18:30 OPENING REMARKS BY CO-CHAIRSAndrew Ball, MB, BS, FAChAM, Senior Strategy & Operations Advisor, HIV/AIDS Department, World Health Organization

Naisiadet Mason, Kenyan HIV activist and older adult with HIV

18:40 GLOBAL EPIDEMIOLOGY AND DEMOGRAPHICS OF THE EPIDEMIC AMONG OLDER ADULTS Joel Negin, University of Sydney School of Public Health, Australia

18:50 MULTIMORBIDITY MANAGEMENT & THE CRITICAL ROLE OF CAREGIVERS Stephen Karpiak, PhD and Mark Brennan-Ing, PhD, ACRIA Center on HIV and Aging and New York University College of Nursing, U.S.

19:05 PREVENTION FOR OLDER ADULTS Kevin Fenton, MD, PhD, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the U.S. Centers for Disease Control and Prevention

19:15 POLICY AND ADVOCACY STRATEGIES

Lisa Power, Policy Director for the Terrence Higgins Trust, U.K..

19:25 PANELISTS/DISCUSSANTS: Ricardo Jimenez, Ecuadorian Red Cross, Ecuador Carolyn Massey, Older Women Embracing Life, Inc., U.S. Ruth Waryaro, HelpAge International, Uganda John Rock, APN+ and International Treatment Preparedness Campaign, Australia

19:55 QUESTION AND ANSWER SESSION

20:25 CLOSING REMARKS – Co-ChairsSATELLITE ORGANIZERS

AIDS Community Research Initiative of America (ACRIA), Terrence Higgins Trust, HelpAge International, Gay Men’s Health Crisis (GMHC), Services and Advocacy for GLBT Elders (SAGE), and Women Fighting AIDS in Kenya (WOFAK). Special thanks to GNP+ (Global Network of People Living with HIV) for its support and assistance.

Made possible by a generous grant from the

HIV and AgingThe Challenge of the Epidemic’s Fourth Decade

SCHOOL OF PUBLIC HEALTH

HIV and Aging: The Challenge of the Epidemic’s Fourth Decade The Emerging Demographic Tide AIDS 2012 Satellite | 25 September 2012

JOEL NEGIN SENIOR LECTURER IN INTERNATIONAL PUBLIC HEALTH

3Source: Prof Amy Justice. October 27, 2010. White House Testimony.

The aging phenomenon is well known in the US

Percentage of people Living with HIV in US aged 50+

This is not only the results of longer survival due to treatment; older adults

accounted for 15% of new cases of HIV in the US in 2005 [Simone and Appelbaum. Geriatrics 2008]

Seen also in Europe and Australia

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› Western European data reveals that 12.9% of newly reported cases of

HIV infection in 2007 were among peopled aged 50 and older compared

to 10.4% in 2003. The percentage of older adults among new infections in

Eastern Europe has doubled over the same time frame. [Lazarus and

Nielsen. HIV Med 2010]

› In the Swiss HIV Cohort, 31% of individuals are aged 50 and older [Hasse

et al. Clin Infec Dis 2011]

› Articles have highlighted the HIV and aging trends in London [Elford et al.

Sex Transm Infect 2008], Italy [Orchi et al. AIDS Care 2008] and Australia

[Pitts et al. AIDS Patient Care STDS 2005].

As more people have begun taking ART, mortality rates have dropped and PLWHA are surviving longer

But these facts have not been recognised in developing countries

HIV among older adults represents a significant blind spot in the global

response to the HIV epidemic

Neglect of the elderly in developing countries

• Covers of recent UNAIDS and WHO HIV-related documents

Absolute number (millions) of older persons (60+):world regions 2005-2050

2005 2025 2050 Increase

Sub-Saharan Africa

37 66 155 4.2 x

Latin America & Caribbean

50 102 187 3.7 x

Asia 363 709 1,249 3.4 x

Northern America

56 95 121 2.2 x

Western Europe 42 58 64 1.5 x

Source: United Nations, World Population Prospects. The 2006 Revision.

HIV infection among older adults is starting to be recognised in other parts of the world too

› In Brazil, percentage of patients aged older than 50 diagnosed with AIDS increased from 7% in 1996 to 13% in 2004 (Pardi et al. JAIDS 2009)

› In Taiwan, 7.7% of those newly diagnosed in 2007 were aged 50 years and older (Kang et al. Journal of the Chinese Medical Association 2011)

› In Thailand, 10.6% of male HIV cases are among those aged 50 years and older as of 2009

Gaps in Information:Current status of HIV reporting

• 49 is the current endpoint for most data collection

o Demographic and health surveys: 15-49 (mainly)

o 49 is the present Inadequate end point for data collecting? 

Make everyone count by counting everyone – Philip Setel

The highest burden of HIV among older adults is in sub-Saharan Africa

› Methods: extrapolating from UNAIDS data and UN population data

› 3 million people aged 50 years or older in sub-Saharan Africa are HIV positive (2007)

› 14% of all people infected with HIV (15+) in sub-Saharan Africa are aged 50 years or older

Source: Negin J, Cumming R. Bulletin of the World Health Organization 2010;88:847-853.

HIV Prevalence in Older People in Sub-Saharan Africa, 2007

Country Number of 50+ HIV+

50+ as % of total HIV+ aged 15+

HIV Prev.age 50+ (15-49)

Cameroon 59,900 12.0% 3.1% (5.1%)

Cote d’Ivoire 48,500 11.6% 2.1% (3.9%)

Lesotho 61,900 23.8% 27.8% (23.2%)

Mozambique 228,500 16.3% 11.2% (12.5%)

Nigeria 300,300 12.5% 2.1% (3.1%)

South Africa 679,700 12.6% 10.2% (18.1%)

Swaziland 31,400 18.5% 29.2% (26.1%)

Uganda 150,100 18.5% 5.4% (6.8%)

Zambia 200,000 20.4% 18.6% (15.2%)

HIV Prevalence, South Africa 2008

Source: South African National HIV Prevalence, Incidence, Behaviour and Communication Survey

South Africa has added men aged ≥50 years to its list of

populations considered to be at greatest risk for HIV infection

Modeled trends suggest increasing prevalence among older adults in Africa

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HIV prevalence in the populations aged 15–49 years and 50 years or older in sub-Saharan Africa for the years 2011, 2025 and 2040, under continued scale-up of antiretroviral therapy.

Source: Hontelez et al. AIDS (special issue) 2012.

Older adults less likely to be tested (and have lower levels of awareness and knoweldge)

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Source: Negin et al. AIDS and Behaviour 2011.

People with HIV Aged 50+

Who are they?

› Survivors (on ARVs)

› Newly diagnosed

› Newly infected

Sexual behaviour of older adults

› A study in Nigeria dismissed older people as no longer being sexually active, confirming what Ory et al. called “ageist assumptions about sexual behaviour”.

› These attitudes limit the development of appropriate responses tailored specifically to older adults.

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Older adults are sexually active

Further Attention Needed

› Seroprevalence studies of HIV in people 50+ (no upper age limit)

› Comorbidities in older people with HIV

› Health worker attitudes towards older people

› Gendered aspects of HIV among older adults

› Understand sexuality in older people