1. Importance of HIV Education of HIV Screening and Risk Among Adults 65 Years Old and Older In A Senior Center JESSICA WARD RN,BSN,FNP COPPIN STATE UNIVERSITY NURS 513

2. WHY THIS TOPIC

3. OBJECTIVES To explain the significance in the selection of this clinical project’s topic To explain the purpose of the study To identify the national guidelines that guided the clinical project Identify risk of contracting HIV in the older adult Analysis of journal articles that support topic Providers Responsibility

4. PURPOSE OF THE CLINICAL PROJECT The purpose of this clinical project, is to look at the perceptions of importance of HIV screening in the elderly population older than 65.

5. HIV BASICS HIV is a virus that spread through body fluids that affects specific cells of the immune system, called CD4cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. When this happens, HIV infection leads to AIDS. (CDC, 2013)

6. HIV BASICS CONT’D CD4 cells are cells that help fight off virus in the body, once these cells fall below 200, AIDS will result(CDC, 2013) Two opportunistic diseases also have to be present to diagnosis AIDS( AIDS, 2010)

7. HIV SCREENING GUIDELINES  HIV screening for ages 13-64(CDC,2013)  Younger adults and older adults who are at increased risk( CDC,2013)  Of the 1.1 million of people living with HIV 20% are unaware of their status(CDC, 2013)

8. OLD VS. YOUNG YOUNG ADULT  Anal, oral, rectal sex  Unprotected sex with an infected person  Sharing needles with infected person  Not knowing one’s status OLDER ADULT  Older adults know less about HIV than younger adults  Healthcare workers do not discuss HIV topic with older adults  Older adults are less likely to talk about sex/drug use with their doctors  Healthcare workers do not educate about risky behaviors

9. WHY THE INCREASE ? Many older adults are newly single, widowed, or have grown children and have more time for sexual activity.( US DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2009) New treatments for erectile dysfunction facilitate sex.( HHS,2009) Older adults may be unfamiliar with condom use or reluctant to use them because birth control after menopause is unnecessary, and condoms can make it difficult to maintain an erection.( HHS,2009) Vaginal dryness is common among menopausal women, making tiny cuts and tears during sex more likely.(HHS, 2009)

10. STATISTICAL IMPORTANCE 53% persons aged 65-74 engage in sex, and 26% of persons aged 75-85 engage in sex.(CDC,2008) 15% of new HIV cases are in people older than 50( cdc,2008) In 2009, 23% of new diagnosed cases were in older adults 50 and over( Administration of Aging,2011) In 2010, it was reported to have 2500 new HIV cases in persons over 60(CDC, 2012)

11. SUPPORTIVE DATA An study was conducted on 745 older adults male and female living in low income housing( Ward et al, 2011) The research concluded that 98% did not see themselves as being at risk for contracting hiv, even though 80% of the participants did not understand the risk of hiv contraction( Ward et al, 2011 )

12. SUPPORTIVE DATA Physician should have a routine panel screening for older adult patients for hiv screening(Clifford et al, 2008) Physicians are failing at screening older adults for HIV( Clifford et al, 2008) Even when appropriate screening questions are asked, answers are not reliable compared to the younger population, leading to false assumptions about risky behavior(Clifford et al, 2008)

13. SUPPORTIVE DATA According to the United StatesPpreventive Service Task Force(2012), target screening is not as effective as universal screening Target screening is more focused on high risk population( USPTF, 2012) Universal screening will diagnosis that 20%-24% of people who do not know they are HIV positive( USPTF, 2012)

14. PROVIDER RESPONSIBITIES HIV screening for all patients 13-64 Screening for high-risk patients at least annually Recommended that providers adopt routine screening and encourage patient to get tested It is recommended that the provider determines repeat screening on and individual basis

15. PROVIDER RESPONSIBILITY Be knowledgeable about HIV screening Educate the patients about HIV risk

16. REFERENCES CENTER FOR DISEASE CONTROL. (2012). RETRIEVED DECEMBER 7, 2013, FROM HIV SURVEILLANCE REPORT: HTTP://WWW.CDC.GOV/HIV/LIBRARY/REPORTS/SURVEILLANCE/INDEX.HTML CLIFFORD, M., FAIN, M., & KLOTZ, S. (2008). THE OLDER HIV POSITIVE ADULT: A CRITICAL REVIEW OF THE MEDICAL LITERATURE. THE AMERICAN JOURNAL OF MEDICINE, 121(12), 1032-1037. HIV BASIC. (2013). RETRIEVED DECEMBER 7, 2013, FROM CENTER FOR DISEASE CONTROL: HTTP://WWW.CDC.GOV/HIV/BASICS/INDEX.HTML OPPORTUNISTIC INFECTIONS. (2010). RETRIEVED DECEMBER 7, 2013, FROM AIDS.GOV: HTTP://AIDS.GOV/HIV-AIDS-BASICS/STAYING-HEALTHY-WITH- HIV-AIDS/POTENTIAL-RELATED-HEALTH-PROBLEMS/OPPORTUNISTIC-INFECTIONS/ SCREENING FOR HIV. (2012). RETRIEVED DECEMBER 7, 2013, FROM US PREVENTIVE SERVICES TASK FORCE: HTTP://WWW.USPREVENTIVESERVICESTASKFORCE.ORG/USPSTF13/HIV/HIVADULTART.HTM THE GRAYING OF HIV. (2009). RETRIEVED DECEMBER 7, 2013, FROM US DEPARTMENT OF HEALTH AND HUMAN SERVICES: HTTP://WWW.USPREVENTIVESERVICESTASKFORCE.ORG/USPSTF13/HIV/HIVADULTART.HTM WARD, E., DISCH, W., SCHENSUL, J., & LEVY, J. (2011). UNDERSTANDING LOW INCOME, MINORITY OLDER ADULT SELF PERCEPTIONS OF HIV RISK. JOURNAL OF THE ASSOCIATIONS OF NURSES IN AIDS CARE, 22(1), 26-37.