So how does HIV effect older populations? Who does it effect and where? Let's start with a quick definition; if you are anything like me, you want a good idea of what we need to look at.
According to dictionary.com:
ep·i·de·mi·ol·o·gy [ep-i-dee-mee-ol-uh-jee, -dem-ee-] noun
The branch of medicine dealing with the incidence and prevalence of disease in large populations and with detection of the source and cause.
Medline's definition is similar:
1: a branch of medical science that deals with the incidence, distribution, and control of disease in a population
2: the sum of the factors controlling the presence or absence of a disease or pathogen
What about incidence and prevalence? Medline tells us that incidence is the rate of occurrence of new cases of a particular disease in a population being studied while prevelance is the percentage of a population that is affected with a particular disease at a given time. WHAT . . . . ?!?
Let's break that down! How many adults over 55 years old in the United States were newly infected with HIV in 2010 - this is your incidence. What is the total number of adults over 55 years old in the United States who have HIV in the year 2010 (this includes new infections and people who were already infected) - this is you prevelance.
Alright! This gives us a good start!
Unfortunately, until very recently, finding these numbers was not such an easy task. As it is, they are still not readily available outside the United States. Many organizations from around the world, such as the CDC, WHO, and UNAIDS who usually tally these numbers for us, have not considered adults over 55 to be a population at risk for HIV so they have not included them in their gathering of data.
A few things have happened over the past couple of decades that have changed things and made older adults a population of interest for HIV. First, scientists developed a special drug therapy called Antiretroviral Treatment. I'm not going to go into detail about the therapy itself but for those of you who are interested, this link is a good place to start: http://www.who.int/topics/antiretroviral_therapy/en/
Anyway, what this therapy has done is allow people who are infected with HIV to live longer. To put it simply, this infection, which was originally a certain death sentence is now a chronic disease kind of like diabetes or hypertension. So now, all of a sudden, all these people who have been infected with HIV are no longer dying at an early age but are living well into old age. Second, scientists stumbled across a special kind of drug they were developing to help patients with hypertension and angina pectoris (chest pain) called Sildenafil or, as you may be more likely to have heard it called, Viagra - the little blue pill. As I am sure you are aware, this has allowed men and women of all ages to enjoy the pleasures of intimacy. In our situation here, that means there are many more men and women having sex well into old age. Unfortunately, this also means that these older adults are at risk for HIV infection much later in life as well.
SO . . . as you can see in some of the graphs here (I know they aren't the best of clarity but there will be a list of references and websites at the end of this post that will take you to several more statistics and relevant data), the United States certainly has become aware of the rising problem of HIV in older adults. From 2001 to 2007, the percentage of older adults who make up the total prevalence of HIV in the United States has increased 61%, going from 17% of the HIV-positive population to about 27%. They also account for 16% of all new cases or incidence in the United States.I would also point out here that - very similar to that of younger populations - gay men, Hispanic and African American men, and African American women are disproportionately affected by HIV in this age group. African-Americans are 12 times as likely as their white peers to have HIV and Latinos are five times as likely. African American women over the age make up 65% of all cases of HIV among women in this age group and incidence among them has increased by 40%. Gay men make up nearly 48% of all HIV cases!
One final point I would like to mention here is that, among older adults, most new cases of HIV are transmitted through sexual contact as opposed to IV drug use. As for sexual contact, the most common mode of transmission is through men who have sex with men though heterosexual contact is a persistant source of infection. Interestinly, as you can see in the graphs that show risk categories in New York City, the perecentage of unknown transmission is particularly high among men.These diagrams and the above information came mostly from a brochure called Growing Older with the Epidemic: HIV and aging from the Gay Men's Health Crisis and from an article in the Journal of the American Academy of Physician Assistants by Jeffery Myers called Growing Old with HIV: The AIDS Epidemic and an Aging Population. There will plenty of other sources that you can check out at the end of this though!
Now, so far we have been focusing specifically on the United States. There are many who would say that this rising problem of HIV among older adults is only a problem in the United States. Not so fast though! While there is still very little information to draw from and a long way to go in knowing and understanding the real rates of incidence and prevalence, I was able to find some articles that give us a n idea that the US is not the only place in the world that is seeing a rise in the epidemic among older adults.
According to bulletin of the World Health Organization (WHO), researchers were able to predict the prevalence of HIV, using extrapolated data, for adults over 50 years of age in sub-Saharan Africa. The calculated the prevalenc rate at 4% compared to that of 5% for men between 15 and 49; nearly 3 milion people! In a 2008 survey found in Older People & HIV/AIDS In Africa that was performed by Carol Ngare, the VCT Manager for the Kenya National AIDS Control Programme, it was found that men older than 55 have a higher infection rate than that of young men 15 to 25 years old.
This is really not nearly enough evidence to show there is a definitive problem world wide but it certainly shows that researchers should be looking into it. It should be a wake up call to world organizations that this population needs to be included in surveys that estimate and record incidence and prevelance!
SO! Enough for this installment! Hope you have learned something new here! I know I have!
Center
for Disease Control and Prevention, Division of HIV/AIDS Prevention. (2011,
April 22). HIV surveillance - Epidemiology of HIV infection (through 2009).
Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/
Gay Men’s Health
Crisis. (2010). Growing older with the epidemic: HIV and aging [brochure].
Retrieved from gmhc.org
HelpAge
International. (2009). HIV prevalence rates amongst older persons in Kenya. Older people & HIV/AIDS in Africa 3,
3.
Klimarx, P. H.
(2009). Global epidemiology of HIV. Current
opinion in HIV/AIDS, 4, 240-5. DOI:10.1097/COH.0b013e32832c06db
Myers, D. M.
(2009). Growing old with HIV: The AIDS epidemic and an aging population. Journal of the American Academy of Physician
Assistants, 22(1), 20-4.
Negin, J. &
Cumming, R. G. (2010). HIV infection in older adults in sub-Saharan Africa:
Extrapolating prevalence from existing data. Bulleting of the World Health Organization [publication]. DOI:
10.2471/BLT.10.076349
Pratt, G.,
Gascoyne, K., Cunningham, K. & Tunbridge, A. (2010). Human immunodeficiency
virus (HIV) in older people. Age and
Ageing, 39, 289-94. doi: 10.1093/ageing/afq009
No comments:
Post a Comment