Middle-aged and older people with AIDS: trends in national surveillance rates, transmission routes, and risk factors.(HIV/AIDS and Aging)

The concerns of middle-aged and older people as infected with or affected by HIV/AIDS have received scant research, programmatic, or policy attention since the beginning of the AIDS epidemic. This is despite the fact that in the United States, to date, there have actually been more cases of AIDS in the geriatric population than in young children. According to national surveillance data (Centers for Disease Control and Prevention [CDC] 1997b), the cumulative case AIDS caseload as of 1997 reported 8,530 cases in adults age 65 and older and 6,343 cases in children age 5 and younger.

The now-classic volume on AIDS in an Aging Society (Riley, Ory, and Zablotsky 1989) first drew attention to the myriad ways older people could be involved in the epidemic and identified research and practice needs. While the number of cases in the older population was relatively modest in the 1980s, the consequences of HIV/AIDS for middle-aged and older people were actually much larger than the small number of cases suggested. Understanding the influence of AIDS in an aging society requires attention to older people at risk for HIV/AIDS, those living and dying with HIV/AIDS, those caring for family members and friends, or those providing professional care for people with HIV/AIDS. Building on the recommendations from the first AIDS and aging conference held in 1987, for the past decade, the National Institute on Aging (NIA) has spurred research efforts to examine the role of aging factors in the HIV/AIDS epidemic (NIA 1997). The Year 2000 National Research Plan for AIDS Research, coordinated through the National Institute of Health's (NIH's) Office of AIDS Research (NIH 1998), has included attention to life-course and aging issues in both basic and intervention research objectives and strategies. While HIV/AIDS behavioral research with aging populations is just emerging, epidemiological studies report that older people are diagnosed later, that survival is shorter, and that prevention programs are generally lacking for the 50-plus population (American Association of Retired Persons [AARP] 1994; Adler and Nagel 1994; Gluck and Rosenthal 1996; Ferro and Alit 1992; Keitz et al. 1996; Nokes 1996; Skiest et al. 1996; University of California, San Francisco 1997b; Whipple and Scura 1996).

Prevention efforts in the 50-plus population are hindered by a lack of public awareness of the AIDS rates, transmission routes, and risk factors in this population. Drawing on CDC surveillance data, this article will document the stability and changes in the numbers of persons with AIDS and routes of transmission. Comparisons will be made between the younger and older population, as well as within the older population itself. It must be noted that these CDC data are based on age at diagnosis of AIDS, not age at the time of infection. Gender and ethnicity differences are also present, but these will not be highlighted since they will be explored in greater depth in other articles in this issue (see Brown and Sankar 1998; Zablotsky 1998). Other data will be cited briefly to assess older people's relative knowledge of AIDS risks as well as self-reports on behaviors to reduce AIDSs-related risks (see Strombeck and Levy 1998 [this issue] for a fuller presentation of these issues). While the majority of data presented will be prevalence rates, new CDC data on AIDS rates in 1997 will also be highlighted to indicate the increased vulnerability for the older population if prevention programs directed toward older people and their health care providers are not initiated.

The …