HIV/AIDS Prevalence in Older Adults in the U.S.

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HIV is the acronym for Human Immunodeficiency Virus.  After initial exposure to the HIV virus, acquired immune deficiency syndrome (AIDS) develops as the human immune system weakens and becomes susceptible to opportunist viruses. According to the Center for Disease Control (2018), the HIV/AIDS epidemic progressed from simian immunodeficiency virus (SIV) after chimpanzees were hunted and eaten in Africa. HIV/AIDS became an epidemic in 1984 in the United States. Treatment for HIV/AIDS is available, however, in older people, the exposure to the virus is growing. The factors leading to this alarming statistic needs to be addressed by Public Health providers. The following paper will address the causes and solutions for the spread of HIV/AIDS in the United States by older Americans.

HIV/AIDS in Americans over 50

When the HIV/AIDS outbreak started, many older Americans were in their teens and 20s. Decades later, a series of medications can help people who are HIV+ live longer and have more fulfilling lives. The Director of NIAID worked tirelessly for years to develop, if not a cure, at least a treatment for the HIV/AIDS virus. Although the largest at-risk segment of the population continues to be young black men, an alarming statistic points to the aging population in the U.S. 

The Issue

The term serostatus is commonly used in HIV/AIDS prevention efforts. In recent times, social advocacy has placed emphasis on the need to learn one's HIV/AIDS serostatus to prevent or slow the spread of the disease. Learning if a potential sexual partner has recently tested for Sexually Transmitted Diseases (STD) was often a discussion before intimacy. In the past, syphilis, gonorrhea, and chlamydia were the most prevalent STDs. If detected early, those STDs were treated without leaving an individual with a diminished quality of life. 

Older adults are often neglected when screening for STDs. In the past, most older adults were not the target age group for HIV/AIDS prevention and treatment. Younger people have a difficult time imagining older adults being sexually active. The Greatest Generation often has an awkward response when addressing the topic of sexuality. The Flower Child Generation is more open to discussing sexuality, and people who grew up in the 1970s and 1980s followed their lead. 

Ethical Concerns

Health Care providers were dealt a difficult hand when it comes to the subject of sexuality and the prevalence of transmitting the HIV/AIDS virus. Broaching the topic of sexual intimacy can be challenging when the patient is older. If a Health Care provider discovers an older adult has indeed been exposed to the virus, then more discussion is required to talk about safe sex and previous sexual partners who may have been exposed. Sensitivity and understanding will be necessary when talking with someone who has unknowingly been exposed to the virus.

The United States passed a law to protect the privacy of patients. The Health Insurance Portability and Accountability Act (HIPAA) was designed to guard patients’ medical records and information. When other health care clinics, hospitals, and doctors need patient’s records the HIPAA protects the dissemination of that information. The stigma of positive HIV/AIDS status goes beyond the threshold of embarrassing for the patient, it is imperative all health care providers know the risks of treating that patient. Older people who are HIV+ also may fear a public attitude stigma and experience a negative self-image stigma (Brennan, Emlet, Brennenstuhl, & Rueda, 2013). Disclosure of HIV+ status is protected by the HIPAA, but for older people, the reassurance may not be enough to continue treatment. Sharing this information is difficult at best in a health care environment, but for elderly people to share with family and friends invites an entirely different level of exposure. Health Care providers are required to treat people who are HIV+ in a fair and non-judgmental manner. The virus can complicate and be contra-indicated with other medications older adult are taking. Methods of treatment must include protection for the provider and any other people who might be exposed to the virus while treating the patient in a health care setting.

Prevention Challenges

Access to care for all individuals living with HIV/AIDS is a common concern. The stigma of the virus is prevalent in American society. Elderly people may live with the disease for years before becoming aware of his/her status. “Older persons are more likely to be at advanced stages of the disease when first identified as living with HIV, progress to AIDS more rapidly, and have poorer medical prognoses and shorter periods of life expectancy” (Lovejoy et al., 2008, p.943). Older people have a range of chronic illnesses associated with the normal aging process. Many mature individuals are not diagnosed early in the disease because health care authorities are concentrating on other health complications. Additionally, “older adults living with HIV/AIDS face two primary sources of stigma: that related to AIDS, and that related to ageism” (Emlet, 2006, p. 781). The double stigma further aggravates the diagnosis and treatment for HIV+ older patients.

Although advances in HIV/AIDS treatments have curtailed the infection rate for younger people, older adults may not be aware of them. When the AIDS crisis became a national health care issue, the diagnosis and treatments were aimed clearly at younger populations in the United States. Most of the older adults living in the U.S. today can remember the beginning of the HIV/AIDS crisis. However, those who remember the AIDS initial outbreak may associate the disease with homosexual encounters. If older adults have never engaged in same-sex intimacy they may think being exposed to the HIV/AIDS virus is an anomaly. Careful, respectable, and health-conscious people do not realize the risk of unprotected sex. Older women may have long ago thrown away birth control believing once the onset of menopause begins, protected sex no longer a priority (Jacobsen, 2011). Strict education regarding behavioral changes is needed for these patients. 

