HIV on the rise among America’s seniors

HIV infections are more common among some segments of the US population: men who have sex with men (MSMs), medically underserved populations, teens and young adults, IV drug users and their sex partners and some other groups.

But data from the CDC from 2008-2010 shows that there has been a steady increase in HIV infections in older Americans, 65 years old and older.

About 10-11% of newly diagnosed US HIV cases per year occur in older adults. That comes out to about 5,000 to 6,000 new cases of HIV in this age range per year. And, for reasons outlined below, there may be many more cases that aren’t diagnosed and reported.

There are a number of ideas as to why this is happening.

Older couple via Shutterstock

Older couple via Shutterstock

One thought is that since the chance of a woman getting pregnant at this age is infinitesimally small, these couples don’t use condoms. Thus the risk of contracting a disease that can spread sexually, like HIV, goes up.

Also, as the population ages, spouses die, move to nursing facilities or divorce. This can leave the other partner free to become sexually active again, this time outside of the monogamous relationship. The newly sexually active spouse may not be used to using condoms and, if a relationship begins, condoms aren’t even mentioned. Additionally, many doctors and other health care providers don’t think of the 65+ age group as being sexually active. Therefore, they spend little or no time talking to them about STDs, safer sex and other sex-related topics.

The same risk factors exist for this age group as for others: multiple sexual partners, frequenting prostitutes, IV drug use, MSM, not practicing safer sex, etc. Specific to this age group is the fact that older women may suffer from thinning of the lining of the vagina. This can make that surface more prone to tearing. Once torn, it’s easier for HIV to gain a foothold and cause an infection. Also, immune function tends to decline with age. So that might also make it easier for older people to contract HIV.

Another contributing factor is that, to date, the CDC doesn’t recommend routine screening for the 65 and older age group. But one of the geriatric professional societies does recommend screening for older people. The US Department of Health and Human Services also recommends screening for all adults regardless of age.

The good news is that older adults, once diagnosed and undergoing treatment, seem to do very well. Even better, in many instances, than those who are younger when the diagnosis is made. People in this population seem to be more compliant with taking medications and sticking to follow-up care with their doctors.

So, if you’re in the 65+ age range and haven’t been tested for HIV, it might be a good idea to get tested. And get retested if you continue to be at risk. (And, it goes without saying, that if you’re under 65, it’s still a good idea to get tested.)


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • j238

    HIV infections are “common” among teens and young adults?

    Do you have per-capita statistics to back that up?

  • AGP

    Thank you Dr. Thoma for a very interesting article. I don’t want to
    hijack this discussion but for those looking for more information about
    HIV/AIDS and those 50 and older please check out the National Library of
    Medicine’s AIDS Portal. They have a section devoted to Aging Adults: http://sis.nlm.nih.gov/hiv/Topic.php?topicID=1203&subtopicID=1208 Also there is a twitter handle @NLM_HIVplus50: news, updates and resources on HIV/AIDS and aging adults. The National
    Library of Medicine is one of the 27 institutes and centers of the
    National Institutes of Health.

  • Jason Cianciotto

    Thank you Dr. Thoma for helping to share this new information from the CDC about HIV among older Americans!

    The report you reference is the culmination of a multi-year effort by GMHC and other partner organizations to work with the CDC to ensure that HIV surveillance data collection and analysis focus on this critical population. The full report is available at http://www.cdc.gov/hiv/pdf/statistics_2010_HIV_Surveillance_Report_vol_18_no_3.pdf

    While an important milestone, these data are just the beginning.

    In addition to the issues you highlight, I was struck by the that fact that, in 2009, 41.5% of older Americans were classified as stage 3 (AIDS) at the time of their HIV diagnosis. Within this cohort, the highest percentage of concurrent HIV and AIDS diagnosis – over 44% – occurred among heterosexual men.

    This emphasizes just how critical it is for the CDC and health care providers to expand efforts to ensure that testing and outreach including people over age 50. It also speaks to how we need to change the way we frame sexuality in society as a whole. People do not stop having sex at a particular age. We can not afford to let stigma around aging prevent the inclusion of people over 50, and their sexuality, in our overall HIV prevention efforts. The lives of our parents and grandparents depend on it.

  • docsterx

    Good point. Only if the used equipment is still contaminated by the HIV patient’s secretions or blood. Much equipment (ventilator tubing, etc.) is single use-disposable and never reused. The non-disposable items are thoroughly cleaned and sterilized before reuse. So it’s extremely unlikely that transmission would occur like that. Having said that, there have been a few cases where needles were reused in office settings (to save a few pennies). And reused needles were used to remove an aliquot of medicine from a multi-use vial and contaminate it. Some patients did get infectious diseases, mostly hepatitis, that way. And those who performed these incredibly stupid and malicious deeds have lost their licenses, paid out millions and many have served jail time.

