It is estimated that by 2017, and possibly as early as 2015, more than half of all individuals with HIV in the U.S. will be age 50 or older. This wonderful increase in life expectancy is largely due to effective treatment, which has created a rapid rise in the number of people over age 50 with HIV. Thirty years into this epidemic, this good news is tempered by other, more troubling facts. Approximately one out of every six new HIV diagnoses is among adults over age 50. In 2009 there were 34,995 new cases of AIDS in the U.S. with nearly one-quarter of these occurring in those aged 50 or older. So while AIDS diagnoses may be decreasing overall, it is of great concern that AIDS diagnoses among older adults are rising.
ACRIA has been at the forefront of HIV and aging, conducting groundbreaking research. Our Research on Older Adults with HIV (ROAH), the largest study ever conducted on older adults with HIV, used a nearly 1,000-person cohort in New York City to examine a comprehensive array of issues, including health status, stigma, substance use, depression, social networks, and spirituality. ROAH was unique in the kinds of questions it asked, for the first time probing in-depth the sexual and drug-taking risk behaviors of older people with HIV, as well as gathering data on medical and psychosocial issues. Following ROAH, we've conducted more in-depth research on HIV, older adults and depression and partnered with others on related studies across the globe, including the Terrance Higgins Trust and Chelsea Westminster Hospital in the United Kingdom, the Center on Halsted in Chicago, Gay Men's Health Crisis in New York City, and Syracuse University, among others.
What we've learned may surprise you. Providers often underestimate the desire for and level of sexual activity in older adults, and maybe especially among gay, bisexual and transgender older adults who are at high risk for HIV, thereby neglecting their STI risk. While many older adults are sexually active, they often do not perceive themselves to be at risk for HIV or other sexually transmitted infections (STIs), if only because HIV disease is largely and wrongly associated with youth. Thus, prevention messages have not targeted this older population and, as a result, they unwittingly engage in high risk behaviors. We also know that many older adults with HIV who know their status continue to engage in high risk conduct at rates comparable to other high risk groups.
Nonetheless, older adults are much less likely to be tested for HIV than younger adults, with many being diagnosed with HIV only when receiving treatment for other medical conditions. Lower rates of testing and delays in detection not only facilitate the spread of HIV, but increase the likelihood of progression to AIDS resulting in increased illness and death rates as well as decreased effectiveness of anti-HIV treatment. Indeed, the likelihood of receiving a concurrent HIV and AIDS diagnosis increases strikingly with age. In light of such data, the need for routine testing to ensure early diagnosis is evident as is the need for a better understanding of HIV transmission among older adults.
Through innovative research, education and advocacy, ACRIA is improving lives by influencing public policy, identifying unmet needs, bringing together HIV, aging and other service providers to improve life-saving services, and identifying research gaps in this understudied population. For example, ACRIA joined an expert panel from across the U.S. to craft the first-ever recommended treatment strategies for older adults with HIV, in collaboration with the American Academy of HIV Medicine and the American Geriatrics Society. This just-released report can be found at www.aahivm.org/hivandagingforum.
In addition, via a partnership with Gay Men's Health Crisis (GMHC) and Services and Advocacy for GLBT Elders (SAGE), and with support from the MAC AIDS Fund, we initiated a public policy and advocacy effort in early 2009 to highlight the needs and challenges of an aging HIV population. Among other actions, we helped to organize and participated in the first-ever White House meeting on HIV and aging in October 2010. Following this meeting, the Office of AIDS Research at the National Institutes of Health created a research advisory group on HIV and aging, which includes an ACRIA researcher.
On this year's World AIDS Day, with more hope than ever that we might in our lifetime bring the AIDS epidemic to an end, much remains to be done. We must maintain (indeed, increase!) our investment in prevention, including routine testing and access to prompt treatment for all with HIV. And we must act now to better understand and address the needs and challenges of what will soon be the majority of Americans with HIV -- those over age 50.
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