Global Health Human Diversity and Disease 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

Misunderstanding of contraception/condoms among post-menopausal women

In addition to the social conditions that have intervened in open sexual discourse among seniors, there are broad cultural factors that have contributed to the isolation of this demographic. According to the National Prevention Information Network (NPIN), one of the reasons that HIV / AIDS remains a growing problem among the elderly is because this a is a demographic that has not historically been targeted with information campaigns or other outreach efforts. The NPIN reports that "people age 50 and older represent almost one-fourth of all people with HIV / AIDS in the U.S. Because older people don't get tested for HIV / AIDS on a regular basis, there may be even more cases than currently known." (NPIN, p. 1)

This oversight of seniors by public health services and the medical community is as much a result of the cultural perceptions of HIV / AIDS as of senior citizens. Such is to say that this is frequently perceived as a condition specifically impacting teenagers, members of urban communities, members of the LGBT communities and needle drug users. Historically, each of these groups has represented its own form of elevated risk. However, this has also contributed to a set of cultural stigmas surrounding the condition. Indeed, for many segments of the public, there remains some perception of HIV / AIDS as a moral disease. According to the study by Valdiserri (2002), while "overt expressions of HIV / AIDS stigmatization had decreased during the 1990s. The bad news is that in 1999, nearly 1 in 5 American adults they surveyed said they "feared" persons with AIDS. One in 6 admitted to feelings of "disgust" related to persons with AIDS. Another study conducted in 2000, a national Internet survey of more than 5600 American adults, revealed similar findings. Nearly 1 in 5 respondents agreed with the statement 'People who got AIDS through sex or drug use have gotten what they deserve.'" (Valdiserri, p. 341)

This cultural impression not only reveals the strong impact the prejudice and misconception still hold over what should be perceived as a general public health issue. Moreover, it creates a sense among those who don't fall into these particular demographics that they are somehow insulated from the risk. In large part, this is a sense that has contributed to the oversight of the elderly by medical professionals and the healthcare community when it comes to providing education about the condition. The result is that far too many senior citizens are not aware of the risks related to unprotected sex. For senior women who are past menopause and run no risk of being impregnated, the use of condoms may only be associated with the idea of contraception.

This denotes that there is a need to alter both the cultural conception of the elderly and of the condition itself. In order to reduce the risks that are facing the elderly, it will be important to broaden the scope of the discussion on HIV / AIDS. Removing the stigma and stereotypes related to the condition is an important step to helping stem the growing tide of infected seniors.

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Epidemiological Factors

Increased life expectancy

Proliferation of erectile dysfunction drugs

Greater biological risk of infection for older women

Difficulty of recognizing symptoms

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.