For persons over 50 years of age, many of the risk factors for HIV infection are the same as those for younger persons.
Sexual Risk Factors
Many older adults are sexually active and thus are as vulnerable as younger
persons to acquiring HIV through sexual transmission. A recent survey of sexual
behavior among older adults showed that 73% of persons aged 57–64 had had sex
during the past year, as had 53% of those aged 65–74 and 26% of those aged 75–85
Older persons who are infected with HIV can spread the disease to their sex
partners. Older persons who are not infected, especially those resuming sexual
relations after a divorce or the death of a partner, may not perceive themselves
as at risk for HIV and may not take preventive measures such as using condoms or
getting tested for HIV. Like younger persons, older persons need to know their
own HIV serostatus and that of potential sex partners.
Older women may be especially at risk for HIV infection because age-related
vaginal thinning and dryness can lead to tears in the vaginal area .
Older women who become sexually active with new partners after many years in a
monogamous relationship may find it awkward to initiate discussions about
potential risks and preventive measures such as using a condom.
Some older persons inject drugs or smoke crack cocaine, which can put them at
risk for HIV infection. HIV transmission through injection drug use accounts for
more than 16% of AIDS cases among persons aged 50 and older .
In one study , although drug users 50 years
and older were less likely than a younger cohort to share needles, they were
just as likely as younger drug users to engage in risky sexual behavior. The
researchers also found that older users who smoked crack engaged in behaviors
that were deemed extremely risky (for example, injecting drugs, having multiple
sex partners, and exchanging sex for drugs or money). Older injection drug users
living with HIV tend to be poorer and to have less social support than their
younger counterparts .
Lack of Knowledge about HIV/AIDS
Some older persons, compared with those who are younger, may be less
knowledgeable about HIV/AIDS and therefore less likely to protect themselves.
Many do not perceive themselves as at risk for HIV, do not use condoms, and do
not get tested for HIV.
- In one study, almost 60% of older single women who had been sexually
active during the past 10 years had engaged in sex without a condom .
- More than half of older rural African American women in another study had
at least one risk factor for HIV infection, such as engaging in sex without
a condom .
- In several studies, researchers have found that older persons had
misconceptions about HIV risks, such as believing that the virus can be
transmitted only by blood transfusions or casual contact .
- Only 13% of older women in one study said that condoms were effective
Being a Member of a Minority Race/Ethnicity
Older persons of minority races/ethnicities may face specific prevention
challenges. For example, in one study, older black and Latino men who have sex
with men were at elevated risk of acquiring HIV because they were sexually
active, had multiple partners, and included drug use in their sexual activity .
Moreover, older men who are not white tend to receive an HIV diagnosis later
than their white counterparts do, thus delaying treatment and increasing the
opportunity for further HIV transmission .
Stigma may be a greater issue for older persons of minority
races/ethnicities. For example, in one study, most elderly HIV-positive African
Americans said that their age was a major barrier to seeking service and family
Underestimation of Risk by Health Professionals
Health care professionals may not consider discussing HIV/AIDS with older
patients and thus may miss opportunities to deliver prevention messages, offer
HIV testing, or make an early diagnosis that could help their patients get early
care. Physicians and nurses may be influenced by the stereotype that older
patients are not sexually active or do not use drugs, so they may not ask about
those risk behaviors. Health professionals also may be uncomfortable about
raising these issues with patients who are older than they are. In a recent
study of sexuality among older persons, only 38% of men and 22% of women said
that they had discussed sex with their doctor since age 50 .
AIDS may not be diagnosed because some symptoms can mimic those of normal
aging, for example, fatigue, weight loss, and mental confusion. Early diagnosis,
which typically leads to the prescription of HAART and to other medical and
social services, can improve a person's chances of living a longer and healthier
life. According to a recent study , HAART
benefits older persons as much as it does younger persons. However, because
older persons tend to receive diagnosis later (after aging has affected the
immune system), their immunological response may be less than that of younger
Older HIV-infected persons, even those who are living longer because of HAART,
may begin to develop other chronic health conditions related to aging, such as
hypertension, diabetes, and Alzheimer's disease. HAART can affect, and possibly
worsen, these medical conditions . Further,
the decreased immune function that results from aging makes older persons more
vulnerable to a rapid progression of HIV infection to AIDS.
The stigma of HIV/AIDS may be more severe among older persons, leading them
to hide their diagnosis from family and friends. Failing to disclose that they
are infected limits or precludes potential emotional and practical support .
In the world of HIV prevention, persons over the age of 50 have been called
the invisible population. Few prevention campaigns have focused their messages
on older adults and their concerns. Moreover, few clinical trials of drug
efficacy and safety have included older persons, and persons aged 50 and older
have been excluded from most sexually transmitted disease risk-reduction trials
. Because more persons are living longer in
good health, those over the age of 50 could benefit from HIV prevention efforts.