Kevin Fenton, MD, PhD, FFPHDirector
National Center for HIV/AIDs, Viral Hepatitis, STD and TB PreventionCenters for Disease Control and Prevention
HIV Prevention Programs Among Older Adult
Populations
AIDS 2012HIV and Aging Satellite Session
July 25, 2012
1. HIV among older adults in the U.S.
2. Prevention challenges3. Improving care and treatment
of older adults with HIV
Overview
The majority of Americans aged 57 to 65 years, and a substantial fraction of those 66 and older, remain sexually active.
Older persons may have been in a long-term monogamous relationship and have poor understanding of HIV transmission
Minority of older patients discuss sexual activity with care givers Few older Americans use condoms
Sexual Health Needs of Aging Adults
Source: Lindau et al, NEJM, 2007; 2008 National Survey of Sexual Health and Behavior
CDC estimates 33% of all persons living with HIV in 46 states are 50 and older; by 2020 more than 50% of all persons living with HIV may be 50 and older
Approximately 11% of new HIV infections are among adults 50 and older In 2001, 13% of new diagnoses of HIV infection were among persons 50
and older, while in 2009, 17% were among those over 50
HIV/AIDS Among Older Adults in the U.S.
Prejean PlosOne 2011; Linley et al., American Journal of Public Health, 2012; Brooks et al., American Journal of Public Health, 2012.
Racial/ethnic disparities in HIV diagnosis rates are greater among persons aged 50 and older than among younger persons Rates of HIV diagnosis among older (50 and older) blacks and
Hispanics/Latinos for 2005-2008 were 13 times and 5 times, respectively, as high as those among older whites
Rates among younger blacks and younger Hispanics/Latinos were 8 times and 3 times as high as those for younger whites
By region, highest average rate of diagnosis per 100,000 among older persons was in Northeast (15.8), followed by the South (12.3)
There was a 3.4% annual increase in diagnosis rates for older persons, compared to a 2.3% increase for younger persons
Prevention ChallengesHIV Health Disparities and Older Adults
Source: Linley, American Journal of Public Health, 2012
Older persons were nearly twice as likely to receive a late diagnosis of HIV infection compared to younger persons (2005-2008).
Half of the older persons received their diagnosis late in course of infection—AIDS developed within 12 months
Prevention ChallengesOlder Adults and Late HIV Diagnosis
Source: Linley, et al., American Journal of Public Health, 2012
HIV-infected older persons increasingly affected by chronic illnesses such as heart disease, bone fractures, and hepatic disorders that occur at rates greater than expected for age
Thus primary and preventive care is especially important
Prevention ChallengesGreater Risk of Chronic Illness
Brooks et al., American Journal of Public Health, 2012
Older persons of minority races/ethnicities may face discrimination and stigma that can lead to later testing, diagnosis and reluctance to seek services
Health care professionals may underestimate their older patients’ risk for HIV and miss opportunities for HIV testing
Physicians may miss AIDS diagnosis because symptoms in older patients can mimic those of normal aging
The stigma of HIV can be more severe for older adults, leading them to hide their diagnosis from family and friends, and missing social support
HIV Prevention for older adultsChallenges for the affected community
CDC, HIV/AIDS among Persons Aged 50 and Older
Resource limitations and need to prioritize and target groups where HIV incidence is increasing, or access is especially challenging.
Limited advocacy by older adults to focus on HIV prevention and sexual health issues
Limited capacity and experience with programming for HIV and older adults
Limited surveillance, health needs assessment and other strategic information to inform program planning
Challenges with integrating sexual health and HIV prevention into other broad health programs for older adults due to stigma, ignorance.
HIV Prevention for older adultsChallenges for public health agencies and CBOs
Note: PMTCT, Screening transfusions, Harm reduction, Universal precautions, etc. have not been included – this is focused on reducing sexual transmission
Behavioural Intervention- Abstinence- Be Faithful
HIV Counselling and TestingCoates T, Lancet 2000
Male Condoms
Female Condoms
Treatment of STIs
Grosskurth H, Lancet 2000
Male circumcision
Auvert B, PloS Med 2005 Gray R, Lancet 2007 Bailey R, Lancet 2007
Microbicidesfor women
Abdool Karim Q, Science 2010
Treatment for prevention
Donnell D, Lancet 2010Cohen M, NEJM 2011
Behavioural positive prevention
Fisher J, JAIDS 2004
Grant R, NEJM 2010 (MSM)Baeten J , 2011 (Couples)Paxton L, 2011 (Heterosexuals)
Oral pre-exposure prophylaxis
Post Exposure prophylaxis (PEP)Scheckter M, 2002
VaccinesRerks-Ngarm S, NEJM 2009
HIV PREVENTION
TOOL-KIT
Healthy aging is the development and maintenance of optimal physical, mental, spiritual and social well-being and function in older adults.
It is most likely to be achieved by individuals who live in safe and supportive
physical environments and communities the effective use of health services to
prevent or minimize the impact of chronic disease
Draw upon principles of healthy aging and HIV prevention strategies for other populations
Integrating Healthy Aging and HIV Prevention
Source: The Healthy Aging Research Network Writing Group. Prev Chronic www.cdc.gov/pcd/issues/2006/jan/05_0054.htm.
Incorporate generational concernsTarget high risk groups such as older
gay men and older womenInvolve older adults as peer
educatorsEducate about HIV riskAddress ageism Provide HIV education and training for
service providers of elderly populations
Enhancing HIV prevention programs for older adults
Sources: http://caps.ucsf.edu/uploads/pubs/FS/over50.php; http://caps.ucsf.edu/uploads/pubs/FS/over50.php; http://www.aoa.gov/AoARoot/Press_Room/Products_Materials/fact/pdf/Seniors_and_HIV_AIDS.pdf
Need to promote healthy aging for those infected with HIV, ensuring preventive services, with emphasis on other health factors as well, such as mental health
Integrate HIV and Sexual Health programming into existing programs targeting older adults
Need for outreach in communities with higher numbers of HIV and STDs among older adults
Need to increase awareness about risk for HIV infection and importance of early diagnosis
Improving linkage to care so that older adults who are HIV infected can be treated earlier
Structural interventions and Policy Implications for Older HIV Population
U.S. Administration on Aging has developed materials aimed at risk reduction for older adults Fact sheets, posters, Powerpoint templates,
video http://www.aoa.gov
Jurisdictions with large numbers of older adults have focused on prevention for over 50 year olds Senior HIV Intervention Project in Broward
County, FL Gay Men’s Health Crisis, NY AIDS Community Research Initiative of
America, NY
Learn from, and disseminate, best and promising practices
Older people are at risk for HIV, and a growing proportion of people living with HIV are over 50, as people live longer lives with ART
Current efforts to focus on older adults reflect limitations in epidemiological, programmatic, policy and fiscal assessment and response
There is a need for additional models of effective prevention, treatment and care programs for older adults
There is a need to raise awareness among older persons as well as their general practitioners about HIV
Summary
Thank YouKevin A. Fenton, MD, PhD, FFPH
Centers for Disease Control and Prevention404-639-8000
Email: [email protected] Twitter: CDC_DrFenton
Web: www.cdc.gov/nchhstp
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