On May 12, the Senate Special Committee on Aging held a hearing to examine the increasing incidence of HIV/AIDS among individuals over the age of 50. Committee Chair Gordon Smith (R-OR) opened the hearing, saying, “Although we often hear how the face of HIV/AIDS is changing to include women, children, and people of color, we generally do not think of it as a problem facing America’s seniors. However, significant breakthroughs in the treatment of HIV—particularly the rise of highly effective antiretroviral therapies—have allowed infected persons to live longer, fuller lives. In other words, people with HIV are aging.” Sen. Smith continued, “Despite myths, seniors are sexually active and their behavior can put them at risk for HIV infection. Older women in particular are at risk because they no longer are under the threat of pregnancy due to menopause. Therefore, most do not believe condoms are necessary. Further, apprehension by health care providers about discussing sexual matters with seniors and failure of HIV/AIDS public health messages to focus on this age group contribute to an overall lack of awareness and increased risk among those over age 50 years.”
Director of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention (CDC) Dr. Robert Janssen discussed HIV/AIDS trends among persons aged 50 and older, as well as CDC prevention efforts for this age group. “The total number of people living with HIV/AIDS is increasing. This is true for both those under 50 and those over 50. For instance, in the 32 states with name-based HIV reporting in 2000, almost 40,000 people who were over 50 were living with HIV/AIDS. This number increased to almost 67,000 by 2003,” he said. However, he added, “We do not believe the increase in people living with HIV or AIDS is caused by an increase in new infections,” noting that in 2003 there were 4,308 new HIV/AIDS cases in persons aged 50 and older and 27,524 new cases in persons under the age of 50. Rather, the CDC attributes the increase to the new treatments available, which allow people who are infected to live longer and healthier lives.
In discussing the statistics, Dr. Janssen pointed to racial disparities: “When you look at rates of newly diagnosed cases of HIV/AIDS among persons age 50 and older by race, rates are 10 to 15 times higher among African Americans than among whites, and 5 times higher among Hispanics than among whites. The numbers of cases among American Indians, Alaska Natives, and Asian and Pacific Islanders are too small to calculate rates among those groups.”
Among the 141 community-based organizations funded by the CDC, nearly 80 percent include persons aged 50 and older as one of their target populations. Prevention services provided include targeted outreach, voluntary counseling and testing, partner counseling and referral, and health education and risk reduction. “One of the challenges of prevention among persons 50 and older is the mistaken belief that they are not at risk for HIV or other STDs [sexually transmitted diseases]. Studies have noted that physicians do not always address sexual health with their older patients and that their patients often have only limited knowledge about risk factors for HIV transmission. This lack of awareness on the part of the health care providers is a barrier to educating older adults about the risk of HIV. CDC recommends that physicians take a sexual history from their older patients and discuss their risk for HIV and other STDs,” stated Dr. Janssen.
Thomas Burner, executive director of the Cascade AIDS Project in Portland, Oregon, described the challenge in dealing with an aging HIV-infected population. He cited a 61-year-old male corporate executive, who contracted HIV from injection drug use and has since divorced from his wife of 30 years. “Fast forward to when eventual fair health and hard-earned confidence prompts Jim’s desire to return to dating and sexual activity. Jim’s most likely to encounter women over 50, unconcerned about pregnancy (and condom use), with little to no knowledge about safe sex practices, and unsuspecting of HIV/AIDS risks. Contrary to the basis of ethics, out of momentary passion, fear or shame, he may or may not disclose his HIV-status…People live longer. Spouses die. Couples divorce. Today’s person over 50 is younger, more vital, more physically active, for a longer period of time,” he said. He encouraged the federal government to adequately fund HIV/AIDS awareness and prevention programs designed specifically for individuals over the age of 50.
Speaking to the issue of long-term care, Jeanine Reilly, executive director of the Broadway House for Continuing Care, a facility for people living with AIDS in New Jersey, stated that the average age of her clients has increased from 26 in 1995 to 44 in 2005. “Baby boomers are not relinquishing their sexuality just because they’re aging,” she said, pointing to commercials for drugs such as Viagra and Cialis. “The message about the threat of AIDS is not out there. Often condoms are not used because the risk of pregnancy for seniors is no longer an issue, and they don’t imagine their peers as potentially HIV+. Sexual negotiation techniques are, at this point in time, a ‘non-starter’ for a senior,” Ms. Reilly said. “In short, long-term HIV/AIDS care is needed for a new population…an older population for those working in the AIDS world, and a younger population for those in the Long-Term Care world. A collision of the two worlds is at hand.”
The committee also heard from Shirley Royster, a 57-year-old African American woman, who has been involved in a relationship for 20 years and tested positive for HIV in 1985. In discussing her health issues, she stated, “When I started menopause, I went to my doctor to ask some basic questions about hot flashes, mood changes, irregular Pap smears, fatigue, and how the HIV/AIDS meds would affect me…My doctors didn’t know how HIV/AIDS symptoms and menopause changes would interact with the many medications I was taking.” She praised the National Association on HIV Over Fifty for providing the needed answers and resources on aging with HIV. “As I age, I would like to be able to know that I can get my HIV/AIDS health needs taken care of with more resources.”
