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Kevin Fenton, MD, PhD, FFPH Director National Center for HIV/AIDs, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention HIV.

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Presentation on theme: "Kevin Fenton, MD, PhD, FFPH Director National Center for HIV/AIDs, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention HIV."— Presentation transcript:

1 Kevin Fenton, MD, PhD, FFPH Director National Center for HIV/AIDs, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention HIV Prevention Programs Among Older Adult Populations AIDS 2012 HIV and Aging Satellite Session July 25, 2012

2 1.HIV among older adults in the U.S. 2.Prevention challenges 3.Improving care and treatment of older adults with HIV Overview

3  The majority of Americans aged 57 to 65 years, and a substantial fraction of those 66 and older, remain sexually active.  Older persons may have been in a long-term monogamous relationship and have poor understanding of HIV transmission  Minority of older patients discuss sexual activity with care givers  Few older Americans use condoms Sexual Health Needs of Aging Adults Source: Lindau et al, NEJM, 2007; 2008 National Survey of Sexual Health and Behavior

4  CDC estimates 33% of all persons living with HIV in 46 states are 50 and older; by 2020 more than 50% of all persons living with HIV may be 50 and older  Approximately 11% of new HIV infections are among adults 50 and older  In 2001, 13% of new diagnoses of HIV infection were among persons 50 and older, while in 2009, 17% were among those over 50 HIV/AIDS Among Older Adults in the U.S. Prejean PlosOne 2011 ; Linley et al., American Journal of Public Health, 2012; Brooks et al., American Journal of Public Health, 2012.

5  Racial/ethnic disparities in HIV diagnosis rates are greater among persons aged 50 and older than among younger persons  Rates of HIV diagnosis among older (50 and older) blacks and Hispanics/Latinos for were 13 times and 5 times, respectively, as high as those among older whites  Rates among younger blacks and younger Hispanics/Latinos were 8 times and 3 times as high as those for younger whites  By region, highest average rate of diagnosis per 100,000 among older persons was in Northeast (15.8), followed by the South (12.3)  There was a 3.4% annual increase in diagnosis rates for older persons, compared to a 2.3% increase for younger persons Prevention Challenges HIV Health Disparities and Older Adults Source: Linley, American Journal of Public Health, 2012

6  Older persons were nearly twice as likely to receive a late diagnosis of HIV infection compared to younger persons ( ).  Half of the older persons received their diagnosis late in course of infection—AIDS developed within 12 months Prevention Challenges Older Adults and Late HIV Diagnosis Source: Linley, et al., American Journal of Public Health, 2012

7  HIV-infected older persons increasingly affected by chronic illnesses such as heart disease, bone fractures, and hepatic disorders that occur at rates greater than expected for age  Thus primary and preventive care is especially important Prevention Challenges Greater Risk of Chronic Illness Brooks et al., American Journal of Public Health, 2012

8  Older persons of minority races/ethnicities may face discrimination and stigma that can lead to later testing, diagnosis and reluctance to seek services  Health care professionals may underestimate their older patients’ risk for HIV and miss opportunities for HIV testing  Physicians may miss AIDS diagnosis because symptoms in older patients can mimic those of normal aging  The stigma of HIV can be more severe for older adults, leading them to hide their diagnosis from family and friends, and missing social support HIV Prevention for older adults Challenges for the affected community CDC, HIV/AIDS among Persons Aged 50 and Older

9  Resource limitations and need to prioritize and target groups where HIV incidence is increasing, or access is especially challenging.  Limited advocacy by older adults to focus on HIV prevention and sexual health issues  Limited capacity and experience with programming for HIV and older adults  Limited surveillance, health needs assessment and other strategic information to inform program planning  Challenges with integrating sexual health and HIV prevention into other broad health programs for older adults due to stigma, ignorance. HIV Prevention for older adults Challenges for public health agencies and CBOs

10 Note: PMTCT, Screening transfusions, Harm reduction, Universal precautions, etc. have not been included – this is focused on reducing sexual transmission Behavioural Intervention -Abstinence -Be Faithful HIV Counselling and Testing Coates T, Lancet 2000 Male Condoms Female Condoms Treatment of STIs Grosskurth H, Lancet 2000 Male circumcision Auvert B, PloS Med 2005 Gray R, Lancet 2007 Bailey R, Lancet 2007 Microbicides for women Abdool Karim Q, Science 2010 Treatment for prevention Donnell D, Lancet 2010 Cohen M, NEJM 2011 Behavioural positive prevention Fisher J, JAIDS 2004 Grant R, NEJM 2010 (MSM) Baeten J, 2011 (Couples) Paxton L, 2011 (Heterosexuals) Oral pre-exposure prophylaxis Post Exposure prophylaxis (PEP) Scheckter M, 2002 Vaccines Rerks-Ngarm S, NEJM 2009 HIV PREVENTION TOOL-KIT

11  Healthy aging is the development and maintenance of optimal physical, mental, spiritual and social well-being and function in older adults.  It is most likely to be achieved by  individuals who live in safe and supportive physical environments and communities  the effective use of health services to prevent or minimize the impact of chronic disease  Draw upon principles of healthy aging and HIV prevention strategies for other populations Integrating Healthy Aging and HIV Prevention Source: The Healthy Aging Research Network Writing Group. Prev Chronic

12  Incorporate generational concerns  Target high risk groups such as older gay men and older women  Involve older adults as peer educators  Educate about HIV risk  Address ageism  Provide HIV education and training for service providers of elderly populations Enhancing HIV prevention programs for older adults Sources:

13  Need to promote healthy aging for those infected with HIV, ensuring preventive services, with emphasis on other health factors as well, such as mental health  Integrate HIV and Sexual Health programming into existing programs targeting older adults  Need for outreach in communities with higher numbers of HIV and STDs among older adults  Need to increase awareness about risk for HIV infection and importance of early diagnosis  Improving linkage to care so that older adults who are HIV infected can be treated earlier Structural interventions and Policy Implications for Older HIV Population

14  U.S. Administration on Aging has developed materials aimed at risk reduction for older adults  Fact sheets, posters, Powerpoint templates, video   Jurisdictions with large numbers of older adults have focused on prevention for over 50 year olds  Senior HIV Intervention Project in Broward County, FL  Gay Men’s Health Crisis, NY  AIDS Community Research Initiative of America, NY Learn from, and disseminate, best and promising practices

15  Older people are at risk for HIV, and a growing proportion of people living with HIV are over 50, as people live longer lives with ART  Current efforts to focus on older adults reflect limitations in epidemiological, programmatic, policy and fiscal assessment and response  There is a need for additional models of effective prevention, treatment and care programs for older adults  There is a need to raise awareness among older persons as well as their general practitioners about HIV Summary

16 Thank You Kevin A. Fenton, MD, PhD, FFPH Centers for Disease Control and Prevention Twitter: CDC_DrFenton Web:


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