HIV and AIDS risk in senior citizens: causes and prevention

Senior Citizens and the Growing Risk of HIV / AIDS

HIV and AIDS are widely recognized as posing a serious challenge to the public health.

Efforts at outreach, dispersal of information and prevention are extensive and have targeted high-risk groups such as sexually active teenagers, minority groups and women.

Outreach has overlooked fastest growing population of HIV / AIDS sufferers in senior citizens

The discussion here is intended to illuminate the dangers posed to this particular demographic both by the condition and by the relative failure of the healthcare community to effectively reach out to this demographic regarding said dangers. In addressing this population and its relationship to the spread of HIV / AIDS, the discussion here will consider the social, cultural, epidemiological and environmental conditions defining the issue.

Several factors will be considered as causes for the growing risk to seniors:

The implications of longer life expectances.

The impact of the advent of male virility drugs.

Cultural conditions specific to the elderly

Epidemiological risks specific to the elderly

The primary focus of this discussion is the growing risk index of senior citizens to HIV / AIDS. Several factors will be considered as causes for this growing risk, including the implications of longer life expectances and the advent of male virility drugs. Additionally, attention will be given to the cultural conditions specific to the elderly which render them more susceptible to exposure than other demographics. Here, the discussion will consider factors such as the relative modesty of older generations where frank sexual discussion is concerned and a mainstream emphasis on younger risk groups.

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Summary

The Population

According to the National Institute on Aging, "10% of all people diagnosed with AIDS in the U.S. -- some 75,000 Americans - are age 50 and older"

The population is nominally referred to as senior citizens but this is a catch-all for both seniors and for those who will soon be entering retirement age, living in senior communities or facing a heightened risk for loss of spouse. Therefore, this discussion considers those who of middle age or late adulthood also to be in need of engagement. According to the National Institute on Aging (NIA)(2012), "the number of older people with HIV / AIDS is on the rise. About 10% of all people diagnosed with AIDS in the U.S. -- some 75,000 Americans - are age 50 and older." (NIA, p. 2)

This growing population helps us to carve out a demographic for evaluation here. Adults who are 50 and older should be considered as being included in this discussion, which will ultimately produce a set of recommendations for reaching out to this demographic and reducing its risk. Before doing so however, it is appropriate to outline the factors impacting the selected population.

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Social Factors

Lack of awareness, education, outreach

Stigma of Discussing Sex Openly

Patriarchal views regarding female sexuality

Seniors are sexually active

Aaccording to a study by the University of Chicago, 60% of men and 37% of women 50 years old and above report engaging in sexual intercourse a few times per month."

Social factors have a substantial impact on the risks facing the selected demographic. This is because, contrary to younger demographics and their immediate families, which have been subjected to AIDS education and outreach for at least the last two decades, many in the elderly communities have been far removed from those educational contexts for far longer. Such is to say that true AIDS awareness and outreach did not begin until most senior citizens had already transitioned into social settings where such matters are not discussed in earnest.

Indeed, from a social perspective, one of the biggest obstacles to overcome with this population is simply removing the stigma from discussing sexuality openly. According to the National Prevention Information Network (NPIN) (2012), "older people are less likely than younger people to talk about their sex lives or drug use with their doctors, and doctors don't tend to ask their older patients about sex or drug use. "(NPIN, p. 1)

Much of this apprehension may arise from traditional views on modestly as well the stigma that historically accompanied the image of promiscuity. For senior women especially, formative experiences may imply that one's sexuality is to be kept as a private matter, even from physicians. The patriarchal tendency of physicians in past generations to preach premarital abstinence may also be a contributing factor to this reticence on sexuality.

This is problematic however, especially because this reticence is out of step with actual behavior among senior citizens. Statistics suggest that the image of the abstinent senior is a misconception and that, especially among men, the majority of seniors are sexually active. Anderson (2005) reports that "according to a study by the University of Chicago, 60% of men and 37% of women 50 years old and above report engaging in sexual intercourse a few times per month." (Anderson, p. 1)

Here, we can see that the social realities among senior citizens differ from the social pressures that have historically surrounded them. This is an incongruity that an outreach plan must seek to resolve

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Cultural Factors

Neglected as an outreach target

Not seen as a primary risk demographic

Misconceptions and stigma still surround HIV / AIDS

Lower survival rate among seniors

An epidemiological discussion the risk of HIV / AIDS among senior citizens must begin with recognition of the reasons for the expanding population of those infected. One of the primary reasons that seniors are the fastest growing population of infected individuals is because Americans are living longer all the time. Increased life expectancy is leading to a larger number of sexually active widows and widowers.

