HIV AIDS

HIV/AIDS IN ELDERS

  • Twenty years after the finical evidence of acquired immunodeficiency syndrome was reported, AIDS has become one of the most devastating diseases humankind has ever faced. While most of its victims are young adults, the pandemic has had major consequences for older people as well.
  • Elders in most societies are a vulnerable group, as a result of a lifetime of hardship, malnutrition, poverty and due to often chronic diseases.
  • The AIDS pandemic is now posing an additional burden on them, further increasing their vulnerability. In old age, when they may need support and expect to be looked after, many of them may have to take on the role of caring for others, in most cases without even the basic necessary resources.
  • Thus, their health is the most precious asset not only to them, but also to their families and communities. Lack of economic, social and psychological support combined with the inaccessibility of health services threatens their ability to provide the care expected from them.
  • All efforts must be made to support and address the vulnerability of these older persons, not the least because it is they who are rearing the future adult generation. 
  • In the last 10 years, there has been a tenfold increase in the numbers of persons diagnosed at 65+ with AIDS.

WHAT MAKES OLDER ADULTS DIFFERENT?
Older Adults

  • Are less knowledgeable about HIV/AIDS
  • Behave in ways that puts them at greater risk.
  • Are different because of their physical condition
  • Have not received prevention messages
  • Are less likely to be screened and receive early intervention
  • Are more likely to have a severe HIV/AIDS disease course
  • More likely to have a delayed diagnosis
  • More likely to have shorter AIDS free interval from HIV+ diagnosis to AIDS diagnosis
  • More likely to have a higher number of opportunistic infections
  • More likely to experience a rapid course of illness and a shorter survival rate
  • Are more likely to be stigmatized and lack social support

Several factors are contributing to the increase in AIDS among the elderly which is pointed out briefly as follow:

RISK FACTORS

  • The dominant risk factor among the 50-and-over age group is the same as for other age groups, and that is heterosexual sex.
  • Specific risk behaviours, such as unprotected sex, multiple sexual partners, sexually transmitted infections and substance abuse are also present in this age group.

IMPLICATIONS OF AGE

  • According to the US-based Centres for Disease Control and Prevention (CDC), age accelerates the progress of HIV to AIDS and blunts CD4 cell response to antiretroviral therapy.
  • Age-related conditions, such as osteoporosis, increase the risk of severe complications. Intravenous infection is also a problem among seniors, partly because of aging baby boomers still doing drugs, but also because of diabetics sharing insulin needles.

UNPROTECTED SEX

  • Elders tend to view condoms primarily as a contraceptive measure, and women who no longer fear unwanted pregnancy may not insist on their use. Women also undergo physical changes with age that affect their vulnerability to HIV. In the post-menopausal stage, their vaginal walls are thinner and lubrication is often reduced. Many doctors believe older women are more vulnerable to vaginal trauma during intercourse, and are thus at greater risk of contracting HIV. Women after menopause are not going to use condoms because they're not afraid of getting pregnant anymore, that’s why older women appear to have a higher incidence than older men.

DELAY IN DIAGNOSIS

  • Early symptoms of HIV infection:
  • Fatigue
  • poor memory
  • shortness of breath
  • sleeplessness
  • weight loss
  • Many of these symptoms may be mistaken for signs of ageing, thus preventing those infected from seeking early medical help that could help them stay healthy and prevent them from transmitting the disease to others.

