HIV & AIDS And The Older Adult

Kathleen M. Nokes

• Publisher: Taylor & Francis
• Year: 2020
• Print ISBN: 9781560324300
• eBook ISBN: 9781317763390
• Topic: Medicine
• Subtopic: History & Theory in Psychology

First published in 1996. The incidence of HIV/AIDS in society has reached epidemic levels. People of all ages are contracting the disease, and with the advances in medication and treatment, those with the disease are living longer. This book discusses the unique issues facing older adults with HIV/AIDS and addresses living with the disease.

Chapter 1
Scope of the Challenge

Joanne Hanna Puleo

OVERVIEW OF HIV/AIDS AND AGING

Since AIDS was first recognized in the early 1980s, humankind has been firmly in the grips of a full-blown, ever-evolving pandemic. The enormity and complexity of the actual and potential impact of HIV/AIDS on individuals and their families and on health and social systems worldwide is coming into focus. We are beginning to see that AIDS does not choose who to infect on the basis of sexuality, gender, national origin, or age.

AIDS catapulted into American awareness in June 1981. A group of physicians practicing in the Los Angeles area had filed reports with the Centers for Disease Control (CDC) that described infections associated with immune deficiencies in five homosexual men with no past medical history of immunocompromise (CDC, 1981). Their immune system disorders had somehow been acquired, and despite aggressive treatments the five men died. The story of their deaths, however, would not be an isolated chapter in the history of American health. The story continues to be written to this day and, tragically, may have no end.

The first reports to the public that described this syndrome emphasized a link to homosexual men and their person-to-person transmission through sexual behavior. Then, late in 1981, the syndrome came to be associated with heterosexual injecting drug users, persons with hemophilia, and women, which suggested that transmission was blood-borne as well as sexual.

In 1984, researchers discovered that a retrovirus, which they initially named HTLV III and subsequently renamed HIV-1, was present in the blood and other body fluids of people with HIV/AIDS. An antibody test (see chapter 2) to detect the presence of antibodies to HIV-1 was developed in 1985, and tracking of the incidence and prevalence of HIV seropositivity in populations worldwide began.

The World Health Organization has estimated that 14 million people from the most metropolitan communities to the most remote areas have been infected with HIV. Four million people have developed AIDS (American College of Physicians, 1993). The CDC (1995) reported the number of documented cases of people with AIDS in the United States to be 441,528 through December 1994 and estimated that the number of Americans infected with HIV numbers more than 1 million. Over the next 20 years, the number of HIV-positive (HIV+) Americans is expected to increase to 7 million or more. In the United States, AIDS is the leading cause of death for people aged 25-AA years (CDC, 1994–1995). As of January 1994, more than 7,500 inmates in 49 separate correctional agencies were confirmed to have AIDS (Criminal Justice Institute, 1994). In New York State prisons, AIDS is the leading cause of death for both men and women of all ages, and it is estimated that as many as 20% of New York’s 63,000 inmates are HIV+ (New York State Department of Health, AIDS Institute, 1994). More than 100 people die of AIDS in the United States every day, 1 every 15 minutes (CDC, 1991). AIDS-related health care costs are expected to surpass $50 billion annually by the year 2010. And, unfortunately, this is only the tip of the iceberg.

Although AIDS principally affects young and middle-aged adults, 10% of AIDS cases reported to the CDC have occurred in persons 50 years of age and older (CDC, 1993). In areas where the older adult population is more highly concentrated, the percentage of persons with AIDS (PWAs) who are 50 or older exceeds the national average. Florida’s Palm Beach County is one such area in which 15% of PWAs are 50 years or older (Speyer, 1994). The figures describing the incidence and prevalence of AIDS in the older adult population underscores that the virus lives in blood irrespective of the age of the host. Yet public health commentary of the current projected biomedical and socioeconomic consequences of AIDS neglects to address the significance of its impact on the older adult population (Feldman, 1994).

HIV INFECTION

Those infected with HIV and those who will eventually develop AIDS are not found randomly throughout the population. Participating in sexual behaviors with an HIV-infected person, sharing drug use equipment with an HIV-infected person, or receiving a blood transfusion or organ donation from an HIV-infected donor are the behaviors associated with transmission. Mother-to-fetus transmission rates average 25%; however, preliminary results of efforts to decrease this rate through early pharmacologic intervention during pregnancy seem encouraging (Samelson, 1994).

