Over 50s HIV Infections Double

posted: 18/08/2010

New HIV infections among people over 50 have doubled in England, Wales and Northern Ireland in the last seven years, and almost half the over 50s were diagnosed late, according to a new study in the latest issue of AIDS.
 

More and more HIV experts are now thinking hard about older people with HIV. Not only are the numbers of older people with HIV rising steeply, older people are also getting HIV, health prospects are worse when you are over 50, and it is clear that there are some different problems in living with HIV when older.
 

This latest study looked at older people with HIV in England, Wales and Northern Ireland between 2000 and 2007. The starting point for ‘older’ is age 50 or over.
 

While the numbers of over 50s with HIV tripled between 2000 and 2007, there was also a sharp rise in the number of older adults getting HIV. Is the tripling of the number of people with HIV over 50 because people are living longer because of HIV treatments, or is it because more people are getting HIV after 50?

To find out the Health Protection Agency decided to analyse the national HIV data for the time between 2000 and 2007.
 

Nearly 1 in 10 new infections among people over 50
They found 8% of all new HIV diagnosis were among people over 50. But the new infection rate among over 50s is still rising and in 2007 it reached 9%. The number of older people who were newly diagnosed more than doubled, from 299 in 2000, to 710 in 2010. Almost three-quarters of these new diagnoses were people aged between 50 and 59.
 

Gay and other men who have sex with men were 40% of all the people diagnosed over 50. A third of the newly diagnosed were heterosexual men, and 25% heterosexual women.
Almost all (94%) the gay men are of white backgrounds. Older heterosexual men and women were rather more likely to be white than heterosexual men and women under 50.
 

8000 and rising
A total of 8255 older adults used HIV clinics between 2000 and 2007. This is 16% of all the people using HIV clinics.
 

Late diagnosis and AIDS
20% of the older adults developed an AIDS defining condition in the years 2000 - 2007. Mostly (91%) an AIDS condition was diagnosed within three months of diagnosis with HIV – this means HIV was diagnosed at a really late stage. This is twice the rate of AIDS diagnoses found among the under 50s.
The Health Protection Agency definition of late HIV diagnosis is when the CD4 count is below 200 at diagnosis. People diagnosed over 50 are significantly more likely to have a CD4 count this low than the under 50s (48% for over 50s, 33% for under 50s).

HIV treatment is now started normally when the CD4 count is around 350, so really many more people were diagnosed late than these HPA figures suggest. By the time the CD4 has fallen to 200 avoidable health harm has already been done.

More deaths, sooner
538 (13%) of the people over 50 died between 2000 and 2007. People diagnosed with a CD4 below 200 were 14 times more likely to die than younger patients with this CD4 count (14% for the over 50s, 1% for the under 50s).
 

Moreover, over 50s who are diagnosed late were approximately two and a half times more likely to die within a year of their diagnosis than under 50s with a CD4 count below 200.
 

The overall mortality rate amongst older patients was 25 per 1000 person-years. In contrast, the mortality rate for younger patients was half that - 12 per 1000 person-years.
 

Half got HIV after 50th birthday
Based on CD4 cell count at the time of diagnosis, they worked out that 48% of the older people with HIV got HIV when they were aged 50 and over. This percentage hasn’t changed between 2000 and 2007.
 

Three-quarters of individuals aged over 50 when they became HIV positive are men, and 54% were gay men.

Source

Reference Smith RD et al. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS 24: 2109-2115, 2010.
 

Disadvantages for HIV+ Over 50s

posted: 22/07/2010

Older people with HIV face many disadvantages, study finds
Most people with HIV aged 50 and over can expect to live a near normal lifespan thanks to modern HIV treatments, but are substantially more disadvantaged than their people of a similar age who don’t have HIV.
 

According to 50 Plus, the first national study of ageing and HIV, launched in Vienna at AIDS 2010, the 18th International AIDS Conference, older people living with HIV have worse health, are poorer, and fear for the future.
 

