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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 AIDS Community Research Initiative of America
ACRIA Dr. Stephen Karpiak

3 AIDS Community Research Initiative of America
ACRIA AIDS Community Research Initiative of America New York City

4 It’s All About The Numbers
8 It’s All About The Numbers STUPID ! 3 1 Dr. Stephen Karpiak Research Director ACRIA AIDS Community Research Initiative of America New York City

5 Impact of HAART HAART Mortality (x 1000) PLWHA (x 10,000) 9 8 7 6 5 4
3 2 1 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 HAART Source: NYC Dept of Health & Mental Hygiene, 2004

6 USA AIDS Cases Over Age 50 - CDC
130000 120000 110000 100000 90000 80000 70000 60000 50000 40000 30000 20000 10000 1995 2005

7 The Aging of the HIV NYC Population (OVER 50)
30000 25000 20000 15000 10000 5000 2001 2002 2003 2004 2005 New Diagnoses People Living with HIV

8 120,750 known people living with the HIV
New York City is the US HIV Epicenter Today in NYC there are approximately 120,750 known people living with the HIV

9 38 % 74 % 2007 NYC HIV Epidemiology (NYCDOH)
of people with HIV/AIDS in NYC are Over 50 74 % of people with HIV/AIDS in NYC are Over 40

10 AIDS Cases 2006 / 07 Over 50 Over 40 SanFrancisco 35 % 76 %
LosAngeles 33 % 77 % Missouri 35 % 76 % Illinois 32 % 74 % Wisconsin* 38 % Michigan* 38 % * HIV/AIDS 10

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

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

13 Research on Older Adults with HIV
Stephen E. Karpiak, PhD Director for Research Co-Principal Investigator ACRIA

14 Research on Older Adults with HIV
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 Bailous Office of AIDS Policy, NYC DOH J. Bookhardt-Murray, MD Medical Director Harlem United & AIDS Institute NYS David Dorfman, PhD Mt. Sinai School of Medicine Arlene Kochman, MSW Yale University School of Medicine Allen Matthews, Mardi Fritz NYC DOH Douglas Mendez, MD Dominican Medical Association Peter Nwakeze, PhD NYC Association for HIV Over 50 and Hunter College Jeffery Parsons, PhD CHEST & Hunter College Cynthia Poindexter, PhD Fordham University Graduate School of Social Service Bobbie Sackman, MSW NYC Council of Senior Centers, Director of Public Policy J. Edward Shaw NYC Commission on AIDS J. Lee Westmaas, PhD SUNY, Dept of Psychology Desieree Byrd, PhD NeuroAIDS, Mt Sinai Richard Havlik, MD NIA/NIH Section Chief

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

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

20 Sexual Self-Identification

21 ROAH Demographics Education___________________________________
Employment Status Working Retired Unemployed Disability Country of Birth USA Other nation Education___________________________________ Less than high school High school graduate College graduate

22 % with AIDS Diagnosis 70 65 60 55 50 45 40 White Black Latino

23 ROAH HIV Care Currently Taking ARVs Black 87.3 Latino 84.8 White 85.3
Male Female

24 ROAH HIV Care 83% Medicaid Dependent Treatment facility %
Private physician 21.9 Public clinic / hospital 58.7 VA Hospital ASO / day program 17.0

25 ROAH Demographics Living Arrangement % Partnered/Married 14.1

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
60% Unprotected Vaginal 40% Sharing Needles 20% Unprotected Anal 0% > 10 years 6-10 years 1-5 years

30 Stigma

31 ROAH: Disclosure of HIV Status


33 ACRIA Consultant and Collaborator
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 %

39 ROAH: Substance Use Substance Current % History % Tobacco 57 84
Alcohol Marijuana Cocaine Crack Heroin Crystal Meth 2 9

40 ROAH: Substance Use Recovery
Recovery Status of Substance Users % Ever enrolled in 12-step 62 Currently in recovery 54 No substance use in past 3 months 48 In recovery for more than 1 year 44 40

41 And other outlandish lies about getting older

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

43 Prevention for Positives
Do you receive HIV prevention information? Yes % No 1 % Does prevention information target older adults? Yes % No % N= 160


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 The NYC Council HIV Prevention Initiative For Older Adults
Challenges and Barriers in Working with 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 Men’s Health Crisis Griot Circle Jamaica Service Program for Older Adults Latino Gerontological Center Institute for Puerto Rican & Hispanic Elderly


49 49

50 Social Networks

51 Social networks are a significant healthcare
ROAH: Social Networks CAREGIVERS are derived from SOCIAL NETWORKS Social networks are a significant healthcare resource 300 Billion Dollars as people age

52 ROAH: Informal Network Composition

53 ROAH: Informal Network Composition

54 Senior Research Scientist ACRIA
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
Women Men Black White Hispanic


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

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

62 62


64 ACRIA’s 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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