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

1. HIV/AIDS Among Persons Aged
50 Years and Older
Karen Whiteman, PhD

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. 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. 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 (AIDS.gov,
2012).
An estimated 20% of persons are unaware of HIV
infection (CDC, 2011).

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. 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. 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. 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. 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. 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. 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. 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. 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. HIV/AIDS Risk
Factors for Persons
aged 50 years and
older

15. Normal Aging

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. 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. 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. 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. 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. 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. 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. Age-related
Disparities in
HIV/AIDS Prevention
Barriers for Older
Persons

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. 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. 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. 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. 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. Major Efforts to
Address HIV/AIDS
among Older
Persons

30. Administration on Aging
HIV/AIDS toolkit
Aoa.gov

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. Next Steps

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. Get clients tested.
• Refer clients for HIV testing
• Follow-up
• To find an HIV testing site near you, go to
http://www.HIVTest.org or call 1-800-CDC-INFO

35. Start talking about HIV/AIDS.
Educate your colleagues on HIV/AIDS and older
persons
Talk about normal aging and stereotypes

36. Contact information
Karen Whiteman, PhD
karen@researchgerontology.com
http://www.karenwhiteman.com/
@karenwhiteman