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

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

3. Sexual Health Needs of Aging Adults
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
Source: Lindau et al, NEJM, 2007; 2008 National Survey of Sexual Health and Behavior

4. HIV/AIDS Among Older Adults in the U.S.
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
Prejean PlosOne 2011; Linley et al., American Journal of Public Health, 2012; Brooks et al., American Journal of Public Health, 2012.

5. Prevention Challenges HIV Health Disparities and Older Adults
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
Source: Linley, American Journal of Public Health, 2012

6. Prevention Challenges Older Adults and Late HIV Diagnosis
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
Source: Linley, et al., American Journal of Public Health, 2012

7. Prevention Challenges Greater Risk of Chronic Illness
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
Brooks et al., American Journal of Public Health, 2012

8. HIV Prevention for older adults Challenges for the affected community
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
CDC, HIV/AIDS among Persons Aged 50 and Older

9. HIV Prevention for older adults Challenges for public health agencies and CBOs
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.

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

11. Integrating Healthy Aging and HIV Prevention
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
Source: The Healthy Aging Research Network Writing Group. Prev Chronic

12. Enhancing HIV prevention programs for older adults
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
Sources:

13. Structural interventions and Policy Implications for Older HIV Population
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

14. Learn from, and disseminate, best and promising practices
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

15. Summary
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

16. Thank You Kevin A. Fenton, MD, PhD, FFPH 404-639-8000
Centers for Disease Control and Prevention
Twitter: CDC_DrFenton
Web: