Impact of HIV/AIDS on Over 50 Population Growing

Impact of HIV/AIDS on Over 50 Population Growing

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NEW ORLEANS--As the global AIDS epidemic continues to age, greater focus is being paid to older adults living with HIV.

AIDS advocates are calling on service providers and health departments to tailor HIV prevention services, including HIV testing, to meet the needs of

HIV Over 50-- A Global Epidemic
The rise in older adults living with HIV is a global phenomenon, according to 2013 report on the worldwide HIV epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The agency estimates that 3.6 million people ages 50 and older live with HIV. And 2.9 million of them are in low-and middle-income countries At the same time, UNAIDS reported, AIDS-related deaths have dropped by 30 percent since the peak in 2005, due to expanding access to antiretroviral treatment.

"People 50 or more are frequently being missed by HIV services," stated UNAIDS Executive Director Michel Sidibe. "This is costing lives. Much more attention needs to be given to their specific needs and to integrating HIV services into other health services."

The HIV Medicine Association of the Infectious Diseases Society of America has updated its HIV care guidelines to reflect that people with HIV are now living normal life spans. It calls on physicians to focus on preventive care, such as by screening for high cholesterol, diabetes and osteoporosis.

The report also suggests that doctors discuss their patients’ sexual history with them (current and past) and counsel them on any risky behaviors, such as the use of illicit drugs—and to do so in a nonjudgmental manner so doctors can determine how patients are coping with HIV and whether they have a sufficient support network.

"Patients whose HIV is under control might feel they don't need to see a doctor regularly, but adherence is about more than just taking ART [medication] regularly; it's also about receiving regular primary care," stated Judith A. Aberg, MD, lead author of the guidelines and director of the Division of Infectious Diseases and Immunology at the New York University School of Medicine.

--Matthew Bajko

people age 50 or more. And new guidelines for doctors with patients with HIV are being released that highlight the need to focus on preventive care. 

The issue of an aging HIV and AIDS population has been a growing focus for local health officials for several years now, with new programs being developed to address the specific needs older adults are confronting due to the AIDS epidemic.

San Francisco’s 50-Plus HIV/AIDS Majority

A 2011 Bay Area Reporter story noted that for the first time people 50-plus accounted for the majority of people living with an AIDS diagnosis in San Francisco.

The 2012 HIV/AIDS Epidemiology Report released by San Francisco’s Department of Public Health revealed decreasing proportions of HIV/AIDS diagnoses for those ages 30-49, but a sharp rise for those 50-plus from 42 to 51 percent between 2009 and 2012.

San Francisco had 8,063 people living with HIV in 2012, plus 5,150 in the 40-49 age group. Nationally, the U.S. Centers for Disease Control and Prevention (CDC) reports there were 872,990 people living with HIV in 2010, 31 percent of them 50 or more.

By 2015, CDC predicts that more than half of people living with HIV will be 50-plus.

"That is a pretty daunting statistic,” said University of Washington, Tacoma, social work professor Charles A. Emlet. "But guess what? Older people have sex and are at risk for HIV regardless of sexual orientation."

During the Gerontological Society of America's recent scientific meeting in New Orleans, Emlet presented a paper titled "The Impact of HIV on the Lives of LGBT Older Adults."

Emlet based the paper on data from the Caring and Aging with Pride (CAP) project, a national study of more than 2,500 LGBT older adults that issued a groundbreaking report in 2011. The researchers estimated that 9 percent of the LGBT older adults in the survey were living with HIV or AIDS. They found that the average age was 66 with 58 percent gay men. About half were living at or below 200 percent of the federal poverty level.

“Double Jeopardy”

"People didn't expect to live. Then antiretroviral therapy came along and they are living longer and healthy lives," said Emlet, who began working on AIDS issues in Northern California from the late 1980s through 1999.

Those living with HIV/AIDS were less likely to have children, were more likely to live alone and have experienced the death of a partner, according to the CAP study paper's findings. The loss of their same-sex partner usually led to the loss of social support as people grow older with HIV, found the researchers.

There is "the possibility of double jeopardy," said Emlet, from living longer with HIV and having elevated stress levels. The respondents in the national study reported having more anxiety and thoughts of suicide. They were also were more apt to be lonely.

"There was no difference in their physical health compared to HIV-negative people. But HIV-positive people had significantly lower mental health," reported Emlet. "Clearly, there is an issue around social support and social connectedness with this population."

Data from the CAP study was unclear on whether the health issues older adults with HIV/AIDS face stem from the virus, age or the effects of medications they must take. The CAP project has received federal funding to conduct a longitudinal study of older LGBT adults that could provide more insight.

The current survey data "begins to paint a picture of pretty serious risk for these individuals," said Emlet. "HIV appears to have additional impacts on LGBT older adults."

Matthew S. Bajko wrote this article for Bay Area Reporter, which published a longer version, through the MetLife Foundation Journalists in Aging Fellowships, a program of New America Media and the Gerontological Society of America.