Positive Aging: HIV T

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION ON AGING, WASHINGTON DC 20201PHONE 202.619.0724 | FAX 202.357.3523 | EMAIL aoainfo@aoa.gov | WEB http://www.aoa.gov 
Introduction/Housekeeping

WelcomeThe Complications of SuccessA Personal PerspectiveImplementation in Community SettingsArea Agencies on Aging & HIVResourcesQuestions

Agenda
Welcome

Kathy Greenlee creta
Presenters

Steve Karpiak, PhD, Director for Researc

AIDS Community Research Initiative oNew York University

Jane Fowler, Director, HIV Wisdom for ODoreen Bermudez, Training Coordinator, 

Resource Center for LGBT Aging/SAGAdvocacy for GLBT Elders

Courtney Williams, Community Planner, 

Columbia Office on Aging 
The Complications of Success: The Aging 

Stephen Karpiak PhDAssociate Director for ResearchAIDS Community Research Initiative of America (ACRIA)ACRIA Center on HIV and AgingNew York University College of NursingNYU Medical Center for AIDS Research
ACRIA: AIDS Community Research Initiativ

founded in New York City in 1991

Clinical Trials

• Antiretrovirals• Side‐effects management

• Comorbid treatments

Older Adults Research

• Social networks

• Depression management• Multimorbidity

management

• Service utilization• Accessing caregivers• Stigma• Spirituality• Sexual behavior and

substance use

Educ

• Staf

need

popu

• Tech

capa

• Cont

cred

• Mate

lang

• Socia

• HIV p
It Has Been 30 Years

By the end of 1990, just nine years from the sta

epidemic, approximately 160,000 Americans ha

diagnosed with AIDS and 110,000 of them had a

As of 2010 there are nearly 1.1 million America

By 2015 the CDC estimates that one‐half of Ame

will be age 50 and older
September 2008: HHS Establish

September 18 as an annualNational HIV/AIDS and Aging 

Oct 2010

White House Office of National AIDS Policy conven

a Special Meeting on HIV and Agin
HIV Infection

HAART

It takes 10 years for the virus to cause

the collapse of the immune system resulting in

AIDS

HAART treatment stops that collapseCDC policy is to test and treatto prevent the development AIDSand to reduce new infections
0

100002000030000400005000060000700008000090000

100000110000120000130000

1994 200

HAART

USA AIDS Cases Over Age 50  ‐ 
'85‐87 '90 to '92 '95 to '97 '00 to '02 

2

4

24.3

27.1

HAART

Median Life Years at Age 20 with HIV an
% OF PEOPLE LIVING WITH AIDS DIAGNOSIS OV

CDC SURVEILLANCE DATA

U.S. Department of Health and Human Services, Administration on Aging, Washington DC 20201 PHONE202.619.0724 | FAX 202.357.3555 | EMAIL aoainfo@aoa.gov | WE

B http://www.aoa.gov

05

10152025303540

1998 1999 2000 2001 2002 2003 2004 2005 
New York City is the U.S

Epicenter

There are approximate

120,000

people living with HIV

42% are over age 50

and 

75% are over age 40
19 % and less

20-29 %30-39 %40 % and more

% of People with HIV Age 50 and Older 2

Please refer to the image description found on page 64 for an 

accessible version of this map.
CARE

CARE

• Drugs to treat HIV are effective thereby t

diagnosis from a death sentence to a long 

• The overwhelming majority of older adult

infected before age 50

Prevention

• Almost 1 in 6 new HIV infections occur in 

older

Prevention

• New HIV infections have been largely igno

efforts have not targeted older adults

Why is the HIV Population Growing an
ACRIA Funded Initial Studies 0n HIV and A

WHO

Are These Older Ad

Living with HIV?
RESEARCH onOLDER ADULTS 

Stephen E. Karpiak, PhD

Mark Brennan, PhD

Principal Investigators

ACRIA Center on HIV and Aging

Nearly 1,000 NYC Adults Over Age 50
ROAH is COMPREHENSI

DemographicsSexual Behavior / SUse Social NetworkPsychological Well­Distress – DepressiHIV Status/HealthReligiousness & SpiLoneliness Among OHIV Stigma and Dis
Latino

