HIV/AIDS Epi Update - May 2004

HIV/AIDS among Older Canadians

Introduction

At A Glance

As of June 30, 2003, 11.7% (2,222) of all reported AIDS cases have been among persons aged 50 years or older.

Approximately 10% of the positive HIV test reports in Canada each year since the beginning of the epidemic have been among those aged 50 years or older.

Sexual contact is the major risk factor for HIV infection in older Canadians.

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.

AIDS Case Report Data¹

• As of June 30, 2003, 18,929 AIDS cases with age information have been reported to the Centre for Infectious Disease Prevention and Control (CIDPC). Of these reports, 2,222 (11.7%) have been among persons 50 years of age or older.
• Figure 1 shows that the annual number of reported AIDS cases among older adults has decreased from the mid-1990s, following a trend similar to the decrease in the number of overall AIDS cases. This is due, in part, to the introduction of new, effective anti-HIV drugs in the mid-1990s. However, the proportion of AIDS cases attributable to those aged 50 years or more has increased over time, from 11.3% in 1994 to over 20% in 2002. This increase may be influenced by the use of the new anti-HIV drugs, which have likely delayed the onset of AIDS to an older age.

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.

Positive HIV Test Reports¹

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).

More Information Needed: Older Adults and Risk Behaviours, HIV Testing Patterns, and Knowledge of HIV/AIDS

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

• In one international study of adults aged 45 years and older (n = 1,384), 51.7% of men and 55.1% of women who reported having a sexual partner (n = 949) reported having sexual intercourse once a week or more during the previous six months.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 shows selected sexual risk behaviours among respondents aged 50 to 59 compared with all respondents in the 1996 National Population Health Survey.³ While sexual risk behaviours were reportedly lower among older participants, they were not insubstantial.

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.

International studies suggest that some older adults may not be aware of HIV prevention methods or behaviours that put them at risk of HIV:

• In a 1996 US-based study, 14.7% of the respondents age 50 to 64 did not know whether condoms were effective in preventing HIV infection compared with 6.3% of the respondents aged 18-49.⁵

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

Comment

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.

References

1. Health Canada.
   HIV and AIDS in Canada. Surveillance report to June 30, 2003. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Health Canada, 2003.
2. AARP/Modern Maturity Sexuality Survey. August 1999.
3. Statistical report on the health of Canadians. Prepared by the Federal, Provincial and Territorial Advisory Committee on Population Health for the Meeting of Ministers of Health Charlottetown, P.E.I. September 16-17, 1999.
4. Geduld J, Archibald CP.
   Late HIV diagnosis among reported AIDS cases in Canada: a lesson for prevention. 15th Annual Conference of the Australasian Society for HIV Medicine, October 22-25, October.
5. Mack KA, Bland SD.
   HIV testing behaviours and attitudes regarding HIV/AIDS of adults aged 50-64. Gerontologist 1999;39(6):687-94.
6. Schrimshaw EW, Siegel K.
   Perceived barriers to social support from family and friends among older adults with HIV/AIDS. J Health Psychol 2003; 8(6):738-52.

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