This factor has combined with the proliferation of drugs designed to treat erectile dysfunction to produce something of a sexual revolution among senior citizens. Anderson reports that "according to Patricia Hawkins, associate executive director of the D.C.-based Whitman-Walker Clinic, the popularity of medications such as Viagra has also contributed to the surge of HIV and AIDS among this group. 'Viagra has contributed a lot to this because there is so much more sexual activity among seniors and yet they are not often using contraception because they aren't worried about pregnancy,' she said. 'I don't think that our medical community has caught up to the impact of Viagra.'" (Anderson, p. 1)

The result is a new generation of sexually active individuals who, as discussed in previous sections, are not possessed in the education or knowledge of sexually transmitted disease or methods of protection. In addition to the creation of this new risk factor by emergent medical developments, there are levels of medical susceptibility which are specific to the elderly. Some anatomical changes, especially for women, can produce a higher degree of vulnerability to infection. For instance, the National Institution on Aging (NIA) (2012) makes the point that "there may be a connection between HIV / AIDS and women in menopause. Women who are no longer worried about getting pregnant may be less likely to use a condom and practice safe sex. Some menopausal women have vaginal dryness and thinning. This means they are more likely to have small tears and abrasions during sex. This can put women at greater risk for HIV." (NIA, p. 1)

In addition to the risk factors for contraction, another level of risk specific to the elderly relates to the general range of health conditions that accompany advancing age. Also on the epidemiological front is the concern that many of the early symptoms of HIV / AIDS may be overlooked by the elderly. Lacking knowledge of the AIDS virus and its symptoms, and also perhaps not perceiving anything out of the ordinary, the NPIN reports that "older people often mistake the symptoms of HIV / AIDS for the aches and pains of normal aging, so they are less likely to get tested." (NPIN, p. 1)

This is not uncommon in the early stages among all of those who might be effected by HIV / AIDS. However, with the elderly, this uncertainty may be exacerbated by a number of facts. First and foremost, senior citizens are inherently more susceptible to a wide array of health concerns and maladies on a daily basis. This susceptibility may overshadow what could otherwise be telltale signs of the HIV / AIDS virus.

Another factor is that few senior citizens actively request or seek out an AIDS text. Similarly, until only recently, it has not been the habit of medical professionals to require such tests with any regularity. This means that the condition may be more likely to go untested for a greater length of time among senior citizens. As the NIA warns, "many people do not have any symptoms when they are first infected with HIV. It can take as little as a few weeks for minor flu-like symptoms to show up or as long as 10 years or more for more serious symptoms. Symptoms can include headache, chronic cough, diarrhea, swollen glands, lack of energy, loss of appetite and weight loss, frequent fevers and sweats, frequent yeast infections, skin rashes, pelvic and abdominal cramps, sores on certain parts of your body, and short-term memory loss." (NIA, p. 1)

It is especially important for the geriatric healthcare community to look for any combination of these symptoms in the elderly. Early detection takes on an added importance for those who are advanced in age and might therefore be especially at risk for serious illness as a result of untreated immune-deficiencies. To this very point, Chiao et al. (1999) note that "survival rates among elderly individuals infected with human immunodeficiency virus (HIV) are consistently decreased in comparison with those for younger patients." (Chiao et al., p. 740)

This increased risk of fatality must be seen as a determinant part of the epidemiological outlook for senior citizens living with HIV / AIDS.

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Environmental Factors

Self-contained communities

Considerations

Past Considerations: The misimpression that seniors are not a sexually active or at-risk population.

Present Considerations: The clear need for a far greater degree of information outreach.

Future Considerations: The concern that seniors are a growing population and, thusly, that the population at risk is growing rapidly as well.

The Plan

Recommendation 1: Information Outreach

Recommendation 2: Removing the Stigma

Recommendation 3: Measures of Prevention

The plan for addressing the risks facing seniors centers around three major recommendations.

Recommendation 1: Information Outreach:

First and foremost among our recommendations is the need to alter the social and cultural influences that shape the current discourse on seniors and sex. Using public information campaigns and other outreach methods is a critical step in the plan to bring greater awareness of the risks that sexually active seniors face. Accordingly, "the National Association on HIV Over Fifty (NAHOF) says that there are specific ways to target older people. Specific programs must be implemented for older adults who need to be informed about the transmission and prevention of HIV, more research is needed to study seniors' sexual and drug-using behaviors to determine HIV disease progression and treatments and programs aimed at reaching health care and service providers should cover misdiagnoses, treatments, support groups and more." (Anderson, p. 1)

In sum, not only must we do more to make sure that seniors are aware of the risks facing them but also to make sure that we as a general public and as a healthcare community also understand these risks.

Recommendation 2: Removing the Stigma

It is also critical that we continue the strides that we've already made toward undermining the stigmas and misconceptions surrounding HIV / AIDS. Outreach should take the form of targeting those environments where seniors are most at risk such as retirement communities and regions with large elderly populations. Here, education must include a broadening discussion on the realities of AIDS. Valdiserri (2002) gives us an array of recommendations for how to achieve this change. Valdiserri reports that "cited among the 10 essential health services of every public health agency are the following activities: empower people about health issues, mobilize communities to solve health problems, develop policies and plans in support of individual and community health, and conduct research to find innovative solutions to health problems. To ensure these essential services in the context of HIV prevention and care, there is no question that we must all -- every segment of the public health community -- confront the impact of HIV / AIDS stigma." (Valdiserri, p. 341)

Separating fact from fiction is essential to making sure that we're reaching the populations that are impacted instead of simply those we associate with the AIDS virus.

Recommendation 3: Measures of Prevention

The emphasis on prevention means that we need to work with medical professionals to engage seniors more regularly in testing for the AIDS virus in order to prevent those who are infected from spreading the condition. Likewise, there is a need to improve senior knowledge regarding methods of contraception such as condoms and female condoms. Educational seminars held in senior communities could be an excellent way to help reduce the impact of the epidemiological risks discussed here throughout.

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