32 %

White

21 %

Black

44 %

Male

69 %

ROAH Mirrors the HIV Population of N

API / A
ROAH: Age Distribut

Mean Age = 55.3 / Age range 5

6

12%

30%

52%

50 to 54 55 to 59 60 to 64 6
Heterosexual

67%

H

ROAH: Sexual Self‐Identif
ROAH:HIV Treatment and 

Treatment facility %

– Private physician 21.9

– Public clinic / hospital 58.7– VA Hospital 4.9– AIDS Service Organizations 17.0

83% of ROAH Participants Rely o
ROAH: Living Arrangem

Alone

70%
ROAH: Stigma and Disclosure of HIV 

35.4

36.4

44.6

52

65

65

6

0 10 20 30 40 50 60 7

Place of Worship

Co-Workers

Drug buddies

Social groups

Friends

Family

Sexual partners

Healthcare
ROAH: Substance Use

Including Tobacco Use

Current :

57 %

Histo

84 
ROAH: Substance Use Rec

Recovery Status 

• Ever enrolled in 12-step 

• Currently in recovery • No substance use in past 3 m• In recovery for more than 1 y
Depression in ROAH vs. Other Ol

Figure 2 Comparison of Average CES-D Scores among Middle-age and who are Community-dwelling, Visually-Impaired, or Living with HIV in on Community- dwelling adults and visually impaired adults were obtaiGump et al. (2005) and Horowitz et al. (2006), respectively.
Over 2/3 of the ROAH participants 

had moderate to severe depression

Depression decreases adhere

medication including HIV 

Although enrolled in medical care their

depression remains poorly managed
A Simple Phone Call

ACRIA Study Using the MacArthur 

for Depression

20181614

es CES-D Scor121086

420

1 2 3 4 5 6 7 8 

Weeks in the study
The Complications 

of Success

Older adults with HIV

are developing at an early 

illnesses that are more typically ass

later senior years.

These include Cancers – Cardiovascular Disea

Liver and Kidney Disease – Diab
ROAH: Comorbid Health Pr
Average Number of Comorb

0

1

2

3

4

5

Elderly 70+ ROAH

1.1

3.3
>50% of Deaths Attributed 

Non-AIDS Events

Cumulative Mortality by COD Among Those initiating HAART(1996-2006) ART-CC, CID 2010: 1387-139
Am

Aca

HIV M

A

G

S

ACRIA Cent

on HIV and

Aging

ExpertPanelof14

LeadersinHIV

TreatmentResearch

andGeriatricCare

AAHIVM: Guides for the Management of Older A
HIV

Cancers – Cardio

Osteoporosis – 

Disease – 

Mental

Health

So

Isola

Multimorbidity

Care

Management
CAREGIVERS

are derived from

SOCIAL NETWORKS

Social networks are a significant 

• services resource 

Caregiving = $400 Billion An
ROAH: Social Network Com

0 20 40 60 

Parent

Child

Sibling

Other 

...

Friend

Living Functional

Percent

Please refer to the image description found on page 6

5 for an accessible version of this

graph.
ACRIA’s Research Demonstrates th

Older Adults with HIV have Fragile Socia

Increase the likelihood they will enter and rem

in long

‐term care facilities

Increase levels of isolation, loneliness and depression t

diminished health outcomes

Lead to greater reliance on formal support s
There is NO

And other outlandish lies about g
Sex is Not Only for the Y

Lindau et al. NEJM 2007 357(8):762-774

Percent reporting sex in last 12 months 83.7 67.0 38.5 61.6 39.5 16.7

0.0

10.020.030.040.050.060.070.080.090.0

100.0

57‐64 65‐74 75‐85

MenWome

Age
In 2009

I of every 6 

New 

HIV Diagnoses

in the U.S.

