July 27, 2012
Ruth Waryaro celebrated her 65th birthday on Wednesday by speaking on a panel of older adults living with HIV. When she picks up her HIV meds at her local clinic, she shared, the staff ask her who she's picking them up for. Waryaro's story highlights one of the biggest obstacles to HIV prevention and care worldwide: the misconception that older people don't have sex and so don't get HIV.
Kevin Fenton of the U.S. Centers for Disease Control and Prevention (CDC) offered data to the contrary: A 2008 national survey on sexual health found that the majority of Americans aged 57 to 65 -- and a substantial proportion of those 66 and older -- are sexually active. Only a minority discuss their sex lives with health care providers, and many who are re-entering the dating scene after long-term relationships have limited understanding of HIV risk.
The CDC estimates that 33% of all people living with HIV in the U.S. are age 50 and older. By the year 2020, this proportion is expected to rise above 50%. An estimated 11% of new HIV infections occurs among adults age 50 and older, and that proportion is increasing, said Fenton.
Given these figures, stated one member of the audience, the CDC should raise the upper limit of the age range for routine testing. Currently the CDC recommends that HIV testing be part of routine health care for all Americans between the ages of 13 and 64 -- an age range that clearly doesn't capture older people who may not know their HIV status.
Older adults living with HIV face additional illnesses, or "comorbidities," such as cardiovascular disease, diabetes, and depression. Indeed, explained Stephen Karpiak of the AIDS Community Research Initiative of America (ACRIA), depression was the most commonly reported comorbidity in the ROAH study, short for "Research on Older Adults with HIV." (View the ROAH results here.)
John Rock of the Asia Pacific Network of People Living with HIV/AIDS (APN+), himself HIV-positive and nearing age 70, added sexual health to the discussion, observing that with HIV-related drops in testosterone levels and the resulting erectile dysfunction, "it's no wonder that we're depressed!"
Karpiak stressed that multiple studies also link depression with non-adherence to medications—including anti-HIV treatment—with implications for individual health and well-being. "If we can resolve depression, we can make major advances in the quality of life of these individuals," Karpiak concluded.
Many HIV-positive adults may lack social support and feel isolated; as Fenton noted, older people experience both age- and HIV-related stigma and may choose not to disclose their HIV diagnosis to family and friends, leaving them with fragile support systems and setting them up for depression.
Lisa Power of the Terrence Higgins Trust presented results from the 50 Plus study, which surveyed more than 400 HIV-positive older adults in the United Kingdom. The study found twice as many long-term medical conditions in older people with HIV compared to their HIV-negative peers, as well as higher rates of unemployment, lower likelihood of having savings or a pension, greater likelihood of living in rented or subsidized housing, and higher rates of depression and anxiety. "HIV systematically disadvantages you across a lifetime," concluded Powers.
To "turn the tide" of HIV/AIDS in older people, the panelists agreed that more must be done to provide high-quality care and services in environments that welcome older adults, and to address HIV stigma, ageism, the social isolation of older people with HIV, and health inequities around the globe. This will require involving older HIV-positive people at every step of the way and learning from their life experiences: "Everyone has gone through something," said health services planner Carolyn Massey. "As we age, we are a resource."