HIV Among Older Adults: Age-Specific Issues in Prevention and Treatment

Nathan L. Linsk, PhD

Disclosures

AIDS Read. 2000;10(7) 

In This Article

Abstract and Introduction

Nathan L. Linsk, PhDA substantial and increasing number of people have acquired HIV infections in their later years, as a result of male-to-male sexual contact or blood transfusion. However, heterosexual transmission also occurs, and substance abuse is often a factor. Health and service practitioners need to develop sensitivity to the needs of HIV-infected elderly people and their families. Prevention efforts and education should be incorporated as part of their initial assessment. Issues of treatment regimens, adherence, confidentiality, social support, and nondiscrimination are critical concerns when serving this population.

Older adults have consistently been a significant part of the HIV population and are affected by the HIV epidemic in a number of ways: Like younger persons, older adults may be at risk for HIV infection by engaging in sex- or needle-related behaviors and may need to seek counseling and testing. They may not be knowledgeable about HIV risk in older adults and therefore require information, education, and behavioral changes. Older adults may be HIV-positive and concerned about care and services. Alternatively, they may be concerned about the possible risks for and HIV status of younger family members, including grandchildren or adult children for whom they may be serving as caregivers.

The issue of HIV infection in later life is, for the most part, only recently emerging as an important concern. Research regarding HIV treatment and prevention, including pharmacologic trials conducted by federal agencies and private corporations, has generally excluded older adults from participation in clinical trials, and the use of antiretroviral drugs for HIV-infected older adults is generally at the discretion of the clinician. HIV-related issues are complex for older adults. In addition to the direct effects of the disease on infected persons and their support networks, HIV continues to be associated with extreme social responses, including fear, stigma, and discrimination.[1]

The term "older adult" is defined somewhat differently in the context of HIV infection from the general designation of old age, reflecting both the upper age range of the HIV epidemic and those who are discounted in HIV care programs because of their senior status. This aggregation of ages stems originally from the CDC, which grouped all ages over 50 together, and continues to be useful as a way of describing the older patients in the epidemic. As described below, 10% to 15% of HIV/AIDS cases occur in individuals over age 50, and since this prevalence of HIV/AIDS parallels the 12% or so of the general population over age 65, the older cohort of HIV- infected individuals is considered in the over-50 range.

This is not to say they are elderly; in fact, many in this group may not consider their needs to be those of older adults outside of the HIV framework. However, after age 50, some changes related to aging do occur. People older than 50 years are sometimes clustered with elderly persons, for instance, through membership in such organizations as the American Association of Retired Persons, receipt of membership invitations, eligibility for senior discounts in some programs, eligibility for some benefits through the Older Americans Act and, it is hoped, preparation by the individual for the later years. More important among HIV-infected people, those over age 50 state they feel marginalized because of age,[2] similar to the effects of age discrimination for people over age 50 seeking work. As people with HIV infection are increasingly living longer, the older adult population among those with HIV disease is likely to expand.

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