Was in People Age 5

and Older
Why are older adults getti

Lack of awareness of HIV risk factors 

– Many older people may be newly sin

death or divorce

– Belief that HIV only affects younger p

• Unprotected sexual activity

– Menopause = No risk for pregnancy = 

– Unaware of safer sexual activities 

• Lack of HIV prevention and interventions 

older adults

• Seniors not considered at risk: don’t ask, 
20 % and more

15-19 %10-14 %9 % and less

2009-2010

% of New HIV/AIDS Cases Age 50 and Old

Please refer to the image description found on page 67 foaccessible version of this map.
ROAH: First Data on Risk Be

in Older Adults

• Substance use impact - Significa• Viagra and other ED Drugs’ Impa• Of those older adults with HIV wh

sexually active 16% engaged in sexual behavior in the last 3 mon
The New York Council Fun

HIV and Older Adults Initia

2007-2011
• Partner with agencies serving older adults creating 

HIV service providers 

• Create awareness about HIV and older adults throu

development and social messaging

• HIV prevention intervention: (Community Promise)• Change knowledge, attitudes and beliefs• HIV testing and access to care 

– 1,500 older adults have been tested – 20,000 condoms distributed– 300 older adults have been brought into care service

The New York Council Funded HIV and Older 

2007-2011
Sample of ACRIA’s Older Adults 
Program Accompli

In New York City and State

• Over 8,000 HIV and aging service provid

peers have attended trainings

• Over 600 days of training on 25 differen• All 51 City Council Districts

Nationally

• 75 organizations receive ongoing CBA/T

• Support from the MAC AIDS Fund
In June 2011

ACRIA launched the first-ever wide spread 

campaign on HIV specifically targeting 
Thank You

Stephen Karpiak, PhD 

Skarpiak@acria.org

AIDS Community Research Initiative of Am

Training, Technical Assistance, Capacity Bu

Materials and Consulting 

Contact: Luis Scaccabarrozzi

LScaccabarrozzi@acria.org

ACRIA Center on HIV and Aging

http://www.acria.org
Jane Pecinovsky Fow

Founder/Director of HIV Wisdom for Old

an outreach program at Family Health Ca

Kansas City, KS, and

HIV Activist and Prevention Speaker/

North Kansas City, MO
www.secondopinion-tv.org/episode/hiv-midd
Doreen Bermudez

Training Coordinator

National Resource Center 

LGBT Aging

HIV & Older Adults

Implementing in Community Service P

Settings
Community Approach on H

Adults

•••••

Assessment(s) on where older adthe communityGaining access to Service ProvidCreating an aging network curriappropriate for service providersCreating a realistic structure proinclusion of HIV “conversations”

Creating & Implementing follow 
Community Approach on HIV 

Adults

••••

Inclusion of HIV testing (associations pre and post counseling) Addressing the LGBT(gay, lesbian, btransgender) community.Non-traditional settingsAdjusting/flexibility of content/time
Sexuality, Older Adults & S

Providers

•••

Making assumptionsLimiting language to define relationshipsHow older adults are alienamarginalized
Sexuality, Older Adults & S

Providers

••••

Understanding minority Cultural competency LanguageConsistency
Sexuality, Older Adults & S

Providers

•••••

Risk factors for older aduHaving a visionCreating a planImplementationCapturing data/evaluat
Area Agencies on Aging

Educating Seniors on HIV

Courtney WilliamsCommunity PlannerDistrict of Columbia Office on Aging441 4th Street, NW, Suite 900 SouthWashington, DC 20001Phone: (202) 724‐5622

Website: http://www.dcoa.dc.gov
Resources

US Administration on Aging 

www.aoa.gov/AoARoot/AoA Programs/Special Pr

AIDS Community Research Initiative of Americ

www.acria.org

HIV Wisdom for Older Women

www.hivwisdom.org

National Resource Center for LGBT Aging 

www.lgbtagingcenter.org

District of Columbia Office on Aging 

www.dcoa.dc.gov

U.S. Department of Health and Human Services, Administration on Aging, Washington DC 20201 PHONE 202.619.0724 | FAX 202.357.3555 | EMAIL aoainfo@aoa.gov | WEB www.aoa.gov
Questions?

