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What's Your Status? HIV/AIDS On The Rise Among Older Adults

August 11, 2011

Even in the Age of Information myths and misconceptions abound about HIV/AIDS prevention and transmission. But, according to UNC Charlotte Associate Professor of Sociology Diane Zablotsky, the most damaging response to HIV/AIDS is silence. Silence has contributed to an upsurge of HIV cases among individuals 50 and older over the course of the epidemic.

Currently, about 19 percent of all people with HIV/AIDS in the United States are age 50 and older. This number reflects a combination of people over 50 who have been recently diagnosed with HIV, as well as people who have been living with the virus for decades since improved treatments are helping people with HIV live longer.

According to a 2005 Centers for Disease Control and Prevention report, individuals over 50 remain a relatively small segment of those at-risk group for sexually transmitted diseases, with four times as many HIV diagnoses occuring in people ages 25 to 44. However, by the end of 2007, approximately 131,742 Americans aged 50 and older were diagnosed with AIDS.

But a confluence of conditions has created an environment for HIV to flourish in a traditionally low-risk, and therefore overlooked, population.

"Historically when you looked at AIDS diagnoses people 50 and older accounted for 10 percent of all diagnoses," Zablotsky said. Midlife and older adults have always been present in the epidemic. By 2007, they made up 12.5 percent of all Americans diagnosed with AIDS.

There are approximately 72 million Baby Boomers (individuals born between 1946 and 1964) in the United States today. Americans who make it to age 65 will live longer on average than their counterparts in the industrialized world, and many will remain sexually active well into their golden years thanks to pharmaceuticals (think Viagra) and other health technologies.

Many older Americans come out of lengthy marriages or relationships and re-enter the dating scene. Some are uneducated about HIV/AIDS or have antiquated views about the virus. A huge group of the over-50 crowd never got sexuality education in school.

Evidence suggests women, who can expect to live an average of five years longer than men, are especially vulnerable. In an analysis of National Health Interview data, Zablotsky found that almost half of women over age 50 were totally uninformed about HIV, compared with only 14 percent of younger adults.

In the early days of the epidemic, Zablotsky explained, blood transfusion was the primary mode of HIV transmission in older people. Currently, the primary mode of transmission for both older men and older women is through sexual activity. While working at the National Institutes of Aging, Zablotsky published one of the first papers on the issue.

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"When I first started my work, when we were trying to explore the situation with HIV generally, our first approach was to alert people that this [HIV/AIDS] was something that people across the life course need to know about," she said.

Though the health community has made strides in tailoring education messages, Zablotsky noted, most funding for preventive education in the last 20 years has targeted traditionally high-risk populations, often excluding older adults because of assumptions about their behaviors.

Zablotsky said prevention begins with open conversation, as well as the acknowledgment that humans are sexual beings across the life course. Labels and stigma associated with sexually transmitted disease remain barriers to conversation, but Zablotsky said fewer people might tune out messages that frame sexual health as a lifelong wellness issue.

"What we need to talk about is how you make choices to stay well," Zablotsky said. Research conducted by AARP indicates that older patients feel uneasy discussing sexual behavior with their physicians. Conversely, many young doctors are uncomfortable talking about risky sexual behavior with people old enough to be their parents or grandparents.

"One of the things that has been part of the discussion is how we can ask about risk factors when we do other types of screenings. The big thing is to keep asking people about their behaviors regardless of age," Zablotsky said.

These conversations do not have to take place within the confines of the doctor-patient relationship. Increasingly, public health professionals and advocates are encouraging teens and their parents to sit down and talk to their elders about HIV prevention.

Seventy-two-year-old HIV prevention advocate Jane Fowler made headlines with just such a suggestion. Fowler, who was diagnosed with HIV in her 50s, said people need to get over their embarrassment and start talking. She encourages doctors, friends, kids, grandchildren, and everyone else to check on the HIV prevention knowledge, motivation and skills of their elders.

Zablotsky concurs. "As a sociologist my goal is make conversations a part of our everyday activity," she said. "The risk does not disappear if we fail to discuss it."

University of North Carolina at Charlotte

More Than A Quarter Of People With HIV In The UK Are 'Undiagnosed'

August 01, 2011

The number of people living with HIV in the UK reached an estimated 86,500 in 2009, but more than a quarter - almost 22,500 - were unaware of their infection, according to figures released by the Health Protection Agency (HPA) today.

A total of 6,630 people were newly diagnosed with HIV in 2009 - 4,400 men and 2,230 women. Although this represents the fourth year-on-year decline in the number of new diagnoses, evidence suggests that there has been no decline in the number of undiagnosed infections in the past decade.

The HPA's report also found that over half of people newly diagnosed in 2009 - 3,450 - were diagnosed late, after the stage when treatment should have started.

