HIV/AIDS and Older Adults: The Invisible Ten Percent

Abstract

Human Immunodeficiency Virus (HIV) was first identified as the virus that causes AIDS (Acquired Immune Deficiency Syndrome) in 1983. Much information has come forward about this complex, elusive, and devastating illness since then. The HIV virus is transmitted via the exchange of certain bodily fluids: blood, semen, and vaginal secretions, exchanged during sexual intercourse; injection drug use; and, in very rare cases today, blood transfusions. Infected mothers can also transmit HIV to their nursing infants via breast milk. The HIV virus replicates itself in an infected individual billions of times a day. It does so by attaching itself to and taking over certain white blood cells (CD4 cells, also known as'T cells), thereby insidiously destroying the body's immune defense system. We have learned to develop treatments that inhibit or manage this cloning activity. Although these treatments do not result in a cure for HIV, they have so far helped many (though not all) infected individuals live longer and often (though not always) healthier lives. It is important to note that HIV/AIDS is not confined to so-called groups. In the past, HIV/AIDS has been erroneously perceived as a gay men's disease because in the United States it first surfaced in the gay community and wiped out almost a generation of this population. It is now known that risk behaviors promote transmission of the virus and that these behaviors are practiced by people of all sorts, including heterosexual men and women (Emlet, 1997). There appears to be much information yet to learn about HIV/ AIDS before a cure is discovered, a goal that has eluded scientists and researchers in the medical profession for more than two decades. In fact, the closer they appear to get, the further they seem to be from this goal. We now approach the third decade of the AIDS epidemic; yet apparently there is one particular aspect of HIV/AIDS we have chosen to deny: age is no barrier. What has been ignored from the outset is what Emlet (1997) calls a hidden population of older persons (persons aged 50 and above) who have been and are being infected in significant numbers. The Centers for Disease Control and Prevention (CDC) (1999) reports that as of June 1999, 75,266 people in the United States aged 50 and above have contracted AIDS, more than 10% of all AIDS cases in the United States (Figure 1). Almost 11,000 were women and more than 20,000 over the age of 60. In New York City, the epicenter of the epidemic in the United States, the numbers are even more dramatic. Older adults in metropolitan New York account for close to 13 percent of all AIDS cases; and in Manhattan that number is nearing 15 percent (New York City Department of Health, 1999). This is also the case in parts of Florida such as Dade and Palm Beach Counties, where there are many retirees, as well as in other densely populated urban areas of the country (Puleo, 1996). Emphasis must be placed on the fact that new AIDS cases are rising faster among this age group than any other; (Saag et al., 1998). New AIDS cases in persons aged 50 and above rose by 22 percent in the five years from 1991 to 1996, while the increase in that same period for persons 13 to 49 was only 9 percent (CDC, 1998)-that's more than double the increase. Another surprising figure surfaced in 1994 when Stall and Catania (1994) determined that by the early 1990s older adults accounted for the highest percentage of heterosexual transmission of HIV/AIDS among all age groups (10%). Prior to 1985, such transmission was virtually unheard of in this cohort. These figures represent persons with AIDS diagnoses only, not individuals that are simply HIV-positive. An HIV-positive test result indicates the presence of HIV-fighting antibodies in the bloodstream; people who are HIV-positive can remain so for a decade or more without any visible signs or symptoms. They have not yet contracted any opportunistic infections (OIs), seen their T-cell counts drop to below 200, or exhibited any of the other indicators which would give them a diagnosis of AIDS. …