Older Adults Overlooked in HIV Prevention & Treatment Efforts

With 1.1 million individuals in the United States living with HIV, health officials are focusing on ramping up preventive efforts. However, it seems that one population is currently being overlooked in this regard: older adults.

In a recent presentation delivered at the 125th Annual Convention of the American Psychological Association, Mark Brennan-Ing, PhD, director for research and evaluation at ACRIA, a nonprofit HIV/AIDS research organization, stressed that implicit ageism could be a key contributing factor to this negligence.

On a broader scale, ageism can be defined as “prejudice and discrimination against older people based on the belief that aging makes people less attractive, intelligent, sexual, and productive.” Thus, older individuals can experience this explicitly, when they face discrimination in hiring practices, for example, or implicitly, when they are met with biased attitudes and face stigma associated with their age on a societal level.

Although many HIV risk factors are the same for older adults as they are for younger individuals (engaging in sexual intercourse without a condom can put all individuals, regardless of age at increased risk of infection), some age-related factors also come into play. For example, according to the US Department of Health and Human Services, older adults who are divorced and begin dating again may not use condoms because they are unaware of the risk of HIV. Furthermore, an older woman who has gone through menopause may not use protection during sexual intercourse because she is no longer concerned that she may become pregnant.

“The lack of perceived HIV risk in late adulthood among older people themselves, as well as providers and society in general, inhibits investment in education, testing, and programmatic responses to address HIV in an aging population,” Dr. Brennan-Ing stressed in his presentation. “Ageism perpetuates the invisibility of older adults, which renders current medical and social service systems unprepared to respond to the needs of people aging with HIV infection.”

Contrary to a popular misconception, HIV is not just a disease of the young. In fact, in developed countries with developed health care systems, it is estimated that about half of those infected with HIV are aged 50 or older, according to the press release. In some of these countries, that number is expected to rise by a whoppinh 70% by the year 2020. Furthermore, this population currently accounts for about 17% of new infections and, unfortunately, has an increased likelihood of receiving AIDS diagnosis at the same time they become aware of their HIV status compared with their younger counterparts.

Not only do these individuals experience stigma related to their age, but they also experience stigma related to the disease; it is estimated that 2/3 of older Americans have experienced stigma related to both factors. According to the press release, the stigma may be amplified in older gay and bisexual men, “because of an increased obsession with age and internalized ageism within the gay community.”

“Internalized gay ageism” can be defined as “the sense that one feels denigrated or depreciated because of aging in the context of a gay male identity.” Stigma due to orientation, age, race/ethnicity, and gender identity can result in several poor health outcomes in this population.

“Stigma results in social isolation, either through rejection by social network members or self-protective withdrawal, leading to loneliness and, ultimately, depression,” Dr. Brennan-Ing explained. “Stigma also makes people reluctant to disclose their HIV status, which could affect their health care treatment or prevent them taking precautions to reduce transmission.”

Believing in negative stereotypes associated with aging can also increase stress, which could have poor physical implications. “If an individual believes that aging leads to inevitable health problems and decline, that person may stop engaging in healthy behaviors, creating a self-fulfilling prophecy,” according to the press release.

“These mechanisms may be responsible for empirical findings that internalized ageism is related to both chronic disease and longevity,” Dr. Brennan-Ing said.

Fortunately, community-level actions to address ageism for those who are at risk for or infected by HIV may help. Dr. Brennan-Ing recommended the following activities, according to the press release:

• Training health providers in HIV screening, early diagnosis, and initiation of antiretroviral therapy in older populations and integration of key services
• Prevention, education, and outreach targeting older adults
• Treatment guidelines for older individuals with HIV
• Funding in line with the aging of the epidemic
• Engagement of communities, community-based organizations, and social service providers in outreach, mental health, and social support
• Addressing the needs of special populations

“With the demographic shift toward adults in the HIV population globally, and the elusiveness of a cure, addressing the care needs of this aging population are paramount.” Dr Brannan-Ing stressed.