Other health problems common

Findings show that older people living with HIV are twice as likely to experience other long-term health problems alongside HIV, such as high blood pressure, kidney and liver problems and arthritis, with two thirds having treatment for these other conditions.
 

Worse off and money worries

Older people with HIV are financially worse off than other people of the same age without HIV. Older positive people are less likely to be working, less likely to have savings or pensions for their retirement and more likely to be on state benefits. Many have serious financial worries about the future. Older people with HIV are less likely to be homeowners and more likely to live in social or private rented housing. One said: “Since I was diagnosed in 1985 I regarded this as a death warrant and ceased to make any pension provisions.”
 

Good health information is top priority

Older people with HIV say having good quality health and treatment information is their highest priority, but three quarters fear needing health and social care in the future. As another person said: “I also fear that, in case I need to be cared for, the carer would be as ill-informed and prejudiced about HIV as the rest of the general public.”
 

Involving older people

The 50 Plus survey was designed with older people living with HIV, and it investigated the needs and concerns of 410 people, to help raise awareness of the issues that this group face and to collect evidence of the specific social care needs.

The 410 people surveyed are one in 25 of all the people aged 50 and over who are using HIV clinics in the UK – there are now well over 10,000 over 50s with HIV, with almost 1000 in the NW of England. Within the next ten years the number of over 50s with HIV will almost double.
 

While most over 50s living with HIV are gay men and white, there are numbers of heterosexual men and women including Africans, among other ethnic minority people.  

Terrence Higgins Trust’s Head of Policy, Lisa Power, said: “As a result of effective treatment options, and our ageing population, the over 50s are now the fastest growing group of people with HIV in the UK, and there’s a long way to go regarding support for this group. Older people with HIV are living with high levels of uncertainty about their future health and social care and need substantially more support than their peers.
“The information we’ve gathered through ‘50 Plus’ is vital in giving us a better understanding of the unique problems that older people with HIV face on a daily basis in the UK. With this insight we can develop support services that are fully tailored to this group’s needs to ensure they have the same quality of life as their peers.”
 

Other key lessons

Other findings from the report show that:

• Older people with HIV are a rapidly growing and diverse group. The majority of this group are gay and bisexual men but there are also high numbers of African migrants and white heterosexuals. Some are long-term survivors, whilst others have been recently infected - one in five (21%) were diagnosed in the 1980s but the greatest number (41%) were diagnosed since 2000.
• Whilst older people with HIV think very well of their HIV clinicians, many report poor experiences in primary care, including discrimination, ignorance and a low standard of clinical treatment, and use their GPs and generalist healthcare services less than older people in general. Many also fear that social care services, care homes and sheltered housing might be HIV prejudiced and/or homophobic.
• Many report feeling isolated and would like more social contact and support. Most prefer to find this through HIV organisations.
• Most were open about their HIV status in key relationships and usually get positive reactions; however, telling others about having HIV is still seen as risky.

In response to these research findings, Terrence Higgins Trust, Age UK and The Joseph Rowntree Foundation made five calls for action:

1. Improvements in healthcare to ensure access to good quality treatment in all settings and availability of better information to older people with HIV.
2. Better employment support, money management courses and benefits advice.
3. Action to deal with homophobia, HIV discrimination and ageism in all services, but especially in social housing, sheltered housing, care homes and health services (particularly primary care).
4. Improved emotional support and opportunities for social contact, to prevent isolation.
5. Greater cooperation and information sharing between organisations and services for older people, and those for people with HIV, to improve policy and practice.

Michelle Mitchell, Charity Director at Age UK, said: “This report clearly shows that the problems many of us face in later life, such as financial pressures, deteriorating health and isolation are all exacerbated by the impact of HIV on people’s lives. Now people are living far longer with HIV than ever before, we need to shift the focus on support services to improving quality of life. To achieve this, it is vital that we increase awareness and understanding of the needs of this group across a range of health, social care, housing and advice services.”
 

Terrence Higgins Trust, Age UK and other HIV organisations like George House Trust, will be using the findings to help development services.
 

