Monday, January 6, 2020
I had blogged previously about meeting with two professors from the School of Social Work at the U. of Missouri. One, Dr. Erin Robinson, was kind enough to write the following blog on this important topic.
The Greying of HIV in America
By: Dr. Erin L. Robinson, MSW, MPH
Assistant Professor, University of Missouri School of Social Work
My name is Dr. Erin Robinson and much of my research focused on older adults, sexual health, and the prevention of HIV. I get a lot of questions about my research, including the need for such research, therefore I am going to share some information with you about the ‘greying of HIV’ in the United States. Over the past decade, older adults have been one of the fastest growing population groups affected by HIV/AIDS in the United States. Currently, 17% of all new HIV infections in the U.S. occur among people ages 50 years and older. This age group also accounts for nearly half of all people currently living with HIV. While the routes of HIV transmission in older adults is similar to that of their younger counterparts, there are some unique factors that contribute to the ‘greying of HIV’ in the U.S. Below are some interesting facts:
Facts about HIV and Aging:
- Older men are disproportionately impacted by HIV, however rates of older heterosexual women becoming newly infected are rapidly growing. This has led to specialized prevention interventions for older, heterosexual women.
- Older African American and Hispanic men and women are disproportionately impacted by HIV.
- 60% of all older adults living with HIV are virally suppressed, which means they have no risk of sexually transmitting the disease to others.
- Older adults are more likely to be diagnosed when HIV is further along in the disease progression (i.e. late-stage HIV). This means treatment options may not be as effective and mortality rates increase. Many of the symptoms for HIV can be similar for other illnesses, therefore if an older person does not test for HIV then they (and their healthcare provider) may attribute the symptoms to other causes.
- HIV can cause dementia-like symptoms, this is called HIV-associated neurocognitive disorders (HAND), AIDS dementia complex, or HIV-associated dementia. However, those symptoms can be reversed with proper HIV medications.
- Over the past few years, new HIV infections have decreased among the aging population. This is due, in part, to tailored prevention interventions among public health officials. However, we still have progress to make in order to curb the disparities.
Why are we seeing this ‘greying of HIV’ in the U.S.?
- Historically, older adults today have higher divorce rates than previous generations. This means older adults are engaging in new romantic relationships at higher rates as well.
- Our older generation today has lived through major historic events that have helped shape their outlook on themselves, their relationships, and their sexuality. This includes the industrial revolution, the 2nd wave of the women’s rights era, the Civil rights movement, the sexual revolution, the gay rights movement, and others.
- Older adults are healthier now than ever before, allowing them to experience sexually satisfying relationships later in life. Over the past 20 years, erectile dysfunction medications have also enabled men to engage in sexual relationships well into their later years.
- After women have reached menopause and can no longer get pregnant, we see lower levels of condom use. This is true for both committed relationships and new sexual encounters with a casual partner.
- Older adults do not perceive themselves to be at risk for STIs and HIV, therefore are less cautious in avoiding transmission.
- A lot of stigma exists around older adults and their sexuality. Many people like to believe that older adults do not engage in sex. Therefore, this creates an environment where older adults feel like they have to hide or deny their sexuality, which exacerbates STI and HIV infection and diagnosis rates.
- Healthcare providers have a difficult time talking to their older patients about their sexual health and HIV. In fact, when there is an age differential and a gender differential between the provider and the older patient, providers report being uncomfortable prompting such conversations. Providers also report that time is a big barrier in initiating such conversations, especially when their older patient has other health concerns.