social workers “help starts here” site: link resources for HIV/AIDS & aging (0112)

HIV/AIDS Current Trends – The Aging of HIV
Reviewed by NASW Center of Workforce Studies Staff

HIV/AIDS and Older Adults
What Are the Transmission Risks for Older Adults?
Sexual Activity
Injection Drug Use
What Are Barriers to Intervention?
How Social Workers Can Help
Facilitating Discussions About HIV/AIDs

Social workers in many different fields of practice must be aware of the risk factors and transmission issues that leave older adults vulnerable to HIV/AIDS infection.

The misconception that older people are not sexually active has, in large part, been a contributor in making older adults an invisible population to many AIDS educators and social workers.

  • Male to male unprotected sex with an infected partner accounts for about 60 percent of all AIDS infection among older adults and is the chief risk behavior associated with HIV infection among older adult Americans.
  • Heterosexual transmission HIV/AIDS among older adults has increased dramatically since the mid 1980s and now accounts for the largest percentage of AIDS cases among any heterosexual group. This is due in part to the fact that condom use—historically linked to preventing pregnancy—is often ignored by heterosexual older adults because pregnancy no longer remains a point of concern.
  • One study found that 20 percent of sexually active older adults use condoms.
  • Older adult women are at a greater risk of HIV infection during intercourse than younger women due to age-related reduced vaginal lubrication and thinning of the vaginal walls resulting from estrogen loss coupled with a decline in the immune system.

People who use drugs intravenously and their sexual partners account for an increasingly high proportion of cases of AIDS. Although considerable research and prevention activities have been directed toward encouraging risk reduction among people who use injection drugs in general, older members of this population have largely been ignored (Levy, 1998).

  • Sharing infected needle equipment accounts for 15 percent of AIDS infections in the older adult population (Williams & Donnelly, 2002).
  • Many people who use injection drugs have numerous health conditions that can mask the effects of the virus.

Furthermore, interactions between the effects of the virus and those of illicit drugs can make it difficult to recognize HIV using standard AIDS criteria.

Early HIV symptoms, such as weight loss, fatigue, and decreased physical and mental activities often are mistaken for other diseases. An example of diseases that have symptoms similar to HIV infection and are common to older adults are Parkinson’s disease, Alzheimer’s disease, and respiratory diseases.

As people transition into older adulthood, symptoms of HIV are often and more readily attributed to signs of normal aging. This misdiagnosis of HIV symptoms can lead to a delay in seeking medical care or an avoidance of medical care altogether (Siegel, Dean, & Schrimshaw, 1999), placing both the infected individual and his or her sexual partner at risk.

From the beginning of the epidemic in 1981, AIDS was closely associated with disfavored minority groups, and culturally and historically taboo behaviors, such as homosexuality, drug use, and commercial sex work.

Although knowledge of HIV transmission has increased, more than 20 years later stigma still persists. Older adults also experience stigma and discrimination associated with ageism. For many, these challenges are compounded byliving with HIV/AIDS.

  • Older adults are members of communities that are increasingly affected and infected by HIV/AIDS, e.g., communities of color, poorer populations, and men who have sex with men. Being an older person with HIV is often coupled with dealing with the stigma and discrimination associated with sexism, classism,homophobia, and racism.

The National Association of Social Workers’ policy statement on HIV/AIDS asserts that proactive efforts must continually be undertaken to educate the most vulnerable populations—those not reached by traditional prevention

and educational programs (NASW, 2003). There are several steps that social workers can take to provide effective service to older adults who are either infected or affected by HIV/AIDS.

Social workers are encouraged to facilitate open discussions with their older clients about their health history as well as their sexual and substance abusehistories

  • Conduct comprehensive bio-psycho-social-spiritual assessment includes questions about sexual practices, alcohol and drug use, and creates an opportunity to talk with clients about HIV transmission risk.
  • Conduct a health assessment history including information about surgery before and after 1985 to determine the possibility of having received infectedblood through transfusion. A good health history also includes an assessment of Sexually Transmitted Infections (STIs).
  • Share harm reduction practices and strategies that address drug and alcohol use and safer sex with older clients to promote HIV prevention. For more information visit
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