PREVENTION

  • Health providers often fall into the trap of age stereotypes, which can be a problem in prevention and diagnosis.
  • Health care workers are less likely to ask older patients about their sexual behaviour and do not provide the prevention information they would routinely offer younger patients. Nor do prevention education programmes target elders.
  • Perhaps due to an increasing denial of sexual needs, social barriers to discussions on sexuality become even stronger with age - with the consequence that there are few effective strategies for this population group.
  • Elders must wrestle with issues not faced by the young person. They find themselves adjusting to the physical and emotional changes associated with ageing in the setting of a debilitating illness.
  • In addition, coping mechanisms among elders are weaker, and they are more prone to depression and less inclined to join support groups.
  • A number of strategies and behaviors can help mitigate the risk of HIV for elders and lessen the impact of HIV/AIDS on those already infected.
  • STRATEGIES AND BEHAVIOR TOWARDS ELDER AFFECTED BY HIV/AIDS
  • Promote, maintain and improve the health of elders, especially those with care-giving responsibilities
  • Provide elders with education and information on HIV/AIDS and related care issues
  • Provide psychological support and counselling for all care providers - health care workers and home-based caregivers
  • Reduce the double stigma (AIDS-related and ageism) and other prejudices among health care workers - particularly through training and education
  • Develop policies and initiatives to strengthen the capacity of older caregivers - such as economic support in the form of subsidies and education
  • Provide additional resources for the caregiver, including housing, medical care and food. 
  • Reduce the stigma surrounding the sexual needs of elders and encourage them to discuss these issues with their health providers and families
  • Educate healthcare providers about the sexuality and sexual practices of elders to allow for improved communication and more accurate risk assessment
  • Integrate HIV programming into services for elders, including secondary prevention education (prevention among HIV-positive people), into specialized care services
  • Educate HIV service providers on the need to provide age-sensitive services and the specific issues related to HIV in an ageing population;
  • Identify areas of research specifically looking into the interactions between age and HIV
  • Involve elders in research on prevention and care.
  • Another major issue of concern to this population, which need actual attention is the elders playing role as care providers for chronically ill and terminally ill patients and the upkeep of children orphaned by AIDS
  • CHALLENGES IN PREVENTION OF HIV/AIDS IN ELDERLY 
  • People over 50 years of age are much less likely to adopt HIV prevention strategies than are younger people who engage in the same behavioural risks.
  • HIV and AIDS are seldom discussed within this community.
  • Older Americans are not suspected of drug use.
  • Many are sexually active, often demonstrating risky sexual behaviors, not using protection, using IV drugs, and sharing needles, which places them at high risk for transmission of HIV."
  • Evidence points to many infected elders contracting the disease through same-gender sexual contact.
  • In addition, elders are often finding themselves dating again due to being widowed or divorced and are engaging in sexual activity without protection.
  • Prevention, counselling, testing and education efforts are not being directed their way, and this problem needs to be addressed in the health care profession.

IMPORTANT THINGS TO REMEMBER

  • Do NOT assume elderly know how HIV/AIDS is transmitted.
  • Do NOT assume elderly know their behaviour puts them at risk.
  • Do NOT assume elderly will ask for an HIV/AIDS test if they feel at risk.
  • Do NOT assume elderly have the support necessary to deal with HIV/AIDS infection.
  • Do NOT assume elderly are NOT sexually active.
  • Do NOT assume elderly are straight.
  • Include a sexual history in other health history questions.
  • Include questions about IV drug use.
  • Consider HIV/AIDS as a possible cause of clinical disease and symptoms such as fatigue, altered mental status, rashes, chronic pain, and weight loss.

EDUCATE OLDER ADULTS

  • Elderly often depend upon primary care providers for health information. Healthcare providers must talk to their elderly patients about their risk and to educate them to prevent infection.
  • Where is your patient getting information about HIV/AIDS if not from you? 
  • Patients have reported that their physicians don't ask. 
  • Talk about HIV/AIDS and risk behaviors with your patients. 
  • Talk about testing.
  • Repeat prevention messages.
  • Help older adults develop the skills to prevent infection

SCREEN & DIAGNOSE ELDERLY FOR HIV/AIDS

  • Older adults are not routinely screened and assessed for HIV/AIDS.
  • As a result, infection is not detected early at a stage when it can be most readily treated and the risk of transmission to others is increased.
  • Differential diagnosis may be challenging given the association of symptoms with multiple conditions.