World AIDS Day: supporting older adults with HIV

Over half of the people living with HIV in the USA are older adults, which brings a new set of challenges to fighting AIDS, says Paul Nash.

paul nash portrait
Instructional Associate Professor of Gerontology Paul Nash

Editor’s note: For World AIDS Day on December 1, Dr. Paul Nash reminds us that it is more important than ever to remember both the lessons learned from HIV/AIDS and the individuals still being impacted by it today.

In the USA, the Centers for Disease Control and Prevention estimate that 1.2 million people are currently living with HIV; however, about 14% of these people are currently unaware of their status and therefore unable to access the support they need. Many stereotypes exist about people living with HIV, including that they are all young people; however, over half of the people living with HIV in the USA are older adults. This is a tale of two halves: successful antiretroviral treatments are keeping people healthy and therefore living longer, and over 16% of all new cases are in those over 50 years of age. Due to this, it is projected that within the next 10 years, over 70% of people living with HIV in the USA will be age 50 or older. While this is largely a success story, this does bring with it a new set of challenges and steep learning curves.

With current antiretroviral treatments, life expectancy is now very close to that of an HIV-negative person, a very different story from when the pandemic broke. However, these highly active antiretroviral therapy (HAART) treatments have only been available since 1995, and as such, the effects of HIV in older adults (those over 50) still requires significantly more research. Much debate exists about accelerated and accentuated aging experienced by older adults with HIV, whether age-related decline occurs sooner (accelerated), and/or if the burden of age-related decline is increased (accentuated). One thing that is widely agreed upon, though, are the social and medical challenges specifically facing older people with HIV.

Ageism is a pernicious and pervasive issue around the world and directly impacts quality of life and services received by older adults regardless of country, income or HIV status. The CDC recognize that:

  • Healthcare providers are unlikely to ask people over the age of 50 about their sexual activity and precautions or screen their sexual health. There is embarrassment on both sides of the relationship, which means that symptoms of STIs or HIV may be overlooked as normal aging rather than being diagnosed and treated/managed.
  • Just because older people are unlikely to get pregnant doesn’t mean that they shouldn’t practice safe sex; however, older people are unlikely to use condoms. Older people’s sexual health is still at risk and low levels of health literacy and targeted interventions are fueling this.
  • Older adults have the longest delay in diagnosis for any age group, putting them at risk of immune system damage and other complications. This is largely due to the lack of testing within this population.

Due to a lack of specific education, HIV awareness and the huge shift in social acceptance over HIV in their lifetimes, stigma and self-stigma is an issue. This may prevent older adults from accessing the HIV care continuum or disclosing their status to friends or family for fear or isolation or other repercussions. The intersectional nature of ageism and HIV stigma impacts cognition, stress and anxiety and has negative health and care outcomes. World AIDS Day gives us the ideal opportunity to reflect on the unique challenges faces by this “New Aging population” and the responsibility of each and every one of us to educate ourselves rather than relying on outdated stereotypes or myths about aging or HIV status.

The US government launched “Ending the HIV Epidemic: A Plan for America (EHE),” which aims to end the HIV epidemic within the next 10 years. Specifically, the plan sets out to reduce new infection rates by at least 90% by 2030. This will only be achieved by approaching the pandemic from multiple angles. We need to increase the funding into research, we need to educate healthcare professionals about HIV within all populations and we need to educate the general population to help reduce the stigma and, in turn, open up avenues to treatment and management. The Undetectable = Untransmissible (U+U) campaign sought to educate that a HIV-positive person on medication, achieving viral suppression where the virus is undetectable, cannot pass on the virus sexually. This was a success within certain communities that were targeted, but in the wider population, the message still goes unheard.

Working with science rather than stereotypes, we can support those older adults living with HIV, help prevent future infections and improve the quality of life for those living with the virus.

Dr. Paul Nash, an Instructional Associate Professor at the University of Southern California Leonard Davis School of Gerontology, is also a Commissioner for the Los Angeles County Commission on HIV, translating research and aging expertise into standards, policy and practice throughout the region.