HIV on the rise among America’s seniors

HIV infections are more common among some segments of the US population: men who have sex with men (MSMs), medically underserved populations, teens and young adults, IV drug users and their sex partners and some other groups.

But data from the CDC from 2008-2010 shows that there has been a steady increase in HIV infections in older Americans, 65 years old and older.

About 10-11% of newly diagnosed US HIV cases per year occur in older adults. That comes out to about 5,000 to 6,000 new cases of HIV in this age range per year. And, for reasons outlined below, there may be many more cases that aren’t diagnosed and reported.

There are a number of ideas as to why this is happening.

Older couple via Shutterstock

Older couple via Shutterstock

One thought is that since the chance of a woman getting pregnant at this age is infinitesimally small, these couples don’t use condoms. Thus the risk of contracting a disease that can spread sexually, like HIV, goes up.

Also, as the population ages, spouses die, move to nursing facilities or divorce. This can leave the other partner free to become sexually active again, this time outside of the monogamous relationship. The newly sexually active spouse may not be used to using condoms and, if a relationship begins, condoms aren’t even mentioned. Additionally, many doctors and other health care providers don’t think of the 65+ age group as being sexually active. Therefore, they spend little or no time talking to them about STDs, safer sex and other sex-related topics.

The same risk factors exist for this age group as for others: multiple sexual partners, frequenting prostitutes, IV drug use, MSM, not practicing safer sex, etc. Specific to this age group is the fact that older women may suffer from thinning of the lining of the vagina. This can make that surface more prone to tearing. Once torn, it’s easier for HIV to gain a foothold and cause an infection. Also, immune function tends to decline with age. So that might also make it easier for older people to contract HIV.

Another contributing factor is that, to date, the CDC doesn’t recommend routine screening for the 65 and older age group. But one of the geriatric professional societies does recommend screening for older people. The US Department of Health and Human Services also recommends screening for all adults regardless of age.

The good news is that older adults, once diagnosed and undergoing treatment, seem to do very well. Even better, in many instances, than those who are younger when the diagnosis is made. People in this population seem to be more compliant with taking medications and sticking to follow-up care with their doctors.

So, if you’re in the 65+ age range and haven’t been tested for HIV, it might be a good idea to get tested. And get retested if you continue to be at risk. (And, it goes without saying, that if you’re under 65, it’s still a good idea to get tested.)

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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