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Office of HIV Planning
January 14, 2016
Terri Clark, MPH
ActionAIDS
Kate Clark, MPA
Philadelphia Corporation for Aging
Kat...
Our Aim
To increase awareness and develop
city-wide action steps around HIV/AIDS
and Aging
2
Agenda
 Overview of HIV and Aging Data
 Sexual Behaviors and Older Adults
 Prevention Strategies
 Primary
 Secondary
...
Nationally: HIV & Aging
Adults 50 and older account for a growing number
of people living with HIV
 Successful anti-retro...
% of People with HIV Age 50 and Older 2009-2010
19 % and less
20-29 %
30-39 %
40 % and more
A National Trend
5
Philadelphia: Testing
HIV & Aging
 2013: 18% of new HIV infections are 50+
 2013: 38% of new AIDS diagnosis are 55+
 Ac...
Philadelphia: Living with
HIV/AIDS
 People who were 50+ made up:
 52% of PLWA
 32% of PLWH
 People who were 45+ made u...
Newly Diagnosed ActionAIDS
Clients, Age 50+
ActionAIDS has served over 1,000 HIV+ adults age 50+
since 2013.
For this anal...
Heterosexual
51%
MSM
18%
IDU
13%
MSM and IDU
5%
Other/Not
Reported
13%
HIV Risk Factor
9
n =
1,019
 More than half of
these clients reside in
5 Philadelphia zip
codes
 We do not currently
have data on the zip
...
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
19144 19136 19134 19132 19120 19104
HIV Risk Factor by Zip Code of Residence
O...
325
63
10
0
50
100
150
200
250
300
350
45 - 54 55 - 64 65+
#newcases
Age Group
New Chlamydia Infections in Philadelphia, 2...
Source: AACO 2013 Surveillance Report
273
65
10
0
50
100
150
200
250
300
45 - 54 55 - 64 65+
#NewCases
Age Group
New Gonor...
Source: AACO 2013 Surveillance Report
214
47
24
0
50
100
150
200
250
45 - 54 55 - 64 65+
#NewCases
Age Group
New Syphilis ...
 Connection between HIV and STIs
 People with HIV on HAART are being treated successfully as
evidenced by viral suppress...
Older Adults and HIV Risks
 We can’t talk about HIV without talking about sex (and
drug use)!
 Discomfort with sexual is...
Sexual Behavior is Alive and
Well Among Older Adults
 73% of adults aged 57-64; 53% of adults aged 65-74; and
26% of adul...
But older adults…
18
 Embarrassed about a continued interest in sex, and lack
resources about reducing the sexual risks
...
But older adults…
19
 Use ED drugs (Prescription does not equal condoms)
 Experience physical changes that increase HIV ...
Levels of Prevention
 Primary is designed to prevent a disease or condition from
occurring in the first place.
 Secondar...
Primary HIV Prevention
 Primary Prevention is still the most effective
 We need to “break the ice” and talk with our sen...
Audience Poll
How many times have you:
• Seen a billboard with the message
that older adults may be at risk for
HIV or oth...
Secondary HIV Prevention
 Re-infection
 Co-infection with a STI
 Transmission
 Condom burnout
23
Prevention Messages for
Older Adults
 www.safersex4seniors.org
 www.ageisnotacondom.org
 ActionAIDS Fact Sheet
24
ACRIA Social Messaging Campaigns
25
Tertiary HIV Prevention
 Social supports
 Co-morbidities
 Accelerated Aging
26
 Families provide the bulk of
hand-on assistance compared
with friends, but this is less
evident among older PWHA
 Hiera...
Co-Morbidities and
Accelerated Aging
 Aging with HIV does appear to increase the risk of
experiencing illness
 Heart att...
HIV and AIDS in Traditional
Aging Services
 16.3% of PLWHA over 50 have unmet needs
 Individuals who know their HIV stat...
Philadelphia Corporation for
Aging
 The mission of Philadelphia Corporation for Aging is
to improve the quality of life f...
HIV and AIDS in Traditional
Aging Services
 Spectrum of Long Term Care:
 Independent Living (includes Senior Centers)
 ...
Older Adults in Philadelphia
 Of those 192,492 older adults who are not currently working or
residing in an institution
...
HIV and AIDS in Traditional
Aging Services
 PLWHA are being served by the Aging Network, but
 Are they disclosing their ...
HIV and AIDS in Traditional
Aging Services
 Education, Education, Education!
 Professional in the HIV/AIDS Network:
 De...
Existing Tools to Spread the
Word
 SEXcessful Aging
 Milestones/PCA News Bulletin (172,000 readers)
 Senior Housing Bui...
2015 White House Conference
On Aging
July 13, 2015
Additional public input sessions
 Policymakers urged to take concrete ...
Recommendations
 HIV and Aging Workgroup/Taskforce
 Development of White Paper
 Infographics
 Primary Prevention Resou...
Thank You!
