‘Older people’ are rarely targeted by doctors for HIV-screening, yet the progression from HIV to AIDS occurs significantly faster the more elderly the individual. In addition, whilst the life expectancy of those diagnosed with HIV between the ages of 5 and 14 is in excess of 13 years, this declines to 4 years for those infected after the age of 65.
Dr George Schmid of the WHO’s Department of HIV/AIDS reports that studies in the USA have seen an increase in HIV incidence in the over-50s from 20% to 25% between 2003 and 2006. In Brazil the HIV infection rate in over-50s increased from 7.5 cases per 100,000 in 1996 to 15.7 cases per 100,000 in 2006.
Although antiretroviral therapy (ART) means that it is unsurprising that there should be an increasing number of older individuals living with HIV, the facts suggest that initial infection incidence in the over-50s is increasing. Furthermore, the antiretroviral argument holds little relevance in the developing world, where ART was introduced significantly later than in the industrialised world.
Explanations for the phenomenon are currently purely speculative, especially given the paucity of available research concerning sexual activity in older individuals, particularly in the developing world.
Scientists suggest that since 1998 the availability of drugs treating erectile-dysfunction has extended the sex-lives of older people. Coupled with a tendency for older individuals born in a world ‘without AIDS’ not to practise safe-sex, this may be extending the reach of the HIV epidemic.
Other explanations include a general decline in immunity in older generations, and the likelihood that risk of infection per sexual act is higher in older people than in the young. This could potentially relate to the thinning of vaginal mucosa with age, and the increase in both sexes of antibodies against the herpes simplex virus 2.
The lack of information concerning – and awareness of – HIV in older people is regarded as worrying by scientists, who report in the WHO article that research into HIV risk factors in this age-group is almost non-existent.
A campaign aimed at informing the over-50s of the risks of HIV infection has been launched in Brazil, a key element of which being the breaking-down of cultural prejudices concerning age and sexuality. Ivo Brito, an adviser to the Brazilian Ministry of Health, says that, ‘Many people do not think the elderly are sexually active; they regard AIDS as a disease of young people.’
The WHO Bulletin article is available at: