HIV/AIDS is generally believed to be a young person's disease and, therefore, little focus has been given to the issue of HIV/AIDS among older Canadians. It should be noted that the age range for "older" is subjective, and the lower age limit in the literature varies between 40 years and 55 years of age. For the purpose of this Epi Update, older individuals will be defined as those aged 50 years or older.
Figure 1. Number of reported AIDS cases among persons 50 years and older and percentage of all reported AIDS cases by year (1994-2002)
Table 1 shows the distribution of exposure categories for all reported AIDS cases among older Canadians up to June 30, 2003. Men who have sex with men (MSM) made up the majority of reported cases among those aged 50-59 and those aged 60 years and older. Other exposure categories included exposure to blood and blood products (before 1985) and heterosexual contact.
Table 1. Distribution of exposure categories among reported AIDS cases for individuals 50 years of age and older in Canada, diagnosed up to June 30, 2003 | ||
Exposure category | Percentage in each exposure category* | |
50-59 years (n = 1632) |
>= 60 years (n = 590) |
|
MSM | 70.1 | 52.1 |
MSM/IDU | 2.4 | 0.7 |
IDU | 3.9 | 1.5 |
Recipient of Blood/Blood Products | 5.4 | 16.4 |
Heterosexual contact** | 17.,9 | 28.0 |
Occupational & Other† | 0.4 | 1.1 |
IDU = Injecting drug users, |
||
*Percentages based on the total number of cases minus those reports for which exposure category was unknown or "not identified." **Heterosexual contact: sexual contact with a person at risk of HIV, origin from a country where HIV is endemic, and heterosexual contact as the only identified risk. †Mode of transmission is known but cannot be classified into any of the major exposure categories. |
While AIDS data provide information on HIV infection that occurred about 10 years in the past, HIV data provide a picture of more recent infections.
Data from provincial and territorial HIV testing programs indicate that 4,124 positive HIV tests with information on age have been reported among persons 50 years and older up to June 30, 2003. As seen in Figure 2, the proportion of annual positive HIV test reports among those aged 50 years or older has risen from 7.2% between 1985 and 1997 to 11.3% during the period 1998-2002. Men have accounted for 87.8% of the cumulative 3,873 positive HIV test reports with known gender information among those aged 50 years or older (data not shown).
Figure 2. Comparison of the age distribution of positive HIV test reports between 1985-97 and 1998-2002
In 2002, 47.1% of positive HIV test reports among those aged 50 years and older with known exposure category information were attributable to MSM. Heterosexual contact accounted for 27.1% of positive HIV test reports among those aged 50 years or older (Table 2).
Table 2. Distribution of exposure categories among positive HIV test reports for individuals 50 years of age and older in Canada, reported between January 1, 2002 and December 31, 2002 | |
Exposure category | Percentage 50 years and older* (n = 289) |
MSM | 47.1 |
MSM/IDU | 0.7 |
IDU | 20.7 |
Recipients of blood/blood products | 0.7 |
Heterosexual contact** | 27.1 |
Occupational and other† | 3.6 |
IDU = Injecting drug users, MSM = Men who have sex with men |
|
*Percentages based on the total number of cases minus those reports for which exposure category was unknown or "not identified." **Heterosexual contact: origin in a pattern II country, sexual contact with a person at risk, or no identified risk other than heterosexual contact. †Mode of transmission is known but cannot be classified into any of the major exposure categories. |
Healthy sexual relationships continue to be an important part of life for the majority of older adults. The availability of sexual partners and health status may be more important factors than age in determining sexual activity.2
Although surveillance data for Canada suggest that sexual contact is the major risk factor for HIV infection among older adults, very little research has been conducted on risky sexual behaviour in this group. However, some information has been captured by national population surveys:
Table 3. High risk sexual behaviours among Canadians aged 15-59 compared with those aged 50 to 59 years, 1996 National Population Health Survey3 | |||
Age category | Never used condoms*†‡ |
Did not use Condom during last sexual encounter*†‡ |
3+ sexual partners in previous year† |
15-59 yrs | 8% | 16% | 3% |
50-59 yrs | 7% | 8% | 1% |
* Use of a condom with a sexual partner of less than 12 months' duration. † As a percentage of those in a relationship with a partner of less than 12 months' duration. ‡ As a percentage of those who had had sexual intercourse in the previous year. |
In Canada, between 1996 and 2002, over 60% of reported AIDS diagnoses in those aged over 50 years old were made within 12 months after the first HIV positive test.4
Table 4 suggests that older Canadians are less likely to have had an HIV test during their lifetime than the general adult population. Additionally, the percentage of older adults who have been tested for HIV declines with age.
Table 4. Lifetime testing for HIV/AIDS, 1996 National Population Health Survey3 | |
Age category | Percentage of lifetime HIV testing |
All ages 18+ | 15 |
45-54 yrs | 11 |
55-64 yrs | 7 |
65-74 yrs | 4 |
75+ yrs | 2 |
International studies suggest that some older adults may not be aware of HIV prevention methods or behaviours that put them at risk of HIV:
Older people may also face greater barriers to wellness, as some research has shown that older people living with HIV/AIDS experience higher rates of isolation and a lack of support from family and friends. In one study, researchers reported that 42% of the subjects in the study needed more emotional support and 27% needed more practical support from family and friends.6
Older adults account for a substantial minority of reported HIV and AIDS cases in Canada. The distribution of age among positive HIV tests reported to Health Canada shows that there is a shift towards an older age group, most marked in males. More epidemiological and behavioural data are needed to better understand the HIV/AIDS situation among older adults and to inform them of prevention and care programs. Population-based surveys should include questions regarding condom use and number of sexual partners, as well as HIV testing behaviours, for all age groups. Attitudes and knowledge about HIV/AIDS should be studied among those aged 50 years and older in order to assess the potential misconceptions or knowledge gaps that older adults may have with regard to HIV transmission and prevention. Given that one of the main exposure categories among older adults with reported positive HIV tests is MSM, research into the risk behaviours of older MSM needs to be supported, and qualitative studies examining the reasons why some older MSM engage in higher-risk practices need to be undertaken.
As our society ages and persons with HIV/AIDS live longer as a result of improved medical treatment, it is likely that HIV/AIDS among older adults will become a broader issue. While older adults have historically been excluded from many aspects of HIV/AIDS policy and programming, the available data show that this should not be the case. The data presented here should help to overcome the ageist assumption that persons aged 50 years and older are not at risk of HIV infection.
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