Terri Clark (ActionAIDS), Kate Clark (Philadelphia Corporation for Aging), and Katie Young (Philadelphia Corporation for Aging) presented on HIV and Aging at the January meeting of the Philadelphia Ryan White Part A Planning Council.

1. Office of HIV Planning
January 14, 2016
Terri Clark, MPH
ActionAIDS
Kate Clark, MPA
Philadelphia Corporation for Aging
Katie Young, MSG
Philadelphia Corporation for Aging
HIV and Aging in Philadelphia

2. Our Aim
To increase awareness and develop
city-wide action steps around HIV/AIDS
and Aging
2

3. Agenda
 Overview of HIV and Aging Data
 Sexual Behaviors and Older Adults
 Prevention Strategies
 Primary
 Secondary
 Tertiary
 Next steps
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4. Nationally: HIV & Aging
Adults 50 and older account for a growing number
of people living with HIV
 Successful anti-retroviral therapies
 New infections (11% of all new HIV infections
are 50+)
 Newly diagnosed as older adult (AIDS dx)
4

5. % of People with HIV Age 50 and Older 2009-2010
19 % and less
20-29 %
30-39 %
40 % and more
A National Trend
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6. Philadelphia: Testing
HIV & Aging
 2013: 18% of new HIV infections are 50+
 2013: 38% of new AIDS diagnosis are 55+
 ActionAIDS 2015: 20% of HIV tests for client 50+
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7. Philadelphia: Living with
HIV/AIDS
 People who were 50+ made up:
 52% of PLWA
 32% of PLWH
 People who were 45+ made up:
 71% of PLWA
 48% of PLWH
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8. Newly Diagnosed ActionAIDS
Clients, Age 50+
ActionAIDS has served over 1,000 HIV+ adults age 50+
since 2013.
For this analysis, clients were included if they:
• received a Ryan White-funded service between 2013-
2015
• Were diagnosed HIV-positive between 2012-2015
• were age 50 or older at the time of the initial service
• n = 75
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9. Heterosexual
51%
MSM
18%
IDU
13%
MSM and IDU
5%
Other/Not
Reported
13%
HIV Risk Factor
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10. n =
1,019
 More than half of
these clients reside in
5 Philadelphia zip
codes
 We do not currently
have data on the zip
code where the
infection or the HIV
test occurred
19144
10.3%
19120
7.7%
19132
7.7%
19104
7.7%
19134
7.7%
19136
10.3%
10

11. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
19144 19136 19134 19132 19120 19104
HIV Risk Factor by Zip Code of Residence
Other/Not Specified
MSM & IDU
MSM
IDU
Heterosexual
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12. 325
63
10
0
50
100
150
200
250
300
350
45 - 54 55 - 64 65+
#newcases
Age Group
New Chlamydia Infections in Philadelphia, 2013
Source: AACO 2013 Surveillance Report 12

13. Source: AACO 2013 Surveillance Report
273
65
10
0
50
100
150
200
250
300
45 - 54 55 - 64 65+
#NewCases
Age Group
New Gonorrhea Infections in Philadelphia,
2013
13

14. Source: AACO 2013 Surveillance Report
214
47
24
0
50
100
150
200
250
45 - 54 55 - 64 65+
#NewCases
Age Group
New Syphilis Infections in Philadelphia, 2013
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15.  Connection between HIV and STIs
 People with HIV on HAART are being treated successfully as
evidenced by viral suppression
 Those ageing with the virus are experiencing a variety of
non-HIV/AIDS conditions
More Facts
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16. Older Adults and HIV Risks
 We can’t talk about HIV without talking about sex (and
drug use)!
 Discomfort with sexual issues in the U.S.
 All adults have the right to express their sexuality
 Many believe that older adults’ sexuality is not worth
considering
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17. Sexual Behavior is Alive and
Well Among Older Adults
 73% of adults aged 57-64; 53% of adults aged 65-74; and
26% of adults aged 75 to 84 (Lindau et al 2007)
 Enormous variability in how U.S. adults described most
recent sexual event (intercourse to fantasy)
 LGBT older adults - 69% sexually active during past year
(ACRIA/COH 2010)
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18. But older adults…
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 Embarrassed about a continued interest in sex, and lack
resources about reducing the sexual risks
 Motivated to maintain sexual activity as an expression
of youthfulness; stereotypes of “old age”
 Want to remain sexually active to sustain intimacy in
both long-term and new relationships

19. But older adults…
19
 Use ED drugs (Prescription does not equal condoms)
 Experience physical changes that increase HIV risk
 Sexual changes with aging men
Sexual changes with aging women

