By Janice Lynch Schuster
The Centers for Disease Control and Prevention estimate that 636,000 people have died from AIDS in the United States since the virus was first identified in the early 1980s. Today, more than a million people live with HIV – however, nearly 20 percent do not know they are infected. Those over age 50 represent approximately 15 percent of the 50,000 new diagnoses annually, nearly one-fourth of all existing cases of HIV, and nearly 30 percent of those with AIDS.
HIV disproportionately affects men who have sex with men, as well as members of certain racial and ethnic minorities (particularly African Americans and Hispanics/Latinos). These rates may be driven by health disparities, including access to prevention and treatment, and social determinants, such as poverty and education.
What is HIV/AIDS?
Human immunodeficiency virus (HIV) attacks the immune system, and leaves people more susceptible to opportunistic infections. The late-stage is called acquired immunodeficiency syndrome (AIDS), which leads to death.
People with HIV often describe themselves as being “positive,” and may be known by the acronym PLWH, or people living with HIV. The virus spreads when through contact with bodily fluids of an infected person: usually, during unprotected sex, or when injection drug users share needles. Positive women can infect their babies, either during birth or while breastfeeding.
Early in the infection, people often have no signs or symptoms, or such vague symptoms that they go undiagnosed. Common signs of HIV include headache, cough, diarrhea, swollen glands, lack of energy, loss of appetite, weight loss, fevers and sweats, repeated yeast infections, skin rashes, pelvic and abdominal cramps, sores in the mouth or on certain parts of the body, or short-term memory loss.
HIV is diagnosed by a blood test. The U.S. Preventive Services Task Force advises clinicians to provide HIV testing for all patients between the ages of 15 and 65. Those over the age of 65 who are at risk – such as those who have unprotected sex, who have multiple sex partners, and injection drug users – should also be tested at least once.
The earlier the infection is detected, the sooner life-prolonging treatments can begin, and the more likely they are to work. Under Obamacare, new health care plans cannot charge a co-pay for HIV tests.
Highly active anti-retroviral treatment (HAART) enables infected people to live for many years, and HIV infection can be a chronic and manageable condition. Many HIV positive people are living to a middle- and old age they had never expected to experience.
These drugs are costly, but all Medicare drug plans cover all retroviral drugs. In addition, the federal Ryan White Program features an AIDS drug assistance program to provide medications for those who do not qualify through other public or commercial insurance programs. However, each state maintains its own drug formulary, and not all make the newest drugs available to these patients, offering them older drugs that, while effective, often come with more risks and side effects.
Facts and figures: HIV and aging
CDC data indicate that people over 50 who are HIV positive represent:
- 15 percent of new diagnoses
- 24 percent of those living with HIV
- 19 percent of all AIDS diagnoses
- 29 percent of people living with AIDS
- Outcomes for older adults with HIV or AIDS are not as good as they are for younger people. People over age 50 comprise 35 percent of all AIDS deaths
In addition to higher mortality rates, survival time after diagnosis is shorter for older adults. In addition, they are more likely to experience other chronic conditions that limit their physical well-being.
HIV presents several challenges for aging people and their clinicians. Those who have lived long with the disease now do so while facing the usual challenges of aging, the ongoing challenges of a complex treatment plan and various psychosocial issues. Aging adults continue to be at risk for infection, often unaware of their risk factors, or of the need for prevention and screening. And clinicians may be reluctant to broach questions about sexuality in older adults, or may not recognize the early symptoms of HIV, dismissing them as “just aging”.
Issues for people aging with HIV
People aging with HIV face three central issues, according to Jesse Milan, Jr., JD, a national expert on HIV who has lived with the virus for 31 years. Milan said that researchers are finding that the presence of the virus itself may accelerate the aging process. Living with HIV requires a commitment to managing the disease, to planning for what Milan calls the “long haul of clinical appointments,” and the need to be “deliberate around issues such as smoking and alcohol, exercise and diet.” Milan explains that older PLWH face:
- The long-term effects of HAART drugs, and the challenges of learning to manage and handle the treatment, including the need to change the “cocktail” when any one component is no longer effective
- The long-term consequences of having the virus in the body, and its effect on the organs and the aging process
- The sociological issues of maintaining treatment adherence, focusing on healthy living, and engaging in sexual activity while preventing infection in partners
Contrary to popular beliefs, older adults are and continue to be sexually active. Being HIV positive can be a barrier to those seeking to form new relationships. Milan said that within the community of men who have sex with men, the issue of “serosorting” often comes up. People want to know if a potential partner is “clean.” Milan says, “If you are HIV positive, are people really willing to have a sexual relationship with you? And what does that does to your self esteem?”
