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

Nathan L. Linsk, PhD


AIDS Read. 2000;10(7) 

In This Article


HIV and age-related problems, each on their own, are difficult enough; yet, the older HIV-infected adult must cope with the double jeopardy of HIV and losses related to aging. Both the aged and those with AIDS face issues of discrimination regarding insurance, housing, accommodations, and work. HIV and aging share commonalities of multidisciplinary care, involving significant others in care, functional and cognitive assessments, and the use of many tiers of institutional and nonhospital settings and care.[15]

The impact of HIV/AIDS on older adults has consistently been denied by all concerned, including HIV experts, geriatric practitioners, and the elderly themselves. It is important to consider HIV education, care, and service needs of older adults, because HIV increasingly involves greater portions of the population of all age groups. Reluctance to deal with the older affected population in HIV care and the reluctance to address HIV issues come together to mask the increasing incidence of HIV among our elderly.

In this emerging area, much work is needed in terms of clinical practice issues involving diagnosis and treatment as well as research. Providers need help in recognizing HIV as a risk for older patients, whom they do not suspect of being directly associated with a risk group. HIV risk and its associated drug and sexual behaviors need to be a part of assessment of all patients, including older adults.

The stigma of sexuality in older adults is often an obstacle to effective risk assessment and prevention. In recent years, treatment of erectile dysfunction has become more openly discussed with the use of new drugs and, notwithstanding issues of pharmacologic treatments, issues about the effectiveness of condoms with potential erectile failure need to be frankly discussed with patients. Similarly, the vaginal changes in women that make them more vulnerable to HIV infection need to be discussed, and older women need to be informed of their risk and need for protection. Prevention materials need to become age-sensitive and address older-adult issues.

We urgently need more data on the use of antiretroviral medications and on treatments for opportunistic infections for older adults. Few data are available about efficacy, modifications of regimens according to age, issues of comorbidity related to the aging process, and how the pres- ence of other illnesses affects HIV- related medication. Associated is- sues for research and clinical application include treatment adherence and how to sustain a very complex assortment of HIV drugs and possible age-associated treatments.


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