50 Plus    4 page summary available now 

The full 50 Plus report will be available from October 2010 at The Joseph Rowntree Foundation

Further data, including all statistical charts and the full literature review, will appear in the autumn in a special section of the THT website.
 

About the study

50 Plus research was conducted through an online and paper questionnaire and 40 in-depth interviews from a sample of adults aged 50 or over with HIV across the UK in 2009. The 50 Plus report is was based on the survey findings. The questionnaire was devised with the support of a Community Advisory Panel and interviews conducted by trained community researchers living with HIV. A literature review and visits to existing ageing and HIV work in the US were also undertaken. Age UK is the name for the merger of Age Concern and Help the Aged. The Joseph Rowntree Foundation (JRF) is one of largest social policy research and development charities in the UK. It aims to influence policy and practice by searching for evidence and demonstrating solutions to help overcome the causes of poverty, disadvantage and social evil.

Source
 

Rise in Over 50s HIV Infections

posted: 21/07/2010

People over 50 are as much at risk from unsafe sex as younger people, the UK’s Health Protection Agency (HPA) has just warned. Today it revealed evidence, at the International AIDS Conference in Vienna, that the number of people over 50 who are catching HIV has more than doubled in seven years.
 

In 2000 there were just 299 new HIV infections among the over-50s, according to the HPA. But in 2007 there were 710 people infected.
 

Gay and bi men are the majority infected when older, but white heterosexual men infected abroad - typically in Thailand - are another significant group of older men who are diagnosed.

Late diagnosis common
Half of those diagnosed when over 50 were diagnosed late. Younger people are much less likely to be diagnosed late. Late diagnosis is bad news when you are older - during the eight year study period three quarters of the deaths among people aged 50 and over occurred within one year of the diagnosis, with half of those diagnosed late. Unfortunately, late diagnosis with HIV reduces people's life expectancy and quality of life. If treatment is started late it cannot undo all the unnoticed damage already caused by HIV.

Some people diagnosed after 50 were infected when they were younger. After some early symptoms (such as flu-like symptoms with a rash), many people after HIV infection remain apparently fit, healthy and continue to feel well, without suspecting they have HIV, for as long as 10 years.

Most are recently infected by risky sex
But half of the over-50s diagnosed had recently been infected, through taking chances without condoms.

Getting away with risks in your earlier years doesn't mean that luck will continue.

Letting down your guard just because you are older can still catch anyone out. We often hear older people say, rather sheepishly, 'I should have known better'.
 

Keep on testing - and condoms
"This highlights the importance of HIV testing, whatever your age," said Ruth Smith, a senior HIV scientist at the HPA's Centre for Infections. "We must continually reinforce the safe sex message – using a condom with all new or casual partners is the surest way to ensure people do not become infected with a serious sexually transmitted infection such as HIV."
 

Her co-author, Dr Valerie Delpech, head of HIV surveillance at the HPA, said people in the older age group needed to be aware that they were just as much at risk as young people if they had unsafe sex.
 

"Although adults aged 50 and over account for just 8% of all new HIV diagnoses, the fact that cases have more than doubled in recent years serves as a timely reminder that anybody is at risk of HIV infection if they do not use protection and practise safe sex," she said.
 

More information from HPA

Source
 

Over 50s - 1 in 12 new diagnoses

posted: 04/05/2010

One in twelve new HIV diagnoses in the UK are in people over the age of 50. Late diagnosis is common among over 50s but almost half of these people were infected after their 50th birthday.

Between 2000 to 2008, one in twelve new adult HIV diagnoses were in a person over the age of 50. The numbers increased year on year, from 304 in 2000 to 787 in 2008.

Typically - male, gay, white, older
The profile of people diagnosed over 50 is rather different to those diagnosed younger. They are more likely to be male, homosexual and white. Older heterosexual men often got HIV in southeast Asia – usually in Thailand.

Infected after 50 – Prevention’s still needed
By looking at the CD4 count when the people were diagnosed, the researchers were able to estimate how long before diagnosis each person had HIV. Just under half (48%) were infected after the 5oth birthday. HIV prevention cannot ignore older adults.

