Underestimated: HIV Over 50

10. October 2017

The view that HIV infections predominantly affect young people is widely held – even among doctors. Yet 17% of new HIV infections occur in the age group 50 plus. Early diagnosis and treatment is important with older patients.

Being infected by the human immunodeficiency virus (HIV) is a relatively recent phenomenon: HIV was first described in 1983 and has spread all over the world since the beginning of the 1980s. Awareness campaigns, preventive and treatment measures are mostly aimed at youth, young adults and middle-aged adults. One group is often overlooked: the growing number of older people who are infected with HIV or are subject to risk of infection. As a result, many older divorced or widowed people who are again looking for partners believe that AIDS is not an issue in their age group. They underestimate the risk of getting infected with HIV.

“The misunderstanding stubbornly endures that HIV is a disease of younger people – especially of younger homosexual or bisexual men”, explains Mark Brennan-Ing, research director at ACRIA, a non-profit HIV and AIDS research organisation based in New York City. The psychologist reported his findings at the 125th anniversary of the American Psychological Association in Washington DC.

Increasingly more HIV infected people are 50 years or older

In actuality, as populations age worldwide the number of older people with HIV or AIDS increases as well. As such it is estimated that in highly developed countries almost half of HIV-infected people are 50 years of age or older. According to information from the Centers for Disease Control and Prevention (CDC), 17% of new HIV infections occur in this age group.

With older adults, HIV infection is often detected at a later time point than in younger adults. Moreover, HIV is more frequently diagnosed when AIDS infection has already been detected: in the USA this is the case for 40% of over 55s who have been diagnosed with HIV. As a result, treatment can only be initiated at a relatively late stage and can present even greater damage to the immune system.

A current study also shows that the life expectancy of HIV-infected persons over 50 years of age has in truth increased significantly in recent years: over the 2006 to 2014 period this has increased by 10 years as compared to the period 1996 to 1999. Nevertheless, it is lower than the life expectancy of the whole population. Thus HIV-infected persons of this age group who receive good treatment and do not even have any accompanying symptoms or symptoms of AIDS have a lower life expectancy than the average population. Furthermore, older adults with HIV often have physical characteristics or illnesses that usually occur in a more advanced age.

Frequently overlooked by the health system

“Both health care workers and older people themselves often have the wrong idea that the risk of HIV infection is low in older age”, Brennan-Ing notes. This can lead to older people with HIV being “overlooked” in the health system, not being tested for an infection and not being adequately treated, he says. “At present, medical and social systems are not focused on addressing the needs of older people with HIV. The supposedly low risk for older adults prevents greater investments in comprehensive HIV testing and systematic treatment approaches for this population group”.

At the same time, many older people infected with HIV are exposed to prejudice and discrimination, both because of their HIV infection and their age. A study from the US in this regard reveals that two-thirds of older adults infected with HIV have already suffered discrimination. This can lead to severe mental stress, which in turn can adversely affect physical health.

“Stigmatisation leads to social isolation – either because those affected are rejected by others or because they become withdrawn. This is followed by loneliness, often also by depression”, Brennan-Ing explains. “Furthermore, the fear of stigma can lead to people not talking to others about their HIV infection and thus not being adequately treated”.

Furthermore, negative expectations regarding their own health in old age, and the knowledge of being infected with HIV, brings with it stress and a high psychological burden. Further problems such as cardiovascular disease can develop from this. Finally, negative expectations with regard to one’s own health can lead to those affected no longer paying attention to their own health and neglecting preventive or therapeutic measures.

Education and care for older HIV-infected persons

It is therefore important to introduce preventive and educative measures for older adults as well as to set up counselling centres that specifically target this age group. According to the CDC, older adults have the same risk factors for HIV infection as do younger adults. Nonetheless, many underestimate their risk of becoming infected with HIV.

Thus, many elderly divorced or widowed people who are again looking for a partner believe that AIDS is not an issue in their age group. Women who have already gone through menopause, thus being able to dispense with contraceptives, more rarely make use of condoms, which protect them from sexually transmitted diseases (STD) including HIV.

Developing treatment guidelines for the older people

However, specialists in the health care system also need to be made more aware of this issue, Brennan-Ing stresses. “They should be trained to motivate older adults to undergo HIV screening, to identify HIV infection early, and to promptly introduce antiretroviral therapy”.

It is also important to develop treatment guidelines for older people with HIV. This is because they much more frequently than younger patients have accompanying or follow-up diseases. In addition, HIV-infected persons generally have increased risk of heart attacks, strokes and certain types of cancer; especially with older patients doctors should therefore be particularly vigilant here.

What’s more, therapy for HIV infection at an older age can lead to more side effects. Finally, interactions can occur with medicines used to treat other diseases that are more common in old age – such as hypertension or diabetes mellitus. All this must be carefully considered during the treatment.

Finding a response on a global level

For this reason, more funds should be invested in research and improved care, according to Brennan-Ing. This also includes establishing more social facilities that provide counselling and psychological and social support for older HIV-infected persons. Such counselling centres could assist those affected by anxiety or depression in connection with the disease or by psychological stress caused by social exclusion.

“It is very important to deal with the needs of this population group”, Brennan-Ing says. The increasing age of people with HIV is a major challenge, particularly in countries with low or medium levels of development, in which the medical infrastructure present in highly developed countries is lacking. “Nevertheless, the topic also offers the opportunity to develop a response at a global level that addresses the needs of the affected people in different regions and situations”.

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1 comment:

Dr Franz Nanni
Dr Franz Nanni

fact… also OLDER people are having SEX.. and are doing same mistakes like the young people, therefore, the infection-rate should be similar pro rata… It looks like that HIV is still underestiamted..

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