  • docsterx

    Most recent statistics I can find from about 4 years ago. Russia is not keeping a lot of accurate statistics. The Russian Federation does help people with HIV get antiretrovirals and does have HIV testing available. They DON’T provide much HIV education and almost no prevention measures. The CDC has been helping Russia tabulate and track patients, assist with helping to restructure Russia’s programs, etc. Estimate is that about 1% of the population is HIV+, somewhere around 1,000,000 people. All the Eastern European countries are experiencing growing numbers of HIV cases, Russia’s number of new cases leads in the area. Statistically, Russia does not keep statistics on how many people with HIV/AIDS die per year or what the cause of death in those people is (e.g. pneumocystis, etc.). Nor do they have accurate numbers on how many babies are born with HIV that was transmitted from infected mothers, subgroup statistics (e.g. are teens the fastest growing group? What percent of IVDAs have HIV? How many prisoners get/have HIV in the prison system, etc.). So most info is from CDC data that was primarily collected in the Moscow and St. Petersburg areas.

  • Anonymous

    If there is another HIV patient in a hospital, it can be transmitted by used equipment, etc

  • http://www.herpeswoo.com/ HerpesWoo.com

    More than 400 million people living with STDs in the world. Most of them suffer from the sickness and loneliness.

  • http://adgitadiaries.com/ karmanot

    I seriously doubt it. HIV is blood transmitted. Contaminated blood is rare these days.

  • http://adgitadiaries.com/ karmanot

    Do you have any stats for HIV in Russia?

  • nicho

    And don’t discount a heavy dose of, “I’m 80 years old. The world is going to hell. My life expectancy is in single digits as it is. What the fuck! Might as well have fun.”

  • Thom Allen

    My sister-in-law moved there a few years ago. She’s an ardent Democrat and gets into frequent arguments with the (retired) Stepford Wives there. She says that it’s a Peyton Place on golf carts. She said that it makes the exploits of the Kardashians look anemic by comparison.

  • docsterx

    Good point. I think that there are a number if factors and ED drugs could easily be one. The number of men asking for Rxes for them has skyrocketed. Even those who don’t have ED want them.

    One reason is aversion to condoms. Some women, when starting a new relationship, might want to have safer sex but are afraid to ask for the male to wear a condom because he might refuse and leave. And, as mentioned, women in this age group are past the age of childbearing and may lump condoms with birth control methods and not even consider using them. Those who have been recently divorced or widowed may not have even considered using condoms for years while they were married and monogamous. And most men just don’t want to wear them.

    One study that I read a few years ago mentioned that the 65+ age group doesn’t think much about getting an STI. They think that syphilis is almost non-existent and the same with gonorrhea. Many don’t even know much about HPV, chlamydia or other “newer” sexual pathogens. Those who have been recently divorced or widowed may not have even considered using condoms for years while they were married and monogamous. Many believe that HIV is only transmitted through male-to-male sex and that they are therefore “immune.” So there is a lack ow awareness and education in this group. This is partially due to physicians not considering that these patients may be sexually active.

    Men and women who want to have sex but who can’t find a suitable partner may use a sex worker and increase risk that way.

    So imagine how easy it is for someone in this group to get HIV. Being ill-informed about STIs and risks, not being aware of newer STIs, not considering safer-sex practices, not being told that they should get HIV tested, using ED drugs – all of this adds to a set up for them to be exposed to HIV and other STIs.

  • GoBlue

    The Villages is a retirement community in central Florida that was built from the ground up by a huge financial backer of candidates named Bush. Most of the residents are also conservative Republicans, i.e., members of the family values party, the Tea Party, whatever the right-wing flavor of the month is. They’ve turned The Villages into a hotbed (I couldn’t resist) of STDs.

  • Hue-Man

    And seniors – women and men – are vulnerable to odious criminals like this (AND get tested!): “A Michigan man has been charged with felony sex offenses after he told police he was HIV-positive and had set out to intentionally infect as many people as he could, police said. Health officials have issued an alert warning that “possibly hundreds of people have been exposed to HIV.”"

    “The woman who spoke to WOOD [NBC Grand Rapids] said she had no doubt that there are many
    other victims. She said Smith told her that he had had sex with as many as 3,000 people, including men as well as women.” http://usnews.nbcnews.com/_news/2011/12/30/9833291-michigan-man-may-have-intentionally-infected-hundreds-with-hiv?lite

    (I don’t want to trigger the ‘criminalization of HIV’ debate; I understand the pros and cons and have mostly sorted out my views.)

  • http://www.americablog.com/ Naja pallida

    Do you suppose the advent of ED drugs is a contributing factor? Causing a generalized increase in sexual activity among seniors that was simply not biologically possible a or so decade ago. It isn’t just HIV rates increasing, I’ve read about gonorrhea and chlamydia cases increasing among seniors too.

  • http://www.americablog.com/ Naja pallida

    Some wingnuts… as in the whole Republican party? :)

  • Anonymous

    I think the causes may not just be sexual, but also from unsanitary hospitals. I wouldn’t be surprised if dilapidated hospitals were infecting poor seniors these days. Some wingnuts already said they should just die if they don’t have money.

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