HIV in older Americans: an epidemiologic perspective.

The elderly population is increasing as baby boomers are beginning to approach retirement. People 65 years of age or older already constitute approximately one eighth of the U.S. population; this proportion is expected to double in the next 50 years. Older Americans have their own population-specific health challenges, such as Alzheimer's disease, osteoporosis, adult-onset diabetes, prostate cancer, menopause, and hypertension. Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are seldom discussed within this community. Prevention, counseling, testing, and education efforts are not being directed their way. In addition, few practitioners are experts both in HIV and health problems associated with aging, resulting in misdiagnosis, especially in the early stages when AIDS symptoms such as fatigue, weight loss, night sweats, and diminished appetite are dismissed as part of the aging process. Very few HIV-related social support services have been aimed at the needs of the elderly, perhaps because older Americans are not suspected to be sexually active or are assumed to be in a monogamous, heterosexual relationship. Older Americans are not suspected of drug use. Yet many are sexually active, often demonstrating risky sexual behavior, such as dispensing with the use of condoms; and the isolation that frequently accompanies old age can lead to alcoholism and injectable drug use. This article examines methods suggested in the literature both in terms of primary and secondary prevention of HIV/AIDS in older Americans. The cost of these efforts is enumerated, and organizations who gear their efforts in reaching and educating older Americans regarding their risks are described.