HIV Among Older Americans

Fast Facts

Americans aged 50 and older have many of the same HIV risk factors as younger Americans.
Persons aged 55 and older accounted for 19% (217,300) of the estimated 1.1 million people living with HIV infection in the United States in 2010.
Older Americans are more likely than younger Americans to be diagnosed with HIV infection later in the course of their disease.

A growing number of people aged 50 and older in the United States are living with HIV infection. People aged 55 and older accounted for almost one-fifth (19%, 217,000) of the estimated 1.1 million people living with HIV infection in the United States in 2010.

The Numbers

New HIV Infectionsa (Aged 55 and Older)

Of an estimated 47,500 new HIV infections in 2010, 5% (2,500) were among Americans aged 55 and older. Of these older Americans:
- 36% (900) of new infections were in white men, and 4% (110) were in white women;
- 24% (590) of new infections were in black men, and 15% (370) were in black women;
- 12% (310) of new infections were in Hispanic/Latinob men, and 4% (100) were in Hispanic/Latino women.
In 2010, 44% (1,100) of the estimated 2,500 new HIV infections among people aged 55 and older were among gay, bisexual, or other men who have sex with men (MSM). Among MSM aged 55 and older, white MSM accounted for an estimated 67% (740) of new HIV infections, Hispanic/Latino MSM 16% (180), and black MSM 15% (160).

This chart shows the age distribution of diagnoses of HIV infection in the United States in 2011. There were 192 diagnoses of HIV among persons under the age of 13; 53 among those aged 13-14; 2,240 among those aged 15-19; 8,054 among those aged 20-24; 7,484 among those aged 25-29; 6,209 among those aged 30-34; 5,285 among those aged 35-39; 5,753 among those aged 40-44; 5,564 among those aged 45-49; 3,951 among those aged 50-54; 2,312 among those aged 55-59; 1,229 among those aged 60-64; and 948 among those aged 65 and over.

HIV and AIDS Diagnosesc and Deaths

In 2011, people aged 50-54 represented 47% (3,951) of the estimated 8,440 HIV diagnoses among people aged 50 and older in the United States. From 2008-2011, the estimated annual numbers and rates of HIV diagnoses in this aged group remained relatively stable.
In 2010, the estimated rate (per 100,000 people) of HIV diagnoses for older blacks was 41.6, which was nearly 11 times the estimated rate for whites (3.9) and nearly 3 times the estimated rate for Hispanics/Latinos (15.4) in 46 states with confidential, name-based reporting.
From 2007-2010, the estimated annual numbers of diagnosed HIV infections attributed to male-to-male sexual contact increased among men aged 50 and over (in 46 states with confidential, name-based HIV reporting).
In 2011, people aged 50 and older accounted for 24% (7,771) of the estimated 32,052 AIDS diagnoses in the United States.
Of the estimated 19,343 deaths among people living with diagnosed HIV infection in the United States in 2010, 10,244 (53%) were among people aged 50 and older. In 2010, HIV was the 10th leading cause of death among men and women aged 50-54.

These two charts show the transmission categories for HIV diagnoses among persons aged 50 and over in 2011.
There were 5,726 diagnoses of HIV among men aged 50 and over in 2011. Sixty percent of those infections were due to male-to-male sexual contact, 23% were due to heterosexual contact, 14% were due to injection drug use, 3% were due to male-to-male sexual contact and injection drug use, and less than 1% were due to other risk factors, such as hemophilia or blood transfusion.
There were 2, 072 diagnoses of HIV among women aged 50 and over in 2011. Eighty two percent of those infections were due to heterosexual contact, 18% were due to injection drug use, and less than 1% were due to other risk factors, such as hemophilia or blood transfusions.

_{a New HIV infections refer to HIV incidence or the number of people who are newly infected with HIV, whether they are aware of their infection or not.
b Hispanics/Latinos can be of any race.
c HIV and AIDS diagnoses refer to the estimated number of people diagnosed with HIV infection, regardless of stage of disease at diagnosis and the estimated number of people diagnosed with AIDS, respectively, during a given time period. The terms do not indicate when they were infected}

Prevention Challenges

Late HIV Diagnoses and Shorter HIV-to-AIDS Intervals

Older Americans are more likely than younger Americans to be diagnosed with HIV infection late in the course of their disease, meaning a late start to treatment and possibly more damage to their immune system. This can lead to poorer prognoses and shorter HIV-to-AIDS intervals. For instance, an estimated 24% of people aged 25-29 who were diagnosed with HIV infection in 2010 progressed to AIDS in 12 months, compared with an estimated 44% of people aged 50 to 59, 49% of people aged 60-64, and 53% of people aged 65 and older. One reason this may be happening is that health care providers do not always test older people for HIV infection. Another may be that older people mistake HIV symptoms for those of normal aging and don’t consider HIV as a cause.

Sexual Risk Factors

Many older Americans are sexually active, including those who are infected with HIV, and have many of the same risk factors for HIV infection as younger Americans, including a lack of knowledge about HIV and how to prevent transmission, inconsistent condom use, and multiple partners. Older people also face unique issues, including:

Many widowed and divorced people are dating again, and they may be less knowledgeable about HIV than younger people, and less likely to protect themselves.
Women who no longer worry about getting pregnant may be less likely to use a condom and to practice safer sex. Age-related thinning and dryness of vaginal tissue may raise older women’s risk for HIV infection.
The availability of erectile dysfunction medications may facilitate sex for older men who otherwise would not have been capable of vaginal or anal intercourse.
Although they visit their doctors more frequently, older Americans are less likely than younger Americans to discuss their sexual habits or drug use with their doctors, who in turn may be less likely to ask their older patients about these issues.

Stigma

Stigma is a particular concern among older Americans because they may already face isolation due to illness or loss of family and friends. Stigma negatively affects people’s quality of life, self-image, and behaviors and may prevent them from seeking HIV care and disclosing their HIV status.

What CDC Is Doing

CDC and its partners are pursuing a High Impact Prevention approach to advance the goals of the National HIV/AIDS Strategy, maximize the effectiveness of current HIV prevention methods, and improve surveillance among older Americans. Activities include:

Support and technical assistance to health department and community-based organizations to deliver effective prevention and evidence-based interventions for antiretroviral therapy adherence for older Americans.

Act Against AIDS, a national communications initiative that focuses on raising awareness, fighting stigma, and reducing the risk of HIV infection among at-risk populations. AAA includes Let’s Stop HIV Together (approximately 40% of campaign participants are aged 50 and older), HIV Screening. Standard Care. (encourages primary care physicians to screen patients of all ages for HIV infection), and Prevention IS Care (provides continuing education and materials for physicians to address complex issues of those living with HIV).

The Care and Prevention in the United States Demonstration Project that supports increased testing and optimizes linkage to, retention in, and re-engagement with care and prevention services for newly diagnosed and previously diagnosed racial and ethnic minorities with HIV.

The Comprehensive Human Immunodeficiency Virus Prevention Programs for Health Departments Funding Opportunity Announcement , a 5-year, $339 million HIV prevention initiative for health departments in states, territories, and select cities, including those serving clients at risk for HIV infection.

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