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
 

Older Gay Men and HIV’s Early Days

posted: 01/07/2010

If you are 50 or older, a gay man and willing to talk about how HIV affected you in the early days of the epidemic, a researcher is keen to talk with you. Dana Rosefeld is a senior lecturer in Sociology at Keele University, looking into the early UK epidemic.
 

She wants to find out how older gay men experienced the HIV epidemic, how it affected you and your friends, and how you handled HIV, including the deaths of friends and partners. How did it affected your social life, and how did you make good your losses?
 

This is a chance to talk about and look back over this challenging time in the lives of many gay men. It will take about 1-2 hours - at a time and place of your choosing - and you will be paid £10 for your time. She can do some interviews at George House Trust.
 

Please contact Dana by email if you are interested.
You can also leave a phone message, but she may be away and not able to respond for some time - 01782 733932.
 

Full details - most of your questions are answered here
 

Making panels for the UK AIDS Memorial Quilt was one way people expressed their feelings and experiences in the early years.
 

Budget Pain Worse With HIV

posted: 24/06/2010

Low income is a major problem already for many people living with HIV. The emergency budget and service cuts will now make a bad situation even worse.

Here we try to pick out how the budget that is claimed to be ‘tough but fair’ will affect people living with HIV in NW England. We find out how tough and unfair it will be on many people living with HIV.

The Institute for Fiscal Studies analysis shows that the poorest 10% of the population (typically people on benefits and workers on the minimum wage) will face the worst financial pain of the whole population. Excluding cuts in Disability Living Allowance, Housing Benefit and funding for important public services like social care, over the next five years they worked out that the spending power of the poorest 10% of the population will fall by 2.6%.

Add in the affect of changes in disability living allowance, housing benefit cuts and cuts to public services and the poorer part of the population will suffer even more than this.

The budget will cut the incomes of the richest 10% of the population by just 0.6% compared with over 2.6% for the lowest income tenth of the population. How fair is that?
 

What we have to tell you below makes for depressing reading.

We think people with HIV have a right to know how the planned changes over the next five years could affect them.

These changes are not all cast in stone. They have to go through Parliament and you can tell your MP what you think.
 

Disability Living Allowance
Many people with HIV receive Disability Living Allowance (DLA), a benefit paid at different rates to compensate for disability and mobility problems. The budget announced that people on DLA will have a strict new medical examination; these medical examinations will start in 2013. Some people will lose DLA, others will go onto a lower rate. The government aims to cut spending by £1.4 billion within two years of these medicals starting.

We do not know yet if people who have DLA ‘for life’ will have these medicals.
 

Housing Benefit
Housing Benefit / Housing Allowance will be cut after one year by 10% for people claiming Job Seekers Allowance. The amount of Housing Benefit will also be capped, depending on how many bedrooms you have.This and other changes will be cuts costing people on the benefit £1.8 billion a year.

People will either have to pay the extra for their rent from their other income, move somewhere cheaper or smaller, and if evicted for rent arrears are likely to be refused rehousing as a homeless person. Eviction for rent arrears is treated as making yourself intentionally homeless so people are not entitled to be rehoused.
 

Unemployment
There are around 2.5 million people unemployed and about 0.5 million job vacancies. Unemployment is higher in NW England than most other regions. The job vacancies are often low paid.

The budget alone will increase unemployment by another 100,000 and independent experts expect it to reach close to 3 million.

Job seeking prospects will worsen and it is already harder to find work with a condition like HIV.
 

Slow-burn cuts and taxes
Over the next five years people on benefits will slip further behind in what their benefits will be able to buy and with tax changes.

VAT rises at the beginning of January to 20% and VAT always hits people on low incomes hardest.

Most benefits will be uprated for inflation in a new way that will leave people increasingly worse off. This will cut £6 billion from benefits over the next five years.

Child Benefit is frozen for three years from next April – a £3billion cut. Parents who are working will be compensated by Tax Credits, but that doesn’t help parents who aren’t working.
 

Social Services
Local Government and other public services are most used by people who are on lower incomes. Social Services departments of local councils now face cuts of between 25-33%. Social Services provide essential services to people with HIV and they help fund HIV community services like George House Trust.

The AIDS Support Grant which is used to pay for extra support for people with HIV and community HIV services is no longer protected by a ‘ring-fence’. This means councils can now spend it on whatever they like.

We don’t know yet how cuts of between one quarter and one third will affect essential social services for people with HIV and community organisations but we should start to know more from October. We can expect some painful cuts and changes.
 

NHS cuts
The NHS in NW England has been told to save almost £1 billion within the next three years. We do not know whether this will affect people with HIV.
 

State Pension Age to rise sooner
Details are sparse but the government is planning to raise the age at which men and women will get a state pension sooner than was planned. Men who are now 59 will have to work one more year before they can claim a state pension. Pension age will be 66, not 65 as now, for men from 2016. It does not stop there.

They are consulting about raising the pesnion age to possibly 70. Pension ages for women and men could be raised by one year every five years until it reaches 70 for both sexes. If they start this in 2016 as they say they now plan to, men now aged 40 would not get a state pension until they reach 70. Three out of four people will have some disability by the age of 68. Many people with HIV (among many others) are not fit enough to work until the current pension age of 65, particularly in a region like NW England.

Benefit cuts and changes will make it harder for people with disabilities like HIV to live with a decent fair income before pension age.
 

Expect more pain
In October the government will publish its Public Expenditure Review. We can expect lots more cuts in government spending. The government is already saying that it will try to reduce cuts in education and some other public services (but it has not said that it wants to protect social services) by making even more cuts and changes to benefits.
 

Since the second world war, no government has managed to cut public spending for more than two years in a row. This government plans five years of cuts.
 

Some reputable economic commentators, and President Obama, are warning that European countries are behaving like a panicking herd, cutting spending harshly and that this has a high risk of plunging the world into recession once again. The harsh medicine of cuts could kill economic recovery and make the situation even worse.
 

Heath Inequality
The Marmot Review earlier this year was to help the government plan policies that will end harsh health inequalities. It showed that the poor die 7 years younger than the rich, and the poor become disabled 17 years sooner. Cuts to services and benefits in NW England will worsen the already bad record of ill-health, disabilities and early deaths in this region. More unemployment and low income harms people’s health and well-being.

Reductions in benefits, and those 25%+ public service cuts expected in the Autumn Spending Review are estimated to increase alcohol related deaths by about 2.8% and cardiovascular deaths by 1.2%. Both of these disproportionately affect people living with HIV. Every £80 cut in social welfare spending per person causes this, according to a Europe-wide analysis by Oxford University epidemiologist David Stuckler, reported in the Guardian on 25 June and in the British Medical Journal. There are likely to be between 6,500  and 38,000 more deaths in the next ten years. If the economy worsens, extra deaths rise steeply. Apart from benefits cuts, it is cuts to social services and health budgets especially that cause the most health harm. 

The Treasury is ending the public sector agreement with the NHS to raise the life expectancy of the poor. Marmot presented the government with a vision and plan to make sure everyone has a ‘healthy income’, enough money to live healthy lives and improve life expectancy.

The budget and cuts to come make it even more likely we will go backwards and poorer people and people with disabilities, like many people with HIV in NW England, will face worsening life expectancy and poorer health.

Sit back or act?
These changes are not all cast in stone. They have to be passed by Parliament and you can tell your MP what you think. With your postcode you can contact your own MP here.

Help for people on Low Incomes on our website

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