Increasing Risk of HIV Among Older People, Doctors Failing to Diagnose Cases in Population, WHO Study Says

People ages 50 and older are more likely to have unprotected sex than younger groups, increasing their risk for HIV and other sexually transmitted infections, according to a recently released World Health Organization study, Reuters UK reports. According to the WHO Bulletin report, "The Unexplored Story of HIV and Aging," physicians are failing to diagnose new HIV cases in this population because the virus still is considered to affect mostly younger populations. Older generations are "assumed not to be at risk," but HIV prevalence and incidence in people ages 50 and older "seem surprisingly high, and the risk factors are totally unexplored," the study said.

According to Reuters UK, the most likely mode of HIV transmission among older people is sexual activity, with the increasing use of impotence treatments a possible explanation for the "increase in frequency." The study said that erectile dysfunction drugs "have been extending the sex life of many older individuals" since 1998 and "may be extending the HIV epidemic into older age groups." The use of such medications "in industrialized countries has been associated with risky safety practices," the study said (MacInnis, Reuters UK, 3/3).

George Schmid, one of the study's nine authors and a researcher with WHO's HIV/AIDS department, said it is "certainly true" that a majority of the attention given to HIV/AIDS screening and prevention has been on younger generations "because those are the ones who are at most risk." However, "it doesn't mean that people who are 50 and older are at no risk, and we think there is an underappreciated number of individuals in that age group who are becoming infected," he said. Experts said that a larger focus needs to be placed on early HIV diagnosis among older people, and the study reports that there is not enough discussion of HIV even at the patient-care level. Schmid said, "Physicians don't think the (over-50s) are at risk, so they don't ask, or else they may be a bit uncomfortable asking." In addition, patients are "somewhat uncomfortable talking about these things," he said (Edwards, Canwest News Service/Ottawa Citizen, 3/4). Schmid also said that few HIV/AIDS surveys collect data about people ages 50 and older and primarily focus on people between ages 15 and 49.

Schmid said that the researchers "have been a bit surprised" by the "somewhat surprisingly high proportion" of older people living with HIV, which is about "one-quarter to one-third of the younger age groups" (VOA News, 3/3). Schmid said the "frequency" of HIV in older people is "worrying." He also said, "We need to understand why and when these people are becoming infected so that public health campaigns can be better targeted to prevent such infections" (AFP/Morningstar.com, 3/3).

According to the Canwest/Ottawa Citizen, separate studies have shown that older people are less likely to practice safer sex than their younger counterparts, which can lead to increased risk of HIV (Canwest News Service/Ottawa Citizen, 3/4). Reuters UK reports that older women may be at a higher risk for HIV transmission from unprotected sex because of thinning of the vaginal mucous membrane -- which gives natural lubrication -- that comes with aging.

According to the study, the life expectancy for people who contract HIV at age 65 or older is four years, despite antiretroviral drugs that can extend life expectancies for some people. The authors said that "[w]anning immunity with age" could be the reason for the decline in life expectancy (Reuters UK, 3/3). The report said that erectile dysfunction and medicine to treat it is "common" and "widely available," but "no study has been done of their possible impact on the HIV epidemic" (Reuters UK, 3/3).

The study is available online.

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