Among what Milan calls “discordant couples,” in which one partner is positive and one is not, the focus is to prevent infection. For some, this raises the question of pre-exposure prophylaxis (PrEP), in which a negative at-risk person takes HIV drugs to prevent infection. Some studies have reported that people who are on HAART and who have a low viral load have a 96 percent chance of NOT infecting an uninfected partner – but that is a risk some are not willing to take.
In addition to the challenges of living with HIV, older positive adults most contend with other chronic conditions. A 2009 study compared age-related differences among PLWH. In that study, older respondents reported more co-morbidities, and were less likely than younger PLWH to report that their health status was excellent. Older respondents were more likely to report problems such as arthritis, high blood pressure, high cholesterol, and neuropathy.
Issues for preventing HIV in older adults
According to GMHC, a leading organization in the fight against AIDS, launched as the Gay Men’s Health Crisis in 1981, by 2015, half of the people living with HIV will be over the age of 50. GMHC reports:
Among people over 50 new diagnoses increased by 25% from 2006 to 2007. Since 2003, the number of newly-diagnosed women 50 and older has gone up by 40%.
Preventing the spread of HIV is a challenge for clinicians and older patients, many of whom may be reluctant to discuss sexuality. In addition, symptomatic older adults are not routinely screened for HIV. According to the National Institute for Aging:
- Older Americans know less about HIV/AIDS than younger people do. They do not always know how it spreads or the importance of using condoms, not sharing needles, getting tested for HIV, and talking about it with their doctor.
- Health care workers and educators often do not talk with middle-aged and older people about HIV/AIDS prevention.
- Older people are less likely than younger people are to talk about their sex lives or drug use with their doctors.
- Doctors may not ask older patients about their sex lives or drug use or talk to them about risky behaviors.
The spread of HIV is part of the larger problem of the rapid spread of other sexually transmitted and infectious diseases, such as Hepatitis C, gonorrhea, syphilis, and chlamydia among older people. In fact, Boomers are the largest group of people with Hepatitis C, which kills more people than HIV.
Women over 50 are at special risk for infection. Menopause leaves them more susceptible to vaginal tears, which provide an easy portal for HIV. However, older women may not consider themselves to be at risk for infection.
Story Ideas
There are numerous story angles for journalists to pursue:
- Describe the issues that affect long-time survivors, people who are newly infected, and those who are newly diagnosed.
- Use the CDC’s online data, www.AIDSview.org, reporters can take a ZIP code look at infections in their communities, and find HIV testing sites and programs.
- Focus on programs in the community that aim to improve health of older adults, and find out whether and how they are working to address sexual health—including HIV prevention.
It is also worth covering the spread of sexually transmitted diseases, and efforts to educate older adults and prevent infection.
Sources
Grant Colfax, MD, Director of the White House Office of National AIDS Policy, 202-456-4533
Jonathan Mermin, MD, MPH, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 404-639-8895| NCHHSTPMediaTeam@cdc.gov
Jesse Milan Jr., JD, HIV expert and advocate, jesse.milan@altarum.org
Antigone Hodgins Dempsey, member of the CDC/HRSA Advisory Committee on HIV & STD Prevention & Treatment Members, Antigone.dempsey@altarum.org
Resources
- Administration on Community Living (formerly the Administration on Aging), Toolkit on HIV and Aging
- American Academy of HIV Medicine, Forum on HIV and Aging
- Centers for Disease Control and Prevention: HIV/AIDS
- Centers for Disease Control and Prevention: Diagnoses of HIV Infection among Adults Aged 50 Years and Older in the United States and Dependent Areas, 2007–2010
- GMHC: Growing Older with the Epidemic: HIV and Aging:
- Health Resources and Services Administration (HRSA)
- Through HRSA’s Ryan White program, people can locate HIV/AIDS treatment providers:
- National Institutes of Health: Information on prevention, treatment and research
- National Institute on Aging: HIV, AIDS, and Older People
- Office of National AIDS Policy (White House)
Janice Lynch Schuster, an award-winning nonfiction writer, has been a senior writer for Altarum Institute since 2008. In addition to the expertise that she provides in covering topics such as multiple chronic conditions, aging, end-of-life care, and hospice and palliative care, she has written about many public health issues.
