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Stigma due to age may impact HIV care in older adults
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Although older adults at least 50 years of age account for almost half of all people living with HIV and represent 17% of new infections in developed countries, a presentation at the 125th Annual Convention of the American Psychological Association suggests that this population is often overlooked when it comes to HIV prevention and treatment, according to a press release.
Mark Brennan-Ing, PhD, director for research and evaluation at ACRIA, a nonprofit HIV/AIDS organization in New York City, said that prejudice and discrimination against older adults, known as ageism, contributes to this neglect.
“The lack of perceived HIV risk in late adulthood among older people themselves, as well as providers and society in general, inhibits investment in education, testing and programmatic responses to address HIV in an aging population,” he said in the release. “Ageism perpetuates the invisibility of older adults, which renders current medical and social service systems unprepared to respond to the needs of people aging with HIV infection.”
Previous research has shown that approximately two-thirds of older Americans living with HIV feel stigmatized by both their disease and age. This stigmatization may be even more pronounced in men who have sex with men (MSM) because of ageism in the lesbian, gay, bisexual, and transgender (LGBT) community, Brennan-Ing said. He added that a combination of stigma related to age, sexual orientation, race/ethnicity, gender identity and expression, and HIV can result in negative outcomes in this population.
“Stigma results in social isolation, either through rejection by social network members or self-protective withdrawal, leading to loneliness and, ultimately, depression,” Brennan-Ing said in the release. “Stigma also makes people reluctant to disclose their HIV status, which could affect their health care treatment or prevent them taking precautions to reduce transmission.”
According to Brennan-Ing, negative expectations related to aging have been linked to poor cognitive test performance, changes in behavior and heightened stress.
“These mechanisms may be responsible for empirical findings that internalized ageism is related to both chronic disease and longevity,” he said.
Although it may be difficult to reduce the effects of ageism at the societal level, Brennan-Ing suggested ways to potentially reduce its impact among those with or at risk for HIV at the community level. He recommends:
- training health care providers in HIV screening, early diagnosis and ART initiation among older adults;
- targeting older adults in prevention, education and outreach efforts;
- developing treatment guidelines for older adults with HIV;
- funding resources to address the needs of older adults with HIV; and
- engaging communities, organizations and social service providers in outreach, mental health and social support.
“With the demographic shift toward older adults in the HIV population globally, and the elusiveness of a cure, addressing the care needs of this aging population are paramount,” Brennan-Ing said. “The aging of the HIV epidemic will be very challenging but provides the opportunity to mount a global response that will address the needs of this population across regions and settings.”
Reference:
Brennan-Ing M. Session 2126. Presented at: 125th Annual Convention of the American Psychological Association; August 3-6, 2017; Washington D.C.
Disclosure: Brennan-Ing reports no relevant financial disclosures.
Perspective
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Paul Volberding, MD
One of the apparent truths in HIV prevention is that transmission of the virus is amplified by stigma and isolation. We have seen this in the case of young African American MSM, and this presentation makes us aware of another important group where this may also be the case. Older persons are not thought of as having a risk for sexually transmitted infections, including HIV. This should be a vital wake up call to change this view and extend our messaging to this important and growing subpopulation. Another part of this problem is the aging of our population of those already infected with HIV who have their own needs for recognition and inclusion in planning care services. Fortunately, we now know that treatment of HIV infection prevents transmission, so this presentation also demands an expansion of testing in our older individuals to improve their care, and to stop further HIV spread. This is a very significant and complex issue that we must address urgently.
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