The seriousness of xenophobic attitudes in older adults regarding same-sex relationships becomes stronger in old age. The convictions that normal, God-fearing, decent people do not get AIDS is a barrier that health care providers need to acknowledge. HIV/AIDS may also be associated with a promiscuous lifestyle. If older Americans have infrequent sex with unknown people they are still at risk (Lovejoy, et al., 2008). During the 1980s and beyond, many people were regularly tested for Sexually Transmitted Diseases. The previous decades of free love morphed into a player’s nightmare. Suddenly potential intimate partners were questioned regarding HIV serostatus. Having been tested negatively was commonly regarded as being safe, and the use of condoms was unnecessary. The health complications of older adults like diabetes, hypertension, osteoarthritis, obesity, and others require the prescribing of many medications. The medication regime for treating HIV/AIDS is often referred to as a cocktail. Dr. Fauci and the team of immunologists at NIAID developed a treatment for the HIV/AIDS virus which provides for a quality of life.

Impacts on the Profession of Nursing

The complications of being HIV+ is compounded by the statistic that in the near future half the people who have the disease will be over 50. According to the Center for Disease Control (CDC), many older adults are at a higher chance for exposure to the HIV+ virus because most people do not understand the risks (2018, HIV and Older Adults). 

 Becoming HIV+ can be devastating for anyone, but for an older adult in the U.S. there are social and economic consequences. It is up to the health care industry to educate and mitigate the discomfiture of a patient’s reaction to the news he/she has tested positive for the virus. Comorbid health conditions further complicate an already difficult diagnosis. The powerful medications used to treat the HIV virus are expensive. Additionally, the result is the patient will need to go to his/her local pharmacy to receive the medication prescribed to treat HIV/AIDS. Collecting this medication can cause embarrassment, and many older adults would rather not take medicine as a result.

Clinics who treat people who are HIV+ specifically may also present a difficulty for older adults. The common misconception among older adults about who is an HIV+ person might also prevent treatment. Older men who were unable to have sexual intercourse have erectile dysfunction medications. Older men who previously were unable to continue to be sexually active were given a little blue pill to quash their angst (CDC, 2018). The rules no longer applied for many men and women who continued to be sexually active. In previous generations, this was not always possible. Now sex was recreational for older adults in the U.S. who were not concerned about procreation. The use of condoms was superfluous, and the result is many older adults have been exposed to the HIV/AIDS virus. The American Association of Nurses in AIDs Care (ANAC) helps the nursing profession learn about care and treatment for patients who have tested positive for the virus. As an organization, the ANAC has developed a network for nurses to exchange information and experiences to advance the care of people who are HIV+ 

(ANAC, n.d.). The organization also promotes public policy and advocates for better health care for people who have AIDS. The challenges for nurses can include grief and sadness when someone dies after all methods have been employed to sustain life. Isolation and the stigma of the virus can also affect nurses. Personal involvement with patients can take on a new meaning for someone caring for an HIV+ elderly person. At best, elderly patients can be a test of professional commitment and human connection. The emotional toll can test the best nurses when the health care issues are overwhelming, and the patient is uncooperative. Unfortunately, for the nursing profession education and advocacy for treatment of HIV+ patients often fall on their shoulders. Teaching personal care, safe sex, and medication regiment expand the role of nursing. It may also be up to the nursing profession to screen older adults for the HIV virus. Developing best practices, continuing education for the subspecialty, and providing support is important for the nurses who take care of all elderly patients, including those who are terminal with the disease. Having a support system is personally important for all professional nurses who met challenges foreign to other occupations. Networking and research can lead to improved care (ANAC, n.d.).

Conclusion

Rejection by other people and isolation are huge factors for older HIV+ people. The treatment comes with barriers that are often self-imposed by the patient. Testing, education, compassionate care, and vigilance are some of the complications of treating elderly people who have HIV/AIDS. In the Health Care Profession, the task of caring for the older population often falls on the nursing profession. Knowing the dangers of exposure, safe medical practices, and self-care are all important for nurses who treat HIV+ patients. The duty to educate and advocate for compassionate care is important. Caring for people is what nurses do, and for HIV+ elderly patients, it is life-saving.

References

American Association of Nurses in AIDs Care (2018). Nursing Practice and Research. Retrieved from https://www.nursesinaidscare.org.

Brennan, D. J., Emlet, C. A., Brennenstuhl, S., & Rueda, S. (2013). Socio-demographic profile of older adults with HIV/AIDS: Gender and sexual orientation differences. Canadian Journal on Aging, 32(1), 31-43. doi: 10.1017/S0714980813000068

Brooks, J. T., Buchacz, K., Gebo, K. A., & Mermin, J. (2012). HIV infection and older Americans: The public health perspective. American Journal of Public Health, 102(8), 1516-26. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22698038.

Center for Disease Control. (2018). HIV among people aged 50 and older. Retrieved from https://www.cdc.gov/hiv/group/age/olderamericans/

Emlet; C.A. (2006). “You're Awfully Old to Have This Disease”: Experiences of Stigma and Ageism in Adults 50 Years and Older Living With HIV/AIDS, The Gerontologist, 46(6), 781–790. Retrieved from https://academic.oup.com/gerontologist/article/46/6/781/584653.

 Jacobson, S. A. (2011). HIV/AIDS interventions in an aging U.S. population. Health & Social Work, 36(2), 149-56. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21661304.

Lovejoy, T. I., Heckman, T. G., Sikkema, K. J., Hansen, N. B., Kochman, A., Suhr, J. A., . . . Johnson, C. J. (2008). Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS and Behavior, 12(6), 943-56. Retrieved fromhttps://www.ncbi.nlm.nih.gov/pubmed/18389361.