The highest risk behavior associated with HIV transmission for persons over the age of 50 is male-male sex with an infected partner. Nearly 60% of all PWAs in the older adult population were infected by means of this route. Fifteen percent of PWAs who are over 50 were infected by sharing infected drug use equipment. Heterosexual transmission among older adults, nearly unknown before the mid-1980s, rapidly increased by 1990 to 10% of all AIDS cases diagnosed in the over-50 population. This is the largest percentage of heterosexually transmitted cases of AIDS among any age group (Stall & Catania, 1994).

Three percent of all known PWAs became infected as the result of transfusion of infected blood or blood components (CDC, 1993). Older persons are more frequent consumers of health care and are more likely than younger persons to have been infected through blood transfusions. Transmission of HIV-infected blood is associated with 17% of documented PWAs who are 50–64 years of age and with 78% of those age 65 and older (Riley, 1989), and the actual numbers may be much higher. According to the National Academy of Sciences (1986), the potential magnitude of HIV transmission through transfusion cannot be fully predicted owing to the impossibility of testing blood supplies on hand before the availability of the HIV antibody test, which was made available in 1985.

Blood donors who participated in behaviors that indicated that they were at high risk for HIV infection were, before the availability of antibody testing, expected to self-identify through questionnaires or interviews (Clark, 1983). At the present time, interviewing potential donors to screen for those with a history of high-risk behaviors coupled with HIV testing of all donated blood detects an average of 50 HIV-infected donors each year throughout the United States. The New York Blood Center (1995), the largest blood bank in the world, has reported an average of 54 HIV+ donors per year. Despite the strengths of the donor screening and donated blood testing protocols, the system is not perfect. Translated into transmission risk, there remains a 1 in 420,000 chance of becoming infected with HIV through a transfusion (Lackritz, 1995).

EDUCATING PEOPLE ABOUT HIV/AIDS

Educating the public regarding how HIV is transmitted, behavioral risks, and prevention are basic to the effort to reduce infection within all populations. In assessing the effectiveness of broad public education programs, which primarily targeted the hardest hit gay male and young adult populations, the National Health Interview Survey of 1992 (Schoenborn, Marsh, & Hardy, 1994) supplemented its questionnaire with questions related to AIDS knowledge and attitudes. Results of this survey were encouraging in that 93% of Americans reported having at least “a little” knowledge of AIDS. One direct result of the success of the educational strategies used to disseminate information concerning AIDS has been the decline in HIV transmission rates among members of certain gay male communities. Moreover, public discussion of potentially sensitive issues related to transmission and prevention of HIV has become more acceptable. Words such as condom and safe sex have become commonplace in the American vocabulary. Graphic descriptions and demonstrations of prevention techniques and behaviors have become the norm in many schools, religious institutions, and other community groups.

Unfortunately, older people have not been targeted to receive even the most basic HIV/AIDS information. This is evidenced in the 1992 National Health Interview Survey just discussed, in which 16% of respondents aged 50 and older reported having no knowledge of AIDS. In addition, 77% of these older respondents thought they had no chance of getting the virus. Consequently, they were less likely to seek or give consent for HIV testing. Only 8% of adults over age 50 were tested for HIV in 1992 as compared with 27% of adults aged 18–29 (Schoenborn et al., 1994). The results of the national survey duplicated the results of the survey conducted in 1987 that determined that persons 50 years of age and older generally had a lower level of basic AIDS knowledge than persons in all other age categories (Dawson, 1988). This persistent lack of knowledge of transmission risk coincided with the alarmingly steady increase in the number of AIDS cases among older adults from 1982 to 1991 (National Center for Health Statistics, 1993).