Late diagnosis is big – some deaths within one year
Nonetheless, late diagnosis is more of a problem in older adults than in younger groups. A total of 48% are diagnosed with a CD4 count below 200 cells/mm3, compared to 33% of people under 50. In gay and bisexual men, double the number of over-50s are diagnosed late compared to younger men (40% and 21% respectively).

Moreover, these late diagnoses make a substantial contribution to short-term mortality. Amongst people diagnosed over the age of 50, 14% of those diagnosed late died within a year, compared to 1% of people not diagnosed late.

Whereas people over the age of 50 represented 11% of the individuals accessing HIV care in 2000, they now make up 17% of those doing so.

More on over 50s in Brighton
The Manchester BHIVA/BASHH conference also heard about the treatment and care needs of older adults. One poster profiled 257 patients aged 50 or over attending HIV services in Brighton. The vast majority were white gay men, their mean age was 58 and they had lived with HIV for an average of 12 years.

85% had at least one other health problem, with 43% having three or more. As a result, in addition to anti-HIV drugs, two-thirds were taking medication for other conditions (12% reported five or more other drugs) and 79% were under the care of other medical specialists (dermatology, ENT, cardiology, gastroenterology, etc,). The authors recommended that HIV clinicians should work in close co-operation with these other specialists.

More tests and reviews

Another conference poster highlighted the importance of carrying out additional tests and assessments, for example for prostate cancer and other malignancies. Moreover regular review of all medication is required to monitor possible drug-drug interactions.

Brighton men speak

Finally, the Brighton researchers also presented findings from 20 in-depth qualitative interviews with people with HIV aged between 52 and 78 (mean age 64). Almost all were white gay men.

Some of the key themes were:

• Health: concerns about the unknown effects of HIV and antiretroviral treatment over time; the number of co-morbidities; a desire to have continuity of medical care and more psychosocial support. “Obviously the antiretrovirals are keeping me alive but there must be some long-term damage,” said one interviewee.
• Survival: stories of outliving peers and of not having prepared for the future because none was expected. “They’re all dead and I’m the only one left alive and I’ve got no pension.”
• Self-esteem and rejection, linked to a youth-orientated gay scene, changes in physical appearance and sexual dysfunction. “Who wants an old faggot like me?” was one comment from the interviews.

Advice and Information 

Coming of Age - a guide to ageing well with HIV - 130 pages, UK, 2010

download is free - it is large (2.8 Mb) pdf file, so please be patient while it downloads  

Ahead of Time: A practical guide to growing older with HIV, Austrailia, 2010

Older Adults with HIV - The ROAH study of 1000 adults over 50 by ACRIA, New York

Sources and references

HIV and Ageing Conference

posted: 06/04/2010

A late April conference on HIV and older people will be held 50 miles south of Manchester, at a Staffordshire University campus.

HIV among older people is one of the new issues in the UK. There are now rapidly rising numbers of people of 50 and older living with HIV. The number of positive over 50s will  triple within the next ten years in NW England.

Triple in 10 years

In NW England there are close to 1000 people diagnosed with HIV who are 50 or older (17% of the total diagnosed), and almost another 2000 people who are in their 40s, who will soon join them.

The conference - Ageing with HIV - is on Wednesday 28 April, at TV Centre, Staffordshire University, Beaconside, Stafford, ST18 0AG,  between 09.00 and 16.15. The cost is £40 (£25 concessions, ask Elaine at bookings).

There are CrossCountry express trains from Manchester (to Birmingham) through Stafford every 30 minutes; it takes about 50 minutes and the Beaconside campus is a taxi ride from Stafford station. 

Conference programme

• The Emerging Population of Older Adults with HIV - AIDS Initiative of America (ACRIA)
• Medical aspects of Ageing with HIV
• 50+ : the needs of people living with HIV over 50 in the UK
• Ageing with HIV
• Compare and contrast : HIV care for the mature versus the less mature

Conference Programme pdf

Booking form word

Bookings please email Elaine Stanway or call her on 01785 353742