U.S. Department of Health and Human Services, Administration on Aging, Washington DC 20201 PHONE 202.619.0724 | FAX 202.357.3555 | EMAIL aoainfo@aoa.gov | WE

B http://www.aoa.gov
Contact Information

Stephen E. Karpiak PhD SKarpiak@acria.orgAssociate Director for ResearchACRIA -AIDS Community Research Initiative ACRIA Center on HIV and Agingand New York University College of Nursing CFARJane P. Fowler jane@hivwisdom.orgDirectorHIV Wisdom for Older WomenDoreen Bermudez DBermudez@sageusa.oTraining CoordinatorNational LGBT Resource CenterCourtney Williams Courtney.Williams@dc.goCommunity PlannerDistrict of Columbia Office on Aging 
Questions/Comments/St

Suggestions for Future HIV a

Webinar Topics?

Send them to:

Danielle.Nelson@aoa.hhs.g

U.S. Department of Health and Human Services, Administration on Aging, Washington DC 20201 PHONE 202.619.0724 | FAX 202.357.3555 | EMAIL aoainfo@aoa.gov | WEB http://www.aoa.gov
Image Description of % of People with HIV Ag

2009-2010 Map

A map of the United States showing the % of people with Hin 2009-2010 (image of map found on page 14): 

40% or More: Connecticut, Idaho, Iowa, Louisiana, MarylanNew Jersey, New York, Pennsylvania, Texas, and Vermon30 to 39%: Alaska, California, Florida, Hawaii, Kansas, MisHampshire, New Mexico, North Carolina, Ohio, Oregon, RhCarolina, South Dakota, Tennessee, Virginia, and Washing20 to 29%: Arizona, Arkansas, Colorado, Delaware, GeorgKentucky, Maine, Michigan, Minnesota, North Dakota, UtahWyoming19 % and Under: Alabama, Mississippi, Montana, Nevada, Wisconsin
Image Description of ROAH: Social Network Co

Parent Living: Slightly above 40%Parent Functional: Below 30%Child Living: Above 50%Child Functional: Below 40%Sibling Living: Nearly 80%Sibling Functional: Above 40%Other.. Living: 50%Other.. Functional: 30%Friend Living: 70%Friend Functional: Below 70%

Image of bar graph found on page 37.
Image Description of Sex is Not Only for the 

Percent reporting sex in the last 12 months: 

Age 57-64: Men 83.7%

 Men 67% 

Men 38.5% 

 Women 61.6%

Age 65-74: Women 39.5%Age 75-85: Women 16.7%Lindau et al. NEJM 2007 357 (8): 762-774

Image of bar graph found on page 40.
Image Description of % of New HIV/AIDS Cases 

2009-2010 Map

A map of the United States showing the % of new HIV/AID

older (image of map found on page 43): 9% or less: Nevada, New Hampshire, Oklahoma, Rhode Is10-14%: Arizona, Arkansas, California, Delaware, GeoKentucky, Maine, Michigan, Minnesota, Mississippi, TexVirginia15-19%: Alabama, Alaska, Colorado, Connecticut, Florida, Massachusetts, Missouri, Montana, Nebraska, New MexicoCarolina, North Dakota, Ohio, Oregon, South Carolina, SouTennessee, Virginia, Washington, and Wyoming20% or more: Idaho, Iowa, Louisiana, Maryland, New JerseVermont