammann, Cowan, Wara et al., 1983; Curran, Lawrence, Jaffe et al., 1984; Peterman, Jaffe, Feorino et al., 1985).
  21. 21. Age-related HIV/AIDS Risk Factors • Biological risk factors • After a woman experiences menopause, there is age- related vaginal thinning and dryness that can lead to tears in the vaginal tissues that could facilitate HIV transmission (Brooks, Buchacz, Gebo et al.). • For men, as they age, they may experience erectile dysfunction (Bacon, Mittleman, Kawachi et al., 2003), which will increase the difficulty of using condoms during sexual intercourse (Levy, 1998).
  22. 22. Age-related HIV/AIDS Risk Factors  Accessibility of erectile dysfunction medications Despite biological changes, persons over the age of 50 show no decline in sexual interest and activity (Sherman, Harvey, & Noell, 2005; Calvet, 2003). These prescription and non-prescription medications are easily accessible and make it possible for men to remain sexually active at older ages, and therefore, increases the likelihood of HIV transmission if safe sex precautions are not taken (Brooks, Buchacz, Gebo et al., 2012).
  23. 23. Age-related Disparities in HIV/AIDS Prevention Barriers for Older Persons
  24. 24. HIV/AIDS Prevention Barriers Aging stereotypes Many persons believe that older persons are not having sexual intercourse because they no longer have a libido. The main predictor of sexual activity in older age is a person’s pattern of sexual activity in their early life (Kennedy, Martinez, & Garo, 2010).
  25. 25. HIV/AIDS Prevention Barriers The percent of persons aged 50 years and older who do not get HIV testing…. a. 25% b. 50% c. 75% d. 100%
  26. 26. HIV/AIDS Prevention Barriers U.S. Preventive Services Task Force (2012) has recommended universal HIV testing of all persons aged 15 to 65 years. Perceptions among healthcare providers that older persons are less likely to engage in high-risk behavior often prevent them from taking an adequate sexual history, assessing their risk, and offering an HIV test (Paul, Martin, Lu, & Lin, 2007).
  27. 27. HIV/AIDS Prevention Barriers Underdiagnosis of HIV/AIDS Healthcare providers may underdiagnosis HIV/AIDS and/or not offer HIV testing to older persons because HIV/AIDS symptoms can mimic the normal aging process such as lack of energy, weight loss, and short-term memory loss (CDC, 2008). HIV may imitate symptoms of neurological disorders such as Alzheimer’s disease, Parkinson’s disease and cerebrovascular dementia (Grabar, Weiss, & Costagliola, 2006).
  28. 28. HIV/AIDS Prevention Barriers Late diagnosis of HIV infection  Many studies have shown that HIV infection is diagnosed at a later stage in older persons than in younger persons (Althoff, Gebo, Gange et al., 2010).  A late diagnosis of HIV infection implies that antiretroviral treatments start late in the progression of the disease, possibly compromising their efficacy.  As a result, older persons are diagnosed with more advanced version of HIV or AIDS than younger persons (CDC, 2010) and are more likely to progress to AIDS at a faster rate since treatment is delayed (Kirk & Goetz, 2009).
  29. 29. Major Efforts to Address HIV/AIDS among Older Persons
  30. 30. Administration on Aging HIV/AIDS toolkit
  31. 31. Age Is Not A Condom Campaign The HIV & Older Adults Social Messaging Campaign was created by the AIDS Community Research Initiative of America (ACRIA). It includes a Facebook Page, a website, and posters on bus shelters throughout New York City. The campaign started on Monday, June 4th 2012.
  32. 32. Next Steps
  33. 33. Have the conversation. • Identify the client’s risk factors for HIV/AIDS using an HIV risk assessment (see packet). • Talk to your clients about HIV/AIDS risk factors and safe sex practices. • Ask them if they have been tested for HIV.
  34. 34. Get clients tested. • Refer clients for HIV testing • Follow-up • To find an HIV testing site near you, go to or call 1-800-CDC-INFO
  35. 35. Start talking about HIV/AIDS. Educate your colleagues on HIV/AIDS and older persons Talk about normal aging and stereotypes
  36. 36. Contact information Karen Whiteman, PhD @karenwhiteman