By: Kandace L. West, Pharm.D.
People are now living longer with HIV due to increases in research and development for antiviral therapies and now – possibly – prevention therapy for HIV infection for high risk groups (i.e. Tenofovir, read more here http://www.medscape.com/viewarticle/805739). This has led to a surprising problem not previously contemplated for people with HIV: how to live well and enjoy life while also controlling their disease? So while HIV/AIDS is no longer the terminal diagnosis it once was, no one would argue that it would be far better to not have to battle it at all. Therefore, the “New Challenge” is not only increasing awareness for this disease for the older adult population so as to prevent its spread, but also how to provide support for individuals with this disease, which is challenging enough at a younger age. September 18th is National HIV/AIDS and Aging Awareness Day and in honor of that, understanding the risk factors for what places an Older Adult at risk for HIV helps to prevent it from occurring and increase awareness. So let’s talk about risk factors for HIV in the Older Adult:
(1) Lack of awareness: For the older adult, there is a fundamental disconnect with who they see as the face of those infected. Posters and advertisements to get tested usually display younger counterparts – hip, youthful, and active. Never is an older adult considered at risk for the disease, even though there are a growing number of people living well into their older adulthood with the disease or being infected with HIV as an older adult in their 40s, 50s, 60s, or even 70s. Also, an older adult who already may be struggling with isolation associated with older age will perhaps be further distanced from others by the diagnosis of HIV.
(2) Least likely to have protected sex: For the older adult, many grew up in a time when both condoms were rarely used, and HIV was not part of the Sexually Transmitted Disease flora. Fact was the only diseases that were heavily considered were those that were luckily curable: Chlamydia, Gonorrhea, and Syphilis. This previous experience, cemented in their consciousness, coupled with the ordinary discovery that menopause makes conception impossible, and at last drowned in the dangerous misconception that the older adult population is least likely to get HIV, are all the reasons why HIV/AIDS has so effortlessly claimed so many older adults.
(3) Medications: The older adult man is likely to be taking pharmaceuticals such as Viagra or Cialis. A research study by Medical News today (04/30/2007) found that a third of sexually active men taking Viagra were unlikely to use protection despite not being in a relationship. Again, this ties into beliefs about protected sex, but also medications play a role in stimulating sexual activity. Those substances that impair judgment (e.g. illicit drugs, certain prescription drugs, and alcohol) may also have a role in increasing the risk for HIV when combined with sexual activity in the older adult population.
(4) No routine testing in Primary Care: Do I need to explain this? Most primary care physicians do not routinely test for HIV; I think it should at least become part of an annual exam for individuals over 50? Ask for it during your next doctor’s appointment.
You can find more info about HIV and Aging here http://aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/taking-care-of-yourself/aging-with-hiv-aids/