1 / 64

1981-2013 - The Aging HIV Epidemic New Strategies for a Changing Demographic

1981-2013 - The Aging HIV Epidemic New Strategies for a Changing Demographic. Overview. HIV Epidemiology Update HIV Medical Update HIV and Aging National HIV Strategy Minnesota’s HIV Services Minnesota Program HH Eligibility. History of HIV.

walt
Download Presentation

1981-2013 - The Aging HIV Epidemic New Strategies for a Changing Demographic

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 1981-2013 - The Aging HIV EpidemicNew Strategies for a Changing Demographic

  2. Overview • HIV Epidemiology Update • HIV Medical Update • HIV and Aging • National HIV Strategy • Minnesota’s HIV Services • Minnesota Program HH Eligibility

  3. History of HIV • June, 1981, the Center for Disease Control reported clusters of an unusual illness • 1982- This illness was labeled AIDS • 1984- HIV was discovered • Initial medications were very expensive and highly toxic • 1996- The advent of highly active antiretroviral therapy

  4. Why Are We Here? • Even with improvements to HIV care and treatment, HIV remains a significant public health threat • New infections on the rise • HIV is a chronic, lifelong condition • With more people living with HIV, the number of new infections is likely to continue to rise

  5. National HIV Strategy • Reducing HIV incidence • Increasing access to care and optimizing health outcomes • Reducing HIV-related health disparities

  6. National Perspective

  7. National Perspective • The Center for Disease Control estimates 1.1 million people in the U.S. are living with HIV • 1 in 5 (18.1%) of those people are unaware of their infection • Over 50,000 Americans become infected with HIV each year • Nearly 636,000 people with AIDS have died in the U.S. since the epidemic began

  8. National PerspectiveBy Sub-Populations • RISK GROUP • MSM • Although MSM represent 4% of the U.S. male population, MSM accounted for 78% of new HIV infections among males • From 2008-2010 there was a 12% increase in new infections among MSM • The number of new HIV infections was greatest among MSM in the youngest age group (13-24) • Young, black, MSM most severely burdened

  9. National PerspectiveBy Sub-Populations • RISK GROUP • Heterosexuals • Accounted for 25% of estimated new HIV infections in 2010 • Injection Drug Users • Represented 8% of new HIV infections in 2010, and 16% of those living with HIV in 2009

  10. National PerspectiveBy Sub-Populations • GENDER • Women • HIV infections among women are primarily attributed to heterosexual contact or injection drug use • Accounted for 20% of estimated new infections in 2010 and 20% of those living with HIV infection in 2008 • There was a 21% decrease from 2008-2010 • Men • Accounted for approximately 80% of those living with HIV infection in 2010

  11. National PerspectiveBy Sub-Populations • RACE • Blacks continue to experience the most severe burden of HIV • Blacks represent approximately 12% of the U.S. population, but accounted for an estimated 44% of new infections in 2010. • Latinos are also disproportionately affected by HIV • Latinos represented 16% of the U.S. population, but accounted for 21% of new infections in 2009.

  12. National PerspectiveBy Sub-Populations • YOUTH • Young people aged 13-24 accounted for 20% of all new HIV infections in the U.S. in 2009 • HIV disproportionately affects young gay and bisexual men and young African Americans • Among young black MSM, new HIV infections increased 48% from 2006-2009

  13. Prevention Challenges for Youth • Sexual Risk Factors • Early age at sexual initiation • Unprotected sex • Older sex partners • Male-to-male sex • Sexual abuse • Sexually transmitted infections • Substance use • Lack of awareness

  14. Younger Patients • Based on a U.S. government report released in August 2012 • The least likely to be receiving medical care and medications • 15% of those aged 25-34 had an undetectable viral load • Compared to • 36% of those aged 55-64 • Only 22% of young adults are taking HIV medications

  15. Transmission and Treatment Rates • The same factors drive high transmission and poor treatment rates among U.S. groups that are disproportionately impacted • Poverty • Lack of access to medical care • Lack of education about what causes HIV and what people can do about it

  16. Minnesota Perspective

  17. Minnesota HIV/AIDS Surveillance • As of December 31, 2012, a cumulative total of 10,112 persons have been diagnosed and reported with HIV infection in Minnesota. • Of these 10,112 persons, 3,459 are known to be deceased • As of December 31, 2012, 7,516 persons are assumed alive and living in Minnesota with HIV/AIDS • 3,974 living with HIV infection (non-AIDS) • 3,452 living with AIDS

  18. Geographical Distribution

  19. HIV Infections† by County of Residence at Diagnosis, 2012 City of Minneapolis – 123 City of St. Paul – 44 Suburban# – 94 Greater Minnesota - 54 Number of Infections None 1-2 Total number = 315 3-5 6-14 15-53 54-180 *Counties in which a state correctional facility is located #7-county metro area, excluding the cities of Minneapolis and St. Paul †HIV or AIDS at first diagnosis

  20. HIV Infections* in Minnesota by Residence at Diagnosis, 2012 Total Number = 315 Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (except Minneapolis), Ramsey (except St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties, outside the seven-county metro area. * HIV or AIDS at first diagnosis

