HIV/AIDS and Older Adults
Henry Pacheco, M.D.
Medicine & Public Health Director
National Hispanic Council on Aging
(NHCOA)
Washington, DC
NATIONAL HISPANIC COUNCIL ON AGING (NHCOA)
Working to improve the lives of Hispanic older adults, their families, and
caregivers
Learning Objectives
1. Review of aging trends in the US
2. A brief overview of the HIV/AIDS in the US
3. A review of sexual and other HIV risk factors for
older adults
4. Understanding barriers that prevent healthcare
providers from recognizing and treating older adults
living with HIV/AIDS
5. The role of stigma and discrimination in HIV
prevention and treatment
Profile of the Older US Population
In 2010
• Persons 65 + represented 13.1% of the population ( 40 million)
(a 15.3% increase since 2000)
• Persons 85 + represented 1.8% of the population
Future Growth of the Older population
• The 65+ population is projected to increase by 36% within a
decade, reaching 55 million by 2020
• The 85+ population is projected to reach 6.6 million by 2020
representing an increase of 19%
• By 2030, people 65+ will represent 19.3% of the population
Source (HRSA, 2011)
Growth of the 65+ Population,
1900 – 2030 (numbers in millions)
Two Decades of HIV/AIDS
State of the HIV Epidemic in the US
•Newly infected with HIV:
48,100 (annually)
•People living with HIV/AIDS:
1.1 million
• HIV infected but don’t know
it:
18%
• People diagnosed with HIV
not in regular care :
50%
(Source: CDC,2012)
• HIV has evolved from an
acute disease into a
chronic disease due to
the success of
treatment (HAART) and
prevention efforts
• AIDS can be considered
a complication of HIV
HIV Disparities
HIV among Older adults
HIV OVER FIFTY:
EXPLORING THE NEW THREAT
HEARING BEFORE THE SPECIAL
COMMITTEE ON AGING
UNITED STATES SENATE
109th CONGRESS FIRST SESSION
WASHINGTON, DC
MAY 12, 2005
1 out of 3 sexually active older
adults infected with HIV has
unprotected sex, according to a
study …. , most were male, took
Viagra and were in a
relationship.
(Source: Medical News Today 4.30.2007)
By 2015,
50% of the people living
with HIV will be 50 or
older
(Effros et al., 2008)
Preventing the spread of
HIV/AIDS among this
population poses many
unique challenges.
HIV and Older Adults (50+)
• The fastest growing HIV
population
• HIV grew by 77% from
2001-05 in this population
(CDC, 2008)
• Older adults comprised 15%
of all new HIV infections in
2007 in the US (CDC, 2010)
• HIV is 12 times higher
among African-Americans
and 5 times higher among
Latinos compared to Whites
Why is HIV Growing Among Older Adults?
• Improved survival of persons living with HIV due to
success of HAART
• Large numbers of older adults become infected with
HIV annually
• The presence of multiple and significant risk factors
that places older adults at risk for HIV
HIV Risk Factors in Older Age
•
•
•
•
Lack of awareness of HIV risk factors
Perception that HIV is a disease of the young
Least likely to practice safe sex (unprotected intercourse)
Not free from drugs of abuse and alcohol
• PCPs don’t consider their older patients at risk for HIV
• Viagra and similar drugs has extended their sexual vitality
• Late or no HIV testing as part of routine health care
• Older women free of pregnancy risk see no need for
condoms
• Vaginal mucosa in post –menopausal women is easily
irritated/ injured, more likely to become infected by HIV
Why is HIV Often Not Recognized
in Older Adults by Health Care Providers?
• Stereotypes of older adults as sexually inactive
• Primary care Providers often do not take sexual
histories or inquire about drug abuse
• Consider their married patients involved in “safe”
monogamous relationships, not at risk of HIV or STIs
• Consider them in heterosexual relationships unaware
of potentially high risk sexual life styles
• Low index of suspicion – low rate of testing
• Symptoms of HIV are often similar to those of aging
The Older HIV Patient: Challenges
for Primary Care Providers
• Comorbidities are more common
• Learning a new “specialty”, drug interactions, side
effects of ARV regimens in older patients
• Are symptoms due to aging, HIV or effects of ARV?
• The importance of adherence and continuity of care
• Need to understand and address the impact of
stigmas (HIV, sexual minorities, ageism, drug abuse)
• Older adults suffer more poverty and social isolation
• Age-related disabilities along with HIV complications
Sources: HIV infection in the elderly, G. Kelly , et al, Current Infectious Disease Reports,
2009
More PLWH are Dying of Non-AIDS Causes
• In NY study: 26% of deaths were non-AIDS
(alcohol/drugs (31%), CVD (24%), Cancer (21%))
• Barcelona: 60% were non-AIDS Liver(23%),
Infection(14%),cancer, (11%),CVD (6%)
• CASCADE Study, UK: 63% were non-AIDS , Liver(20),
Infections(24%), Unintentional (33%), Cancer (10%),
CVD, (9%)
Source: (Amy Justice, May 2010)
Many of the Challenges are not Clinical
• Care of the elderly requires more provider and other
staff time including coordinated care
• A team approach is necessary when caring for PLWH
• HIV is a complex disease: care can be costly
• Clinicians productivity is slowed
• HIV patients may require support services that can be
difficult to arrange and pay for
• Minority and non-English speaking HIV patients
require culturally and linguistically competent care
Stigma: A Major Barrier
to Eliminating HIV/AIDS
23 %of HIV+ patients had physicians
with negative attitudes toward
injection drug users. M. Ling
Harvard Study (MNToday:2005)
• Stigma in HIV is a persistent
and pernicious problem
• It destroys the familial,
social, and economic lives
• It is a major barrier to
accessing prevention, care
and treatment
( A. Mahajan, Stigma & HIV/AIDS ,
AIDS. 2008 August; 22(Suppl 2):
Some factors that lead to
stigma and Discrimination :
• HIV is often related to
stigmatized behaviors or life
styles (i.e., injecting drugs,
homosexuality)
• HIV is still a feared disease
• The belief that HIV can be
caught via casual contact
• The belief that having HIV/
AIDS is a sign of moral failure
that merits punishment
Resources for Primary Care Providers
Sources of Training for Clinicians:
• An increasing number of
primary care providers
(PCPs) will be expected
to care for PLWH
• HIV is already a chronic
disease, along with
diabetes, hypertension
and others that primary
care providers will have
to address
The HRSA /HAB AIDS Education and
Training Centers (AETC):
www. Aidsetc.org
A current review:
HIV and Aging: State of Knowledge,
JAIDS Journal of Acquired Immune
Deficiency Syndromes:
1 July 2012 - Volume 60 - Issue - p S1–
S18 (on-line)
Thank you !