Increasing Rates of HIV in Older Adults:
Contributing Factors and Possible Interventions
By Mikaila Hogan – University of Victoria
Mikaila Hogan, Department of Anthropology
This research was supported by the
Jamie Cassels Undergraduate Research Award,
University of Victoria
Supervised by Dr. Eric Roth
March 6, 2019
Introduction
The number of adults over 50 years of age living with HIV is on the rise worldwide (Roberson, 2018). There are two reasons for the growth in this demographic. First, people with HIV are living longer lives due to treatment options, like Highly Active Antiretroviral Therapy (HAART), which makes HIV a chronic, manageable condition. Secondly, the number of new HIV infections (the incidence rate) is increasing in older adults (Bourgeois et al., 2016). The purpose of this poster, which is a product of a literature review, was to determine the factors contributing to the increase in new HIV infections in adults over 50 and to make suggestions for possible interventions. Additionally, the findings of this research will inform my future research at the Master’s level.
Why Should We Be Concerned?
In Canada in 2015, approximately 24% of new diagnoses were of adults over 50 years old and the new cases in this age group have been steadily increasing over the last five years (Bourgeois et al., 2016). See figure 1.
Figure 1: Number of reported HIV cases in Canada by age group between 2013–2017 (Bourgeois et al., 2016).
Why is the incidence rate of HIV in older adults
increasing?
Reluctance to Discuss Sex
• Healthcare providers and older patients are reluctant to discuss sex due to embarrassment or discomfort (Davis et al., 2016).
• Due to assumptions that older adults are not sexually active, doctors are significantly less likely to offer them routine HIV testing (Roberson, 2018).
Lack of Age-Appropriate HIV Information
• Most sexual health education targets young adults for prevention of HIV/STIs or unwanted pregnancy. • This may contribute to less condom use and less
HIV testing in older adults (Davis et al., 2016).
Image 1: Condoms provide effective prevention against HIV at any age (Sasint from Pixabay).
Misconceptions About HIV
• Due to a lack of education, older adults may believe HIV is only a concern for younger people (Roberson, 2018).
Older Adults Dating for the First Time in Years
• Post-menopausal women may consider condoms as a form of birth control only (Lindau, Leitsch, Lundberg, & Jerome, 2006).
• Other methods of preventing sexual transmission of HIV are available, like female condoms and Pre-Exposure Prophylaxis (PrEP).
Ignoring Symptoms of HIV as Normal Aging
• These include cognitive changes, fatigue, weight changes, skin changes, and frailty (Lindau et al., 2006).
Cultural Bias Against Older Adult Sexuality
• Popular media’s unflattering portrayals of older adult sexuality, e.g., “the dirty old man”, creates stigma about sex and discourages productive discussions.
How Can We Begin to Address This Issue?
Two related concerns are: (1) the lack of HIV prevention programs aimed at older adults; and (2) a lack of discussion of older adult sexuality. Healthcare providers, including employees of assisted living facilities, should be provided with training on how to discuss sexual health, condom use, STIs, and HIV with older patients.
Image 2: Island Sexual Health is a non-profit that has been serving Greater Victoria since 1969.
As part of my research I created educational resources for the Island Sexual Health Clinic in Victoria, BC. Three posters were created with information directed at older adults to highlight the importance of condom use, the ease of HIV/STI testing, and the accessibility of sexual health information and services at clinics like Island Sexual Health.
HIV prevention information for older adults can be distributed via:
• Posters in health clinics, doctors’ offices, and pharmacies.
• Brochures listing online resources (encourages learning in comfort and privacy at home).
• Ads on social media and dating sites for older adults.
Discussion
Older adults are sexually active even into their 90s (Lindau et al., 2006), and represent a significant at-risk population for contracting HIV. Healthcare providers represent one of the greatest possible areas for improvement to accessible sexual health and HIV prevention information for adults over 50 (Davis et al., 2016). A sex positive approach, that focuses on pleasure and prevention, can help reduce HIV transmission, and help improve older adults’ sexual health and overall quality of life.
Future Research
This project was formative research to help generate ideas for future graduate work. I plan to conduct ethnographic interviews with older adults to discuss possible factors contributing to increasing HIV rates and the stigma surrounding older adult sexuality. This proposed research could provide valuable insight into sexual behaviours, norms, and perceptions of sexual risk that may be preventing older adults from using condoms and ultimately help decrease HIV transmission.
References
Bourgeois, A., Edmunds, M., Awan, A., Jonah, L., Varsaneux, O., & Siu, W. (2016). HIV in Canada-surveillance report, 2016. Canada Communicable
Disease Report, 43(12), 248-256.
Davis, T., Teaster, P. B., Thornton, A., Watkins, J. F., Alexander, L., & Zanjani, F. (2016). Primary care providers’ HIV prevention practices among older adults. Journal of Applied Gerontology, 35(12), 1325-1342. 10.1177/0733464815574093
Lindau, S., Leitsch, S., Lundberg, K., & Jerome, J. (2006). Older women's attitudes, behavior, and communication about sex and HIV: A community-based study. Journal of Womens Health, 15(6), 747-753. 10.1089/jwh.2006.15.747\
Roberson, D. (2018). Meeting the HIV prevention needs of older adults. Janac-Journal of the
Association of Nurses in Aids Care, 29(1), 126-129.
10.1016/j.jana.2017.08.004
Acknowledgements
The author thanks Dr. Eric Roth for his ongoing support and feedback during the research process. Thanks to Jennifer Gibson at Island Sexual Health for her time and helpful suggestions.
Image 3: The red awareness ribbon is a symbol of solidarity and hope for People Living with HIV/AIDS.
