HIV/AIDS among Older Canadians

HIV/AIDS Epi Updates

April 2003

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HIV/AIDS among Older Canadians

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Introduction

HIV/AIDS is generally believed to be a younger 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 to 55 years of age. For the purpose of this report, older individuals will be defined as those age 50 years or older.

AIDS Case Report Data¹

• As of June 30, 2002, 18,332 AIDS cases with age information have been reported to the Centre for Infectious Disease Prevention and Control (CIDPC). Of these reports, 2,123 (11.6%) have been among persons 50 years of age or older.

• Figure 1 shows that the number of annual AIDS cases reported among older adults has decreased since the first half of the 1990s. This is similar to the decrease in the number of overall AIDS cases, which is due in part to the introduction of new, effective anti-HIV drugs in the mid-1990s. However, with respect to all reported AIDS cases, the proportion among those aged 50 years or older has increased over time to 21.3% in 2001. This increase may be influenced by the use of the new anti-HIV drugs, since it has likely delayed the onset of AIDS among those for whom AIDS has been prevented.

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Table 1 shows the distribution of exposure categories for all reported AIDS cases among older Canadians up to June 30, 2002. Men who have sex with men (MSM) made up the majority of reported cases among those age 50-59 and those age 60 years and older. Other common exposure categories were exposure to blood and blood products (before 1985) and heterosexual contact.

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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, 2002.

IDU = Injecting Drug Users, MSM = Men who have sex with men

¹   Percentages based on the total number of cases minus those reports for which exposure category was unknown or "not identified."

^*   Mode of transmission is known but cannot be classified into any of the major exposure categories.

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HIV Testing Data¹

While AIDS data provide information on HIV infection that occurred about ten years in the past, HIV data provide a picture of more recent infections.

Data from provincial and territorial HIV testing programs indicate that 3,858 positive HIV tests with known age information have been reported among persons 50 years and older up to June 30, 2002. As seen in Figure 2, the proportion of annual positive HIV test reports among those age 50 years or older has been roughly 10% since the early to mid 1990s. Men have accounted for 88.2% of the cumulative 3,586 positive HIV test reports with known gender information among those age 50 years or older (data not shown).

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In 2001, 46% of HIV positive test reports among those age 50 years and older with known exposure category information were attributable to MSM. Heterosexual contact accounted for 34.4% of positive HIV test reports among those age 50 years or older (Table 2).

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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, 2001 and December 31, 2001.

IDU = Injecting Drug Users, MSM = Men who have sex with men

¹   Percentages based on the total number of cases minus those reports for which exposure category was unknown or "not identified."

^*   Mode of transmission is known but cannot be classified into any of the major exposure categories.

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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 one's state of health may be greater factors in determining sexual activity than is age.²

• In one international study of adults age 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 past 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 among older Canadians. However, some information has been captured by national population surveys:

• Table 3 compares selected sexual risk behaviours among respondents age 50-59 in the 1996 National Population Health Survey to all respondents.³ While sexual risk behaviours were reportedly lower among older participants, they were not insubstantial.

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Table 3: High-Risk Sexual Behaviours among Canadians Age 15-59 Compared to Those age 50 to 59 years, 1996 National Population Health Survey³

Age Category Never used condoms*,a,b Did not use condom at last sex*,a,b 3+ sexual partners in last yearb 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.

^a   As a percentage of those in a relationship with a partner of less than 12 months duration.

^b   As a percentage of those who had sexual intercourse in the previous year.

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• 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.

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Table 4: Lifetime Testing for HIV/AIDS, 1996 National Population Health Survey³

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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 50-64 did not know if condoms were effective in preventing HIV infection compared to 6.3% of the respondents age 18-49.⁴

Comment

Older adults constitute a substantial minority of reported HIV and AIDS cases in Canada. More epidemiological and behavioural data are needed to better understand the HIV/AIDS situation among older adults and to inform 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 age 50 years and older in order to assess the potential misconceptions or knowledge gaps that older adults may have in regard to HIV transmission and prevention. Given that one of the main exposure categories among reported positive HIV tests among older adults 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 due to improved medical treatment, it is likely that HIV/AIDS among older adults will become a greater 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 age 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, 2002. Division of HIV/AIDS Surveillance, CIDPC, Health Canada, November 2002.

2. AARP/Modern Maturity Sexuality Survey. August 1999. http://research.aarp.org/health/mmsexsurvey_1.html

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. Mack KA, Bland SD. HIV Testing Behaviours and Attitudes Regarding HIV/AIDS of Adults Aged 50-64. Gerontologist 1999; 39(6):687-694.

For more information please contact:

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Health Canada