Terri Clark, MPH
tclark@actionaids.org
ActionAIDS
Kate Clark, MPA
kclark@pcaphl.org
Philadelphia Corporation fo...
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HIV and Aging in Philadelphia

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Terri Clark (ActionAIDS), Kate Clark (Philadelphia Corporation for Aging), and Katie Young (Philadelphia Corporation for Aging) presented on HIV and Aging at the January meeting of the Philadelphia Ryan White Part A Planning Council.

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HIV and Aging in Philadelphia

  1. 1. Office of HIV Planning January 14, 2016 Terri Clark, MPH ActionAIDS Kate Clark, MPA Philadelphia Corporation for Aging Katie Young, MSG Philadelphia Corporation for Aging HIV and Aging in Philadelphia
  2. 2. Our Aim To increase awareness and develop city-wide action steps around HIV/AIDS and Aging 2
  3. 3. Agenda  Overview of HIV and Aging Data  Sexual Behaviors and Older Adults  Prevention Strategies  Primary  Secondary  Tertiary  Next steps 3
  4. 4. Nationally: HIV & Aging Adults 50 and older account for a growing number of people living with HIV  Successful anti-retroviral therapies  New infections (11% of all new HIV infections are 50+)  Newly diagnosed as older adult (AIDS dx) 4
  5. 5. % of People with HIV Age 50 and Older 2009-2010 19 % and less 20-29 % 30-39 % 40 % and more A National Trend 5
  6. 6. Philadelphia: Testing HIV & Aging  2013: 18% of new HIV infections are 50+  2013: 38% of new AIDS diagnosis are 55+  ActionAIDS 2015: 20% of HIV tests for client 50+ 6
  7. 7. Philadelphia: Living with HIV/AIDS  People who were 50+ made up:  52% of PLWA  32% of PLWH  People who were 45+ made up:  71% of PLWA  48% of PLWH 7
  8. 8. Newly Diagnosed ActionAIDS Clients, Age 50+ ActionAIDS has served over 1,000 HIV+ adults age 50+ since 2013. For this analysis, clients were included if they: • received a Ryan White-funded service between 2013- 2015 • Were diagnosed HIV-positive between 2012-2015 • were age 50 or older at the time of the initial service • n = 75 8
  9. 9. Heterosexual 51% MSM 18% IDU 13% MSM and IDU 5% Other/Not Reported 13% HIV Risk Factor 9
  10. 10. n = 1,019  More than half of these clients reside in 5 Philadelphia zip codes  We do not currently have data on the zip code where the infection or the HIV test occurred 19144 10.3% 19120 7.7% 19132 7.7% 19104 7.7% 19134 7.7% 19136 10.3% 10
  11. 11. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 19144 19136 19134 19132 19120 19104 HIV Risk Factor by Zip Code of Residence Other/Not Specified MSM & IDU MSM IDU Heterosexual 11
  12. 12. 325 63 10 0 50 100 150 200 250 300 350 45 - 54 55 - 64 65+ #newcases Age Group New Chlamydia Infections in Philadelphia, 2013 Source: AACO 2013 Surveillance Report 12
  13. 13. Source: AACO 2013 Surveillance Report 273 65 10 0 50 100 150 200 250 300 45 - 54 55 - 64 65+ #NewCases Age Group New Gonorrhea Infections in Philadelphia, 2013 13
  14. 14. Source: AACO 2013 Surveillance Report 214 47 24 0 50 100 150 200 250 45 - 54 55 - 64 65+ #NewCases Age Group New Syphilis Infections in Philadelphia, 2013 14
  15. 15.  Connection between HIV and STIs  People with HIV on HAART are being treated successfully as evidenced by viral suppression  Those ageing with the virus are experiencing a variety of non-HIV/AIDS conditions More Facts 15
  16. 16. Older Adults and HIV Risks  We can’t talk about HIV without talking about sex (and drug use)!  Discomfort with sexual issues in the U.S.  All adults have the right to express their sexuality  Many believe that older adults’ sexuality is not worth considering 16
  17. 17. Sexual Behavior is Alive and Well Among Older Adults  73% of adults aged 57-64; 53% of adults aged 65-74; and 26% of adults aged 75 to 84 (Lindau et al 2007)  Enormous variability in how U.S. adults described most recent sexual event (intercourse to fantasy)  LGBT older adults - 69% sexually active during past year (ACRIA/COH 2010) 17
  18. 18. But older adults… 18  Embarrassed about a continued interest in sex, and lack resources about reducing the sexual risks  Motivated to maintain sexual activity as an expression of youthfulness; stereotypes of “old age”  Want to remain sexually active to sustain intimacy in both long-term and new relationships
  19. 19. But older adults… 19  Use ED drugs (Prescription does not equal condoms)  Experience physical changes that increase HIV risk  Sexual changes with aging men Sexual changes with aging women
  20. 20. Levels of Prevention  Primary is designed to prevent a disease or condition from occurring in the first place.  Secondary attempts to identify a disease at its earliest stage so that prompt and appropriate management can be initiated.  Tertiary focuses on reducing or minimizing the consequences of a disease once it has developed. 20
  21. 21. Primary HIV Prevention  Primary Prevention is still the most effective  We need to “break the ice” and talk with our seniors  Encourage testing for those older adults at risk  Develop message tailored for diverse older adults, including LGBT communities 21