Several possibilities have emerged regarding the health and social policies responsible for neglecting to target older adults for basic HIV/AIDS education despite the significant rise in incidence and prevalence of HIV disease and AIDS within this population. There exists in American society an undercurrent of reluctance, or possibly repugnance, in acknowledging the sexuality and sexual activities of older adults. The practice of stereotyping older adults as asexual grandmas and grandpas is widely accepted. This may be the result of a subconscious Victorian association of sexuality with procreation. Yet, although sexual activity among older adults is likely to be dependent on one’s cultural norms, functional abilities, partner availability, and opportunity, sexual expression in the senior years can meet the participants’ basic human needs for companionship, physical pleasure, and intimate communication. Despite limited research on the sexual behaviors and activities of the older adult population, rising HIV/AIDS cases within this population demonstrate that older adults are likely to be sexually active and to engage in a variety of sexual activities within a monogamous relationship or with multiple partners (Ryan, Dane, & Tepper 1991). As long as older adults have the ability to make choices in terms of sexual intimacy and other behaviors, they need and deserve inclusion in education campaigns targeting populations at risk for HIV/AIDS infection. Also, because knowledge of one’s HIV antibody status is vital to the overall risk reduction effort, older adults need to acknowledge that they are at risk of infection.

The American community is currently experiencing tremendous turmoil and change in the struggle to redefine morality, equality, tradition, family, and the dynamics of relationships over time and lifetimes. Simultaneously, the American population is aging, and acknowledgment of the impact of the older adult on the collective human drama must be made. HIV/AIDS must be recognized as part of older adults’ current and future reality. Likewise, the need for immediate action on the part of older adults in matters related to HIV/AIDS necessitates their claiming partial ownership of the expanding tragedy.

Although the variety of HIV/AIDS public educational programs implemented by federal, state, and local agencies have resulted in varying degrees of success in younger populations, they may not prove quite as successful in educating older adults. Learning needs and abilities change as people age. Cognitive efficiency as well as visual and auditory acuity may decline. The need for one-on-one instruction, frequent summarization, and restatement of what is being taught begins to increase as people age. Educating the older adult about HIV/AIDS is further complicated by its negative social stigma and the necessary discussion of sexuality and other topics frequently regarded by older adults as private. Many may “tune out” and fail to recognize that they may be infected. Even though many have recognized the “graying of America,” the majority remain relatively ignorant of the diverse composition of the aging society.

In 1995, 44 million persons were over the age of 60, and 14% represented minority ethnic groups. Over the next 30 years, primarily as a result of immigration, the population of older African Americans will grow by 300%, older Hispanics by 395%, and older Whites by 197%. By the year 2030, it is projected that minority elders will total nearly 25% of the older adult population (Harper, 1995). These figures highlight the need not only for educational programs specifically designed for the learning needs of the older person, but for programs that are additionally and progressively culturally sensitive.

Although it is undoubtedly possible to design and implement sensitive multimedia HIV/AIDS educational programs targeted for the older adult, the greatest opportunity for risk assessment and education already exists in the health care setting. Unfortunately, a tendency persists in this setting to neglect taking a sexual history, HIV/AIDS risk assessment, and basic HIV/AIDS education, especially in populations of older adults. Despite the fact that 76% of all Americans visit a physician at least annually, only 15% can recall discussing AIDS during any visit (Gerbert, Maguire, & Coates, 1990). Older adults, as the greatest consumers of health care in this country, average 8.9 physician visits per person p...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Foreword
• Preface
• Contributors
• Chapter 1 Scope of the Challenge
• Chapter 2 Health Care Needs
• Chapter 3 Medical Issues
• Chapter 4 Psychosocial Issues
• Chapter 5 Creating a Support Group
• Chapter 6 The Older Gay Man
• Chapter 7 Long-Term Care
• Chapter 8 Legal and Ethical Issues
• Chapter 9 Caregiving Issues
• Chapter 10 HIV/AIDS and Aging Networks
• Chapter 11 Voices
• Appendix A 1993 Revised Classification System for HIV Infection and Expanded AIDS Surveillance Case Definition for Adolescents and Adults
• Appendix B States Prohibiting Sexual Orientation Discrimination and Additional Resource Information
• Appendix C Disposal Tips for Home Health Care
• Appendix D Resources for Grandparents
• Appendix E Where Older Persons with HIV Disease Can Get Help and Additional Agencies and Organizations
• Index