The Aging HIV Population


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  • This bar graph is from the ROAH study and hows the comoribities of the HIV-positive older adults that were included in the study. ROAH study participants had 3 times the US average number of comorbidities Comorbidities included: depression arthristic, hypertnention, diabetes, pneumonia, heart conditinn, migrains, cancer, stoke - An emerging challenge in diagnosing HIV/AIDS in older persons is the difficulty in deciphering the signs and symp- toms of infection, disease progression and aging. (because many of these disease related symptoms may mimic those of aging)
  • I ’ m about to bring you on a tour of online resources on HIV & aging so that you will be able to stay up to date on this topic, but first I ’ m going to quickly summarize the major priorities or concerns that research on older adults and HIV has so far identified. The following bullets are from a recent report published in the Journal of the American Academy of Physician Assistants by Jeffrey Myers. In the conclusion Myers summarizes his lit review by calling for health care providers to better address the context of HIV positive older adults lives by: First, considering and planning for the long-term effects of disease management on the aging population (both at a health care provider level and policy level) Second, devoting more resources to understanding and addressing the blurring lines between HIV and aging etiologies, symptoms, and conditions. In order to successfully tackle any issues related to HIV & aging, sexuality of older adults needs to accepted and understood in more depth. And I just want to add that this means training staff . And really the backbone of all this is understanding and addressing the lives of hiv positive older adults: incorporating sexual and social behaviors and social trends into the formula of how best to meet clients needs. Additionally, Myers makes a call for additional research specifically focusing on long-term effects of treatment, and understanding the metabloc and hormonal changes within HIV-infected older adults.
  • The Aging HIV Population

    1. 1. The Aging HIV PopulationAlanna Costelloe-Kuehn, Health SpecialistOlder Adults Technology Services (OATS)Supported by ACRIA, NYC Council andthe NYC Department of Health and Mental HygieneOlder Adults, HIV and Online Resources Webinar Series
    2. 2. Agenda• Older adults and HIV– Population characteristics– HIV infection and testing– Needs and concerns– Resources on HIV and aging
    3. 3. NYC Population ProjectionThe New York Academy of Medicine, 2008
    4. 4. • About 33% of all people living with HIV/AIDS are50 years of age or older• By 2015, over 50% of PLWH/A will be 50 years ofage or older• Older African Americans and gay men aredisproportionately affected by HIV– African-American women make up 65% of all HIVinfections among older womenOlder Adults and HIVin the US
    5. 5. New York City is the USHIV Epicenter• Today in New York City there areapproximately 107,000 known people livingwith HIVNew York City Department of Health, 2010
    6. 6. • 75% of people with HIV/AIDS in NYCare over 40• 38% of people with HIV/AIDS in NYCare over 502010 NYC HIV EpidemiologyNew York City Department of Health, 2010
    7. 7. • There are three groups of older adults with HIV– Newly infected– Newly diagnosed– Aging individuals/longtime survivors• These groups have different but overlappingmedical and psychosocial needsHIV Among Older Adults
    8. 8. Drugs, Sex and OlderAdults• Older adults remainsexually active andengage in risky behaviors• Sexual activity amongthose aged 57 to 64 yearswas 73% and declined to53% among respondentsaged 65 to 74 years
    9. 9. Older Adults Living With HIVin NYC• 33% reported having unprotectedinsertive sex within the past 3 months• 47% sexually active participants usedrugs or alcohol before sexualintercourseAIDS Community Research Initiative of America. ROAH, 2006
    10. 10. Growing Older with the Epidemic. GMHC, 2010.QuickTime™ and adecompressorare needed to see this picture.
    11. 11. Challenging Myths• Many clinicians do not ask older patients abouttheir sexual activity– Only 38% of older men and 22% of older womenreported discussing sex life with health care providers– Silence and stigma of older adults’ sexual behaviormay limit honest patient-doctor conversations• Overlooking possibilities that a older people areas risk for HIV– Older adults over 50 at risk for HIV were 80% lesslikely to be tested for HIV as at-risk adults 20 to 30years of age
    12. 12. Older Adults’ HIV Knowledge• Lack of formal sexual health education– New world of HIV and STDs– Misconceptions about HIV transmission throughcasual contact or blood transfusion– Condom disinhibition• Increased health literacy among serviceproviders and older adults will improveprevention, increase accurate diagnoses andreduce stigma
    13. 13. Older Women & HIV Infection• Less likely to use a condom during sex– Lack of contraceptive incentive– Gender imbalance leaves women with lessbargaining power• Hypoestrogenism and natural thinning ofthe vaginal walls increases biological riskof infection
    14. 14. Routes of Transmission• Sexual Exposure– Anal Sex– Vaginal Sex– Oral Sex (very low risk)• Blood exposure– Injecting drug use/needle sharing– Occupational exposure– Transfusion of blood products
    15. 15. HSV-2 SuppressivetherapyCervical Barriers:vaginal diaphragmsMale circumcisionExposure prophylaxis MTCTPEPPrEPImmunization:VaccinesBehavioralInterventionsHIVPREVENTIONMicrobicidesMale and FemaleCondomsVoluntary Counseling& TestingSTI Treatment Strategies
    16. 16. QuickTime™ and adecompressorare needed to see this picture.
