Aging with AIDS: An epidemic's changing face

Our view: As the AIDS population ages, people must rethink the risks of becoming infected

August 25, 2011

In the 1980s, when researchers first identified the virus that causes AIDS, a positive HIV test was a virtual death sentence. There was no cure for the disease and no effective treatment; patients usually died within a few months or years of being diagnosed.

But beginning in the 1990s, with the development of powerful antiretroviral drugs, that began to change. AIDS became a manageable, chronic illness rather than an invariably fatal disorder. Today, people infected with the virus are living longer even as their numbers have grown and the rate of new infections has declined. AIDS, once associated primarily with people in their 20s and 30s, is now a disease in which more than a third of victims are in their 50s, 60s and even 70s.

In Baltimore, the demographic shift has been swift. This month, the Greater Baltimore HIV Health Services Planning Council released the results of a survey that found two-thirds of the region's HIV victims were age 45 to 64. The last time the group conducted this study, just seven years ago, the majority of HIV cases were among those were 25 to 44.

The aging of the AIDS population has presented new challenges to physicians and public health officials. Not nearly enough is known about the long-term effects of the highly active antiretroviral drugs that allow people with AIDS to live for decades or longer, nor are the physical and social effects of aging on people with AIDS well understood. Meanwhile, the problems associated with providing elder care for people with AIDS and the training of their caregivers and social service professionals are becoming ever more urgent.

Moreover, health professionals must find ways to reduce the growing racial and class disparities among older AIDS victims. African-Americans, for example, are 12 times more likely than whites to become infected with the AIDS virus, and Latinos are five times more likely. African-American women, who make up just 11 percent of women over 50, comprise 65 percent of HIV infections and half of all AIDS cases among older women.

One of the most significant changes brought about by the aging of the AIDS population is the way the virus is transmitted from person to person. Where once the primary transmission routes were through homosexual sex between gay men or by the sharing of infected needles among intravenous drug users, today the majority of new infections occur through heterosexual sex, because older people tend to have sex with people their own age.

Most of these new infections result from unprotected sex between the partners or former partners of intravenous drug users and uninfected people who do not even realize they are at risk. Nationally, nearly one-fifth of people 55 or older who were living with HIV in 2009 did not know they were infected.

The rapidly changing dynamic of the epidemic due to the aging of the AIDS population requires an equally dramatic change in the way older people think about the disease. Until recently, people in their 50s and 60s believed they were at little risk of contracting the virus. But that's no longer a safe assumption.

That's why the National Institutes of Health are recommending that everyone, regardless of age, get tested at least once during their lifetime, and that people who have multiple partners or engage in risky behaviors get tested every year. The new drug therapies have allowed people with HIV to live much longer, healthier and more productive lives, but the corollary to that is that everyone must also be much more vigilant.

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