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The Graying HIV Epidemic: Evolution Requires Revolution.

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Presentation on theme: "The Graying HIV Epidemic: Evolution Requires Revolution."— Presentation transcript:

1 The Graying HIV Epidemic: Evolution Requires Revolution

2 Dr. Stephen Karpiak AIDS Community Research Initiative of America ACRIA

3 AIDS Community Research Initiative of America New York City

4 Dr. Stephen Karpiak Research Director ACRIA AIDS Community Research Initiative of America New York City

5 Mortality (x 1000) HAART Impact of HAART Source: NYC Dept of Health & Mental Hygiene, 2004 PLWHA (x 10,000)

6 USA AIDS Cases Over Age 50 - CDC

7 The Aging of the HIV NYC Population (OVER 50) New DiagnosesPeople Living with HIV

8 Today in NYC there are approximately120,750 known people living with the HIV New York City is the US HIV Epicenter

9 2007 NYC HIV Epidemiology (NYCDOH) 38 % of people with HIV/AIDS in NYC are Over % of people with HIV/AIDS in NYC are Over 40

10 Over 50 Over 40 Over 50 Over 40 SanFrancisco35 %76 % LosAngeles33 %77 % Missouri35 % 76 % Illinois32 %74 % Wisconsin*38 % Michigan*38 % AIDS Cases 2006 / 07 * HIV/AIDS

11 Concurrent HIV/AIDS among persons diagnosed with HIV in 2006 by age group, United States Source: CDC HIV/AIDS Surveillance Report, Concurrent HIV/AIDS

12 ACRIAs Center for HIV and Aging Excerpt from a training video developed by The AIDS Community Research Initiative of America ACRIAs Center for HIV and Aging Funded by the NYC City Council

13 R esearch on O lder A dults with H IV Stephen E. Karpiak, PhD Director for Research Co-Principal Investigator ACRIA

14 R esearch on O lder A dults with H IV Stephen E. Karpiak, PhD Director for Research Co-Principal Investigator ACRIA

15 ROAH Research Collaborators/Advisory Group Chairperson: Marjorie Cantor, Emerita Fordham U & Brookdale Scholar Stephen BailousOffice of AIDS Policy, NYC DOH J. Bookhardt-Murray, MDMedical Director Harlem United & AIDS Institute NYS David Dorfman, PhDMt. Sinai School of Medicine Arlene Kochman, MSWYale University School of Medicine Allen Matthews, Mardi FritzNYC DOH Douglas Mendez, MDDominican Medical Association Peter Nwakeze, PhDNYC Association for HIV Over 50 and Hunter College Jeffery Parsons, PhDCHEST & Hunter College Cynthia Poindexter, PhDFordham University Graduate School of Social Service Bobbie Sackman, MSWNYC Council of Senior Centers, Director of Public Policy J. Edward ShawNYC Commission on AIDS J. Lee Westmaas, PhDSUNY, Dept of Psychology Desieree Byrd, PhDNeuroAIDS, Mt Sinai Richard Havlik, MDNIA/NIH Section Chief

16 HIV Status/Health Religiousness & Spirituality Psychological Well-Being Lonliness Among Older Adults Distress – Depression HIV Stigma and Disclosure Social Networks Sexual Behavior Demographics ROAH Modules

17 ROAH Study Design Purpose: A Profile To establish empirically valid normative data describing the growing and changing population of older adults with HIV Participants (total N = 1000) NYC community-dwelling, HIV-positive adults over 50 Procedure Participants completed a self-administered survey after giving informed consent HIPAA Compliant and IRB Approved

18 Demographics

19 Male 69 % Female 31% Black 44 % White 21 % API / Am. Indian 3 % Latino 32 % 2004/2007 NYC HIV Epidemiology

20 Sexual Self-Identification

21 ROAH Demographics Employment Status Working 8.3 Retired 6.9 Unemployed20.1 Disability 64.2 Country of Birth USA83.5 Other nation16.5 Education___________________________________ Less than high school 20.4 High school graduate 58.6 College graduate 21.5

22 % with AIDS Diagnosis WhiteBlackLatino

23 ROAH HIV Care Currently Taking ARVs Black87.3 Latino84.8 White85.3 Male86.0 Female83.0

24 ROAH HIV Care 83% Medicaid Dependent Treatment facility % Private physician21.9 Public clinic / hospital58.7 VA Hospital 4.9 ASO / day program17.0

25 ROAH Demographics Living Arrangement% Partnered/Married14.1

26 Proportion Living Alone: ROAH vs. Community-Dwelling NYC Elderly


28 Years Since HIV Diagnosis by LGBT Status

29 Transmission Mode in ROAH: The Changing HIV Population 0% 20% 40% 60% > 10 years6-10 years1-5 years Unprotected Vaginal Sharing Needles Unprotected Anal

30 Stigma

31 ROAH: Disclosure of HIV Status


33 Comorbidities Richard Havlik, MD Ret. Section Chief NIA ACRIA Consultant and Collaborator



36 Average Number of Comorbidities

37 Substance Use

38 ROAH: Tobacco Use Current %History % 57 84

39 ROAH: Substance Use Substance Current %History % Tobacco5784 Alcohol3881 Marijuana2371 Cocaine1563 Crack1647 Heroin744 Crystal Meth29

40 ROAH: Substance Use Recovery Recovery Status of Substance Users % Ever enrolled in 12-step62 Currently in recovery54 No substance use in past 3 months48 In recovery for more than 1 year44

41 And other outlandish lies about getting older

42 Center for HIV/AIDS Educational Studies and Training Hunter College, City University of New York Sexual Behavior

43 Prevention for Positives N= 160 Does prevention information target older adults? Do you receive HIV prevention information?


45 ROAH: First Data on Risk Behavior in Older Adults Substance use impact - Significant Viagra and other ED Drugs Impact - None Of those who are sexually active 16% engaged in high risk sexual behavior in the last 3 months

46 Challenges and Barriers in Working with Older Adults The NYC Council HIV Prevention Initiative For Older Adults

47 $2 Million NYC Council Initiative 2007 NYC Council Initiative to support an HIV prevention and education program targeting older adult communities and providers ACRIA and the worked as partners with: Council of Senior Center Services (CSCS) Services & Advocacy for GLBT Elders Gay Mens Health Crisis Griot Circle Jamaica Service Program for Older Adults Latino Gerontological Center Institute for Puerto Rican & Hispanic Elderly



50 Social Networks

51 ROAH: Social Networks CAREGIVERS are derived from SOCIAL NETWORKS

52 ROAH: Informal Network Composition


54 Depression Mark Brennan, PhD Senior Research Scientist ACRIA

55 ROAH: Prior History of Depression

56 ROAH: Symptoms of Depression

57 CES-D: Level of Depression Symptoms WomenMenBlackWhiteHispanic


59 ACRIA Study Using the MacArthur Model Intervention for Depression Dr Marlena Vega Study Clinician Funded by the Robert Mapplethorpe and Keith Haring Foundations

60 Interim Follow-up Results Change in CES-D Scores Over 20 Weeks; All weeks significantly lower than baseline Week of Assessment CES-D Score

61 ROAH Collaborative Efforts Center for HIV Educational Studies and Training (CHEST) NYU School of Nursing & CFAR (Dr. Valentine) Fordham University, Dept. of Economics Syracuse University, Dept. of Sociology Columbia University School of Social Work University of Alabama Chelsea Westminster Hospital, London UK (Dr. Youle) American Academy of HIV Physicians University of Ohio at Miami American Geriatrics Society



64 ACRIAs HIV Older Adults Booklet

65 Research on Older Adults with HIV: An In-depth Examination of an Emerging Population Editors: M. Brennan, S. E. Karpiak, M. H. Cantor & R. A. Shippy Nova Science Publishers, Table of Contents The Emerging Population of Older Adults with HIV and Introduction to ROAH the Research Study S. E. Karpiak & M. Brennan Health Status, Comorbidities, and Health-related Quality-of-Life; R. J. Havlik Mental Health; A. Applebaum & M. Brennan Substance and Alcohol Use; A. Applebaum & M. Brennan Sexual Behavior among HIV+ Older Adults; S. A. Golub, C. Grov, & J. Tomassilli HIV Stigma and Disclosure of Serostatus; M. Brennan & S. E. Karpiak Social Support Networks of Older People with HIV; M. H. Cantor, M. Brennan, & S. E. Karpiak Loneliness among Older Adults with HIV; M. Brennan & A. Applebaum Psychological Well-being; M. Brennan & S. E. Karpiak Religiousness and Spirituality; M. Brennan Aging with HIV: Implications and Future Directions; S. E. Karpiak & M. Brennan About the Authors Appendix: Methodology of the ROAH Study

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