  22. 22. Audience Poll How many times have you: • Seen a billboard with the message that older adults may be at risk for HIV or other STIs? • Heard of an HIV testing campaign targeting your grandmother? • Known about programs that teach your father how to practice condom skills? • Read articles encouraging older adults living with HIV to seek healthcare? 22
  23. 23. Secondary HIV Prevention  Re-infection  Co-infection with a STI  Transmission  Condom burnout 23
  24. 24. Prevention Messages for Older Adults  www.safersex4seniors.org  www.ageisnotacondom.org  ActionAIDS Fact Sheet 24
  25. 25. ACRIA Social Messaging Campaigns 25
  26. 26. Tertiary HIV Prevention  Social supports  Co-morbidities  Accelerated Aging 26
  27. 27.  Families provide the bulk of hand-on assistance compared with friends, but this is less evident among older PWHA  Hierarchical Compensatory Model - older adults with HIV frequently turn to government and community-based services for their needs Social Supports Formal Services Friends & Neighbors Distant Family Close Family 27
  28. 28. Co-Morbidities and Accelerated Aging  Aging with HIV does appear to increase the risk of experiencing illness  Heart attack, stroke, some cancers, fractures, organ dysfunction  Social functioning, mental health, stress, and depression are also strongly associated with chronic disease burden  After beginning HAART, there was no significant increase in the conditions as they aged. Rasmussen LD, May MT, Kronborg G, et al. Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study. Lancet HIV. 2015; in press. 28
  29. 29. HIV and AIDS in Traditional Aging Services  16.3% of PLWHA over 50 have unmet needs  Individuals who know their HIV status but are not in primary medical care  May not be receiving medical case management to assist with basic needs (housing, food, safety)  In 2012 37.38% of Southeastern Pennsylvanians over the age of 50 were uninsured 29
  30. 30. Philadelphia Corporation for Aging  The mission of Philadelphia Corporation for Aging is to improve the quality of life for older Philadelphians or people with disabilities and to assist them in achieving their maximum level of health, independence and productivity. Special consideration is given to those with the greatest social, economic, and health needs. 30
  31. 31. HIV and AIDS in Traditional Aging Services  Spectrum of Long Term Care:  Independent Living (includes Senior Centers)  Adult Day Center  In Home Support  CCRCs  Assisted Living  Nursing Home  Hospice Care 31
  32. 32. Older Adults in Philadelphia  Of those 192,492 older adults who are not currently working or residing in an institution  21.4% live below 100% of the poverty level  52.2% live below 200% of the poverty level  9% were served by the senior center network  120 senior housing buildings 32
  33. 33. HIV and AIDS in Traditional Aging Services  PLWHA are being served by the Aging Network, but  Are they disclosing their status?  Do the professionals have pre-existing stereotypes that influence their interactions?  Are there HIV/AIDS services that aging professionals need to be in touch with and vice versa?  How many PLWHA are NOT being touched by the aging network and are thus falling through the cracks 33
  34. 34. HIV and AIDS in Traditional Aging Services  Education, Education, Education!  Professional in the HIV/AIDS Network:  Debunk Myths on Aging  Impact of Aging training  Professionals in the Aging Network:  Debunk Myths on HIV/AIDS and aging – reduce stigma  Older Adults’ Sexual Health workshop: information/resources  Encourage testing 34
  35. 35. Existing Tools to Spread the Word  SEXcessful Aging  Milestones/PCA News Bulletin (172,000 readers)  Senior Housing Buildings (~120 subsidized housing building for seniors)  Senior Centers (33 Centers and Satellites)  HIV service organizations  HIV and Elders Google Group  GenPhilly (600+ emerging professionals)  Jefferson HIV & AIDS Awareness Day  What else??? 35
  36. 36. 2015 White House Conference On Aging July 13, 2015 Additional public input sessions  Policymakers urged to take concrete actions to address the needs of diverse groups and foster changes to better the lives of all older adults, including people with diverse backgrounds (people of color, LGBT communities, those living with HIV, and older adults with physical, intellectual and cognitive disabilities). 36
  37. 37. Recommendations  HIV and Aging Workgroup/Taskforce  Development of White Paper  Infographics  Primary Prevention Resources  Education of direct care workers/healthcare staff  Increased testing opportunities for 50+ population  Media/public health campaign  Targeted information dissemination strategy  National HIV and Aging Awareness Day 37
  38. 38. Thank You! Terri Clark, MPH tclark@actionaids.org ActionAIDS Kate Clark, MPA kclark@pcaphl.org Philadelphia Corporation for Aging Katie Young, MSG kyoung@pcaphl.org Philadelphia Corporation for Aging 38

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