HIV/AIDS Interventions in an Aging U.S. Population

Although safe sex practices and education are supported for many sectors of the U.S. population, negative ideas regarding sex and aging remain (Hooyman & Kiyak, 2005). Some Americans erroneously believe that older adults are not sexually active. As a result, many doctors fail to discuss sexuality with their older patients (Kuehn, 2008). In reality, almost 75 percent of adults ages 57 to 64, more than 50 percent of adults ages 65 to 74, and more than 25 percent of adults over the age of 75, are sexually active (Kuehn, 2008). Some of these older adults are at risk of sexually transmitted infections. According to the Centers for Disease Control and Prevention (CDC) (2008a), 25 percent of people living with HIV in 2006 were age 50 and older. The number of adults over age 50 living with HIV or AIDS increased from approximately 65,000 in 2001 to approximately 116,000 in 2005 (Kuehn, 2008).These prevalence levels indicate the number of people living with the virus, not those newly infected, so they do not indicate the age of infection (CDC, 2008a). The increase could be attributed in part to the effectiveness of antiretroviral treatments extending the lives of adults infected at an earlier age (Kuehn, 2008). Nevertheless, there is some evidence that the infection rate for adults over the age of 50 may be rising. In Georgia, 189 adults over the age of 50 were newly diagnosed with HIV and AIDS in 1998, compared -with 341 new diagnoses in 2007. In Florida, 11 percent of new HIV diagnoses in 1998 were adults over the age of 50. For the same cohort, the percentage of new diagnoses increased to 17 percent in 2007. The number of older women newly diagnosed with AIDS rose 40 percent between 2000 and 2005 (Hooyman & Kiyak, 2005). According to the CDC (2008b), in 2005, adults age 50 and older accounted for 15 percent of new HIV and AIDS diagnoses and 35 percent of all AIDS-related deaths. Older adults may be more susceptible to HIV infection for biological reasons. During menopause, older women may be more at risk for vaginal tears through which the virus can penetrate due to difficulty with lubrication and delicate tissue (Kuehn, 2008). Older adults also tend to already have weakened immune systems. Low T-cell levels can increase the likelihood of infection and may explain the shortened incubation period for HIV among older adults (Hooyman & Kiyak, 2005). For adults over the age of 50, the average time for untreated HIV to progress to AIDS is 5.7 years, as opposed to 7.3 for people under age 50 (Hooyman & Kiyak, 2005). Older adults are also at risk for HIV infection because of decreased condom usage. After menopause, older women may assume that because they can no longer become pregnant, their male partners do not need to use a condom (Hooyman & Kiyak, 2005). Some older gay, lesbian, bisexual, and transgender people see AIDS as a disease that only affects young people and engage in high-risk sexual behaviors, including not using a condom and not being tested for HIV (Cahill, South, & Spade, 2000). Difficulty applying a condom could also explain decreased usage (Kuehn, 2008). Incomplete erection and arthritic hands can make putting on a condom very difficult, just as poor vaginal lubrication can make it uncomfortable. In addition, Zablotsky (1998) proposed the possibility that the changing gender ratio and scarcity of male sexual partners may cause older women to forgo safe sex practices for fear of losing a potential sexual partner to a woman who is willing to have sex without a condom. Diagnosis of HIV and AIDS in older adults is often delayed or missed (Kuehn, 2008).Because some doctors and HIV-testing programs falsely believe that older adults are not sexually active, many do not regularly test this population for HIV and AIDS (Hooyman & Kiyak, 2005). In addition, older adults do not usually report symptoms during the early stages of HIV or AIDS because they may believe these are signs of normal aging. …