    17. 17. “Routine voluntary HIV screening should be anormal part of medical practice, similar toscreening for other treatable conditions, with apatient “opt-out” provision and arecommendation that prevention counselingshould not be required with HIV diagnostictesting or as part of HIV screening programs inhealthcare settings”- Current CDC Screening Recommendations
    18. 18. Finding Testing Locations• Check list for healthy aging• Hispanic AIDS Forum• 311 testing sites in NYC•
    19. 19. Testing Resources• Information about testing––• Couples counseling & partner notification• Online support groups––’s “Ask the Expert”
    20. 20. Aging Bodies, GrowingQuestions• Need for increased research on HIV and aging– Comorbidities, drug interactions and life cycle effects• Must expand research on HAART and aging– Separate treatment guidelines?– What are toxicities of long term use of HAART?• Do aging processes change due to viralinfection?Effros et al., “Workshop on HIV Infection and Aging:What is known and Future Research Directions.”
    21. 21. Office of AIDS Research• Special Initiative Working Group on HIVand Aging• Coalition for HIV and Aging Research andPolicy Advocacy (CHAPRA)– David Evans at
    22. 22. Research on Older Adultswith HIV (ROAH)• In 2006, the AIDS Community Research Initiative ofAmerica (ACRIA) conducted interviews with 914 HIV-positive adults over 50 in New York City• Provides first data set on physical and mental health,sexual behaviors, substance abuse, social networks andquality of life of older adults living with HIVAIDS Community Research Initiative of America. ROAH, 2006QuickTime™ and adecompressorare needed to see this picture.
    23. 23. ROAH Population• ROAH sample matches NYC HIV epidemiology– 50% African American– 33% Latino– 14% White– 70% Male, 30% Female
    24. 24. • What we know aboutHIV among olderadults• What we do not yetunderstand• What improvementcan be made to betterprepare the country tocare of this populationQuickTime™ and adecompressorare needed to see this picture.In 2010, GMHC published review covering:
    25. 25. Growing Older With the Epidemic• Epidemiological– Disparities across race and sexual behavior• Context of HIV-positive Older Adults’ Lives– Impact of HIV-, sexuality- and aging-related stigma• Aging Bodies– Biological impact of HIV on aging bodies• Healthcare and Senior Services– Social service and health care programs for olderadultsGay Mens Health Crisis (2010). Growing older with the epidemic:HIV and aging. New York, NY: GMHC.
    26. 26. • Comorbidities– Effect of all other diseases an individual patientmight have other than the primary disease ofinterest• Drug interactions and toxicities• Immune systems respond slower totreatment• Liver and kidney disease• Bone lossAging bodies -- Illnessesassociated with aging
    27. 27. QuickTime™ and adecompressorare needed to see this picture.
    28. 28. Aging Bodies (con’t)• Effects of long term use of HAART– Cognitive impairment and depression• The lines between cognitive changes inducedby therapy and viral effects and those causedby aging begin to blur
    29. 29. HIV Stigma, Ageism & Isolation• HIV stigma includes prejudice, discounting,discrediting, and discrimination directed atpeople perceived to have HIV and AIDS• Stigma of age is powerful, affecting healthstatus & is significantly related to socialisolation, depression, and loneliness• 96% of older adults living with HIV haveexperienced HIV stigma• 71% experienced HIV stigma and ageismC. Emlet, Experiences of stigma in older adults livingwith HIV/ AIDS: A mixed-method analysis (2007)
    30. 30. Isolation• 70% living Alone• 30% living with others• Feelings of isolation from social supportnetworks• Food insecurity
    31. 31. Combating Stigma -Services for older adults• Congregate living facilities often provide insufficientsupport for older adults living with HIV• Lack of support for nontraditional caregivers and same-sex spouses of domestic partners compounds thechallenges of caring for people living with HIV• Service utilization and need for specific, age-relatedservices must be addressed• HIV/AIDS agencies cannot take the place of existingservices for older adults: Partnerships must occur!
    32. 32. Health Care ProvidersMust Address• Long-term effects of disease management• HIV and aging etiologies in older patients• Sexuality in older patients• Context of HIV-positive older adults’ livesJ. Myers, Growing old with HIV: The AIDS epidemic andan aging population. JAAPA (2009)
    33. 33. Online Resources
    34. 34. CDC Fact Sheets on HIV/AIDS• The CDC website ( has reliablehealth information, including fact sheetson HIV/AIDS• Fact sheets on older adults and HIV/AIDS–
    35. 35.
    36. 36. Upcoming WebinarsHealth Literacy, Adherence and Access toBenefitsThursday, February 24th at 3pmUsing Social MediaThursday, March 3rd at 3pmVisit see full webinar schedule
    37. 37. Discussion• To ask a question you can:– Ask by audio– Send you question via chat– Email your question to• This webinar and the rest of the series will beavailable to download