20. Levels of Prevention
 Primary is designed to prevent a disease or condition from
occurring in the first place.
 Secondary attempts to identify a disease at its earliest stage so
that prompt and appropriate management can be initiated.
 Tertiary focuses on reducing or minimizing the consequences
of a disease once it has developed.
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21. Primary HIV Prevention
 Primary Prevention is still the most effective
 We need to “break the ice” and talk with our seniors
 Encourage testing for those older adults at risk
 Develop message tailored for diverse older adults, including
LGBT communities
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22. Audience Poll
How many times have you:
• Seen a billboard with the message
that older adults may be at risk for
HIV or other STIs?
• Heard of an HIV testing campaign
targeting your grandmother?
• Known about programs that teach
your father how to practice condom
skills?
• Read articles encouraging older
adults living with HIV to seek
healthcare?
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23. Secondary HIV Prevention
 Re-infection
 Co-infection with a STI
 Transmission
 Condom burnout
23

24. Prevention Messages for
Older Adults
 www.safersex4seniors.org
 www.ageisnotacondom.org
 ActionAIDS Fact Sheet
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25. ACRIA Social Messaging Campaigns
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26. Tertiary HIV Prevention
 Social supports
 Co-morbidities
 Accelerated Aging
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27.  Families provide the bulk of
hand-on assistance compared
with friends, but this is less
evident among older PWHA
 Hierarchical Compensatory
Model - older adults with HIV
frequently turn to government
and community-based services
for their needs
Social Supports
Formal
Services
Friends &
Neighbors
Distant
Family
Close
Family
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28. Co-Morbidities and
Accelerated Aging
 Aging with HIV does appear to increase the risk of
experiencing illness
 Heart attack, stroke, some cancers, fractures, organ
dysfunction
 Social functioning, mental health, stress, and depression
are also strongly associated with chronic disease burden
 After beginning HAART, there was no significant increase
in the conditions as they aged.
Rasmussen LD, May MT, Kronborg G, et al. Time trends for risk of severe age-related diseases in individuals with and without HIV
infection in Denmark: a nationwide population-based cohort study. Lancet HIV. 2015; in press.
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29. HIV and AIDS in Traditional
Aging Services
 16.3% of PLWHA over 50 have unmet needs
 Individuals who know their HIV status but are not in
primary medical care
 May not be receiving medical case management to assist
with basic needs (housing, food, safety)
 In 2012 37.38% of Southeastern Pennsylvanians over the
age of 50 were uninsured
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30. Philadelphia Corporation for
Aging
 The mission of Philadelphia Corporation for Aging is
to improve the quality of life for older Philadelphians
or people with disabilities and to assist them in
achieving their maximum level of health,
independence and productivity. Special
consideration is given to those with the greatest
social, economic, and health needs.
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31. HIV and AIDS in Traditional
Aging Services
 Spectrum of Long Term Care:
 Independent Living (includes Senior Centers)
 Adult Day Center
 In Home Support
 CCRCs
 Assisted Living
 Nursing Home
 Hospice Care
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32. Older Adults in Philadelphia
 Of those 192,492 older adults who are not currently working or
residing in an institution
 21.4% live below 100% of the poverty level
 52.2% live below 200% of the poverty level
 9% were served by the senior center network
 120 senior housing buildings
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33. HIV and AIDS in Traditional
Aging Services
 PLWHA are being served by the Aging Network, but
 Are they disclosing their status?
 Do the professionals have pre-existing stereotypes that
influence their interactions?
 Are there HIV/AIDS services that aging professionals need
to be in touch with and vice versa?
 How many PLWHA are NOT being touched by the aging
network and are thus falling through the cracks
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34. HIV and AIDS in Traditional
Aging Services
 Education, Education, Education!
 Professional in the HIV/AIDS Network:
 Debunk Myths on Aging
 Impact of Aging training
 Professionals in the Aging Network:
 Debunk Myths on HIV/AIDS and aging – reduce stigma
 Older Adults’ Sexual Health workshop: information/resources
 Encourage testing
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35. Existing Tools to Spread the
Word
 SEXcessful Aging
 Milestones/PCA News Bulletin (172,000 readers)
 Senior Housing Buildings (~120 subsidized housing building for seniors)
 Senior Centers (33 Centers and Satellites)
 HIV service organizations
 HIV and Elders Google Group
 GenPhilly (600+ emerging professionals)
 Jefferson HIV & AIDS Awareness Day
 What else???
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36. 2015 White House Conference
On Aging
July 13, 2015
Additional public input sessions
 Policymakers urged to take concrete actions to address
the needs of diverse groups and foster changes to better
the lives of all older adults, including people with
diverse backgrounds (people of color, LGBT
communities, those living with HIV, and older adults
with physical, intellectual and cognitive disabilities).
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37. Recommendations
 HIV and Aging Workgroup/Taskforce
 Development of White Paper
 Infographics
 Primary Prevention Resources
 Education of direct care workers/healthcare staff
 Increased testing opportunities for 50+ population
 Media/public health campaign
 Targeted information dissemination strategy
 National HIV and Aging Awareness Day
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38. Thank You!
Terri Clark, MPH
tclark@actionaids.org
ActionAIDS
Kate Clark, MPA
kclark@pcaphl.org
Philadelphia Corporation for Aging
Katie Young, MSG
kyoung@pcaphl.org
Philadelphia Corporation for Aging
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