"Compelling need" for HIV prevention in people over 50

By

By Marilynn Larkin

NEW YORK (Reuters Health) – Given the rising incidence of HIV infection in people over age 50, more-targeted testing, educational and preventive interventions are needed, researchers say.

Dr. Lara Tavoschi from the European Centre for Disease Prevention and Control told Reuters Health, “The steady increase in the number of new HIV diagnoses among people over the age of 50 shows that the HIV epidemic in Europe is evolving in new directions.”

“This increase is potentially a result of a lack of awareness of HIV and how it is transmitted in this group,” she said by email. “This also means that they may underestimate their own risk of infection.”

To investigate, Dr. Tavoschi and colleagues compared European HIV surveillance data from 2004 through 2015 between people age 50 or older and those ages 15 to 49, stratifying by age, sex, migration status, transmission route and CD4-cell count.

More than 54,000 new HIV diagnoses were reported in older adults, according to the study published online September 26 in The Lancet HIV.

The average rate of new diagnoses in older people was 2.6 per 100,000 population across the 12-year period. Within this older group, diagnoses increased significantly among men (annual average change, 2.2%); women (1.3%); men who have sex with men (5.8%); and injecting drug users (7.4%).

Rates also increased significantly in 16 countries during the study period, clustering in central and eastern European Union/European Economic Area countries.

In 2015, compared with younger adults, older people were more likely to originate from the reporting country, to have acquired HIV infection via heterosexual contact, and to present late, defined as a CD4 count <350 cells per microliter at diagnosis. Specifically, rates for new diagnoses were 1.05 per 100,000 older women and 4.3 per 100,000 older men.

“Our findings suggest that there is a compelling need to deliver more targeted testing interventions for older adults and the general adult population,” the authors conclude.

Dr. Tavoschi observed, “We see that sexuality is generally stigmatized in this age group, and that healthcare providers may not perceive older adults as a population in need of HIV testing services."

"Health professionals can help a lot by engaging in discussions about sexual risks - and by simply offering an HIV test that people can then opt out of,” she suggested. “That way, they help to normalize HIV testing instead of making it an exceptional test.”

“In addition, so-called ‘indicator-condition guided’ testing can be an option,” she said, “which means that the offer of HIV testing is triggered by specific health conditions (e.g., other sexually transmitted infections, certain cancers or hepatitis) that might point at HIV infection. This is a very effective and promising approach that could successfully target older adults if more broadly implemented.”

"We saw that particularly for older people, an active offer in general practitioner, primary care, or emergency settings was a welcome prevention intervention,” she noted.

“Overall," Tavoschi said, "diversifying and complementing testing opportunities is probably the best strategy to reach older people: testing in community settings and self-testing could be valuable additions to increasing access and promoting normalization of HIV testing among older individuals and the adult population at large.”

“Safer sex and HIV prevention campaigns have tended to target younger age groups or well-defined risk groups, such as men who have sex with men,” she added. “These initiatives may not be as successful in reaching older age groups.”

Dr. Janet Seeley of London School of Tropical Hygiene and Medicine in England, author of a related editorial, told Reuters Health by email, "This issue is not something public health has given adequate attention to – older people are ‘at risk,’ but this is often not appreciated."

"Hence why campaigns such as ACRIA’s ‘Age is not a condom’ are so important," she observed. "That campaign highlights the need to use a condom because even if pregnancy is no longer likely, sexually transmitted infections including HIV are." (http://bit.ly/2yfpm3G)

"Some mention of sexual health could be incorporated in health screening provided for over 50s in the UK and elsewhere," she added, "but we need to be realistic about the ability of primary healthcare practitioners raising sensitive issues about sexual health with all older patients."

"NGO initiatives combined with leaflets/posters in primary healthcare centers can be a first step in spreading awareness, plus information in the media," Dr. Seeley concluded.

SOURCES: http://bit.ly/2ybV9oV and http://bit.ly/2gf02q5

Lancet HIV 2017.

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