  21. Number Living with HIV/AIDS None 1-20 21-100 101-500 501-1000 1000-2000 2001-4190 Living HIV/AIDS Cases by County of Residence, 2012 City of Minneapolis – 2,943 City of St. Paul – 1,025 Suburban# – 2,393 Greater Minnesota – 1,111 Total number = 7,472 (44 people missing residence information) #7-county metro area, excluding the cities of Minneapolis and St. Paul

  22. Gender, Race and Ethnicity

  23. Persons Living with HIV/AIDS in Minnesota by Gender, 2012 5,771 (77%) 1,745 (23%)

  24. Population† (n = 5,303,925) HIV Diagnoses (n = 315) HIV Infections* Diagnosed in Year 2012 and General Population in Minnesota by Race/Ethnicity * HIV or AIDS at first diagnosis † Population estimates based on 2010 U.S. Census data. n = Number of persons Amer Ind = American Indian Afr Amer = African American (Black, not African-born persons) Afr born = African-born (Black, African-born persons)

  25. Number of Cases and Rates (per 100,000 persons) of HIV Infection* by Race/Ethnicity† – Minnesota, 2012 * HIV or AIDS at first diagnosis; 2010 U.S. Census Data used for rate calculations. † “African-born” refers to Blacks who reported an African country of birth; “African American” refers to all other Blacks. †† Estimate of 72,930 Source: Retrieved from MNCompass.org on 3/22/12. Additional calculations by the State Demographic Center. ^ Other = Multi-racial persons or persons with unknown race

  26. Age

  27. Average Age at HIV Diagnosis by Race/Ethnicity†:2010-2012 Cases with unknown or multiple race or unknown age were excluded. † “African-born” refers to Blacks who reported an African country of birth; “African American” refers to all other Blacks.

  28. Persons Living with HIV/AIDS in Minnesotaby Age Group†, 2012 † Age missing for 8 people .

  29. HIV Medical Update

  30. What is the difference between HIV and AIDS? • HIV versus an AIDS diagnosis • How long does this progression take? • What is the average life expectancy of someone with HIV?

  31. Common Lab Counts • CD4 Count • A key measure of immune system health • Viral load • This test measures the amount of virus in the body • How do non-medical providers interpret these numbers?

  32. Medications • AIDS drug cocktail vs. combination therapy • Adherence rates • Goal of medication • Medications as part of national HIV strategy • Health of individual • Public health approach • Medications and Aging • Drug resistance

  33. HIV and Aging- Associated Diseases • Illnesses typically associated with aging that are elevated in persons with HIV and can occur at a younger age • Cardiovascular and lung disease • Kidney and liver disease • Bone loss, increased fracture risk and frailty • Cognitive impairment • Cancer • Arthritis • Diabetes and high blood pressure

  34. Factors Associated with Accelerated Aging-Related Illnesses • Inflammation • Immune dysregulation • Polypharmacy • Long-term drug toxicities • Co-infections and comorbidities • Hepatitis B or C • Substance-use disorders • Stress, depression

  35. What do HIV and Aging have in Common? • Inflammation • Weakening immune system • High levels of depression and isolation • Leads to skipping medication • Which aggravates other maladies

  36. Transmission • What are the four fluids that transmit HIV? • Blood • Semen • Vaginal fluid • Breast milk • What are the most common ways HIV is transmitted today? • Unprotected anal, vaginal and oral sex • Sharing needles • From mother to child

  37. Transmission Considerations for Older Adults • Aging of the sex organs • Lining of the vaginal and anal walls • Decrease in natural lubrication • The role of erectile dysfunction medications • Long term partner • New partners after epidemic began • Multiple partners, partner not monogamous • HIV education

  38. Sex Among Older Adults With HIV • Some choose not to have sex at all • Fears about infecting others • Fears about exposure to STI’s • Shifting priorities • Disinterest in sex • Negative body image • Difficulty with sexual performance • Fear of rejection

  39. Prevention • Universal precautions • Barrier methods • Syringe exchange and pharmacy access • Post-exposure prophylaxis • Pre-exposure prophylaxis

  40. Prevention and Older Adults • Condom use • Only 18% of HIV negative and 58% of HIV positive sexually active men ages 49-80 said that “always” wear condoms. • Reasons for not using condoms • No need to worry about pregnancy • Loss of sensation and erectile dysfunction • Uncomfortable talking about safer sex • Sex under the influence of drugs and alcohol

  41. Testing • How long does it take after an HIV exposure to receive a definitive HIV test result? • 3 months • Testing options • Rapid testing • Home test • Testing sites

  42. Testing in Older Adults • HIV testing guidelines- informed consent • Annual blood draws • Role of health care provider • Sexual health history

  43. Stigma • More than half of HIV positive people (50-65) practice “protective silence” • Not telling others to manage stigma • Social Stigmatization • Ageism and HIV-related stigma • Health care and social service providers • Infantilizing “elderspeak” • Violation of patient confidentiality • Exclusion of patient from provider/family discussion of patient care

  44. Burden in Older Adults With HIV • Creating a new life after bracing for death • Changing community activism • Financial • Worries of growing older alone • Housing and senior centers

  45. The Traditional Service System Medical Care Case Management Housing Financial Assistance Transportation Food Assistance Benefits Counseling Legal Social and Support Groups Employment

More Related