Dr Valerie Delpech, consultant epidemiologist and head of HIV surveillance at the HPA, said: "We're very concerned that a large number of people in the UK are unaware of their HIV status and that half of all newly diagnosed people are diagnosed late, meaning they may not benefit from very effective treatments.

"The HPA would like to see increased access to HIV testing in areas where rates of HIV infection are high. Pilot studies have shown that in these areas testing all adults registering at GPs or accessing certain hospital services can make an impact.

"The evidence shows that this testing is feasible to undertake and acceptable to patients. We would like to see this rolled out in areas where HIV infection is more common to reduce the number of people who are unaware of their HIV status and increase the chances of early diagnosis, when treatment is more successful."

Across the UK, 1.4 people per 1,000 of the population - both diagnosed and undiagnosed - were living with HIV in 2009. Expanded HIV testing is recommended in areas where the number of people diagnosed is greater than 2 per 1,000 population. Of the 37 PCTs in England with rates above this level, 26 of them were London boroughs. Overall in London, 5.24 per 1,000 people were living with a diagnosed HIV infection in 2009. Other areas with rates above 5 per 1,000 were Brighton and Hove City (7.57 per 1,000 people) and Manchester (5.22 per 1,000 people).

As well as monitoring early diagnosis, the HPA has developed measures to evaluate the quality of treatment and care HIV patients receive. Analysis of data across London in 2008 found that over 80 per cent of patients were seen for HIV care within one month of diagnosis. And a high level of care in the UK was also observed - close monitoring of those undergoing treatment found that over 90 per cent of patients had an undetectable viral load within a year as well as a restored immune system. This not only confirms that treatments are effective for the patient but that the chance of transmitting the virus is greatly reduced.

Dr Delpech added: "Thanks to the development of anti-retroviral treatments and universal access to world class health care through the NHS, HIV is a manageable illness for the vast majority of people in this country. We're very pleased that 8 out of 10 people in London newly diagnosed with HIV are receiving immediate access to care but we need to ensure this is maintained and improved upon across the UK."

Dr Paul Cosford, HPA's director of Health Protection Services, said: "Today's figures suggest that extra effort is needed to ensure more people are aware of their HIV status. This will enable faster access to treatment, improve survival and reduce the risk of transmission to partners.

"As well as widespread access to HIV testing, the HPA recommends that people who are at higher risk of HIV, such as men have sex with men and black Africans living in this country, should know their status and consider testing regularly. And it's crucial to remember that using a condom with all new or casual sexual partners is the best way to prevent sexually transmitted infections, including HIV."


1. HIV in the UK report - the Health Protection Agency's 'HIV in the United Kingdom: 2010 report' is available on the HPA's website.

2. Estimating undiagnosed HIV infections - statistical modelling frameworks and techniques are applied to combine different surveillance and survey data to obtain an estimate of the prevalence of HIV in the population. Further details of the methodology and data sources employed are available from Presanis et al Insights into the rise in HIV infections, 2001 to 2008: a Bayesian synthesis of prevalence evidence. AIDS 2010 24:2849-58. Or for more information about HIV prevalence visit here.

3. Late diagnosis
- adults diagnosed with a CD4 cell count of less than 350 (within 91 days of diagnosis) are defined as diagnosed 'late', adults diagnosed with a CD4 cell count of less than 200 are defined as diagnosed 'very late'. For more information about late diagnosis, visit here.

4. Access to HIV testing
- the Department of Health has funded eight projects looking at the feasibility and acceptability of offering HIV testing in medical and community settings. The HPA has been tasked with analysing the results of these projects. An interim report entitled, 'Time to Test for HIV', will be presented at a conference being organised by the British Association for Sexual Health and HIV (BASHH) on Wednesday 1 December (World AIDS Day).

5. People with newly diagnosed HIV infection in 2009

- 3,560 (54 per cent) new HIV diagnoses were acquired heterosexually
- 2,760 (42 per cent) new HIV diagnoses were acquired by men who have sex with men
- 170 new diagnoses were acquired through injecting drug use
- Four out of five men who have sex with men acquired their infection in the UK
- A third of heterosexuals acquired their infection in the UK - the remaining two thirds are thought to have been acquired in sub-Saharan Africa

6. AIDS and deaths in people with HIV infection in 2009

- 547 people were diagnosed with AIDS in the UK, almost all of them at the time of their HIV diagnosis
- 516 people with HIV infection were reported to have died of any cause
- Of those who died, 73 per cent had been diagnosed late (with a CD4 cell count of less than 350)
- The number of HIV related deaths has remained stable over the past decade and the number of AIDS diagnoses has continued to decline

7. Accessing HIV care in the UK in 2009

- The number of people accessing care across the UK rose from 22,575 in 2000 to 65,319 in 2009 - including a seven per cent increase from 2008 when the figure was 61,110
- 78 per cent of diagnosed HIV cases in the UK were receiving anti-retroviral therapy in 2009, up from 76 per cent in 2008 and 70 per cent in 2000

Health Protection Agency

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