HIV rates are climbing in the over-50s in the UK and across
Europe,
while the rate of new infections among younger people is dropping,
according to new research which warns that the epidemic may be taking a
new direction.
The study, from the European Centre for Disease Prevention and
Control in Sweden, says that older people are most likely to be infected
through heterosexual sex. They are also likely to have more advanced
disease – which will be harder to treat and could be life-threatening –
when it is finally picked up.
The study’s authors suggest that the over-50s may be either
complacent or ignorant of the risks of HIV, which has dropped out of the
headlines since it became a
treatable disease. Their doctors also tend to assume that older people are not running risks through unsafe sex.
“Our findings suggest a new direction in which the HIV epidemic is
evolving,” said lead author Dr Lara Tavoschi. “This potentially is a
result of older peoples’ low awareness of HIV and how it is transmitted,
leading to misconceptions and low perception of their own risk.
“This perception of older people not being at risk is shared by some
healthcare providers, and HIV-related services focus more on younger
people. Our study shows the need to ensure all ages are appropriately
targeted by sexual health services.”
The study, published in the Lancet HIV journal,
has found that one in six new cases of HIV are in people over the age
of 50. Between 2004-2015, the rate of diagnosis in older people
increased in 16 countries. That included the UK, where the rate of new
diagnoses went up from 3.1 per 100,000 to 4.32. Belgium, Germany and
Ireland also saw rises in the rate of infection among older people. By
2015, the rate in over-50s was highest in Estonia, Latvia, Malta, and
Portugal.
While the rate of newly reported cases remained steady in those aged
15 to 49, it grew by 2.1% each year overall in older people across the
28 European nations, increasing from 2.1 people in every 100,000 in 2004
to 2.5 per 100,000 in 2015.
Infection through sex between men increased in both age groups
between 2004-2015. Cases due to heterosexual sex reduced in younger
people and remained stable in older people, while those attributable to
injecting drug use also reduced in younger people but increased in older
people.
The National Aids Trust said they had been aware of the rising rates
in older people in the UK for some time and that action was needed to
prevent these infections, such as targeting different age groups – not
just the young – with information about their risks and offering HIV
tests in places other than sexual health clinics, such as GP surgeries.
“In recent years there has been a steady increase in HIV diagnoses
amongst people over the age of 50 in the UK, accounting for 9% of new
diagnoses in 2006 and 17% in 2015,” said Kat Smithson, director of
policy and campaigns. “The trend is not limited to, but is more
prominent, in the heterosexual population. This presents a challenge to
think about whether our prevention efforts meet the needs of changing
demographics.”
Government
cuts to public health budgets were damaging local authorities’ capacity to offer prevention and testing
to older people,” she said. “High prevalence areas are spending a third
less on HIV prevention than they were two years ago, and it’s targeted
services that are suffering most. We are concerned that generalised
health promotion around sexual health and HIV may not reach some smaller
but growing areas of need, such as in the older heterosexual
population. We have the tools to reverse this trend, but without
investment we cannot use them.”
Professor Janet Seeley from the London School of Hygiene and Tropical
Medicine, who wrote a commentary in the Lancet on the study, said that
many older people did not think they were running a risk. “The main
thing is complacency, and also they are in relationships where pregnancy
is not a problem, so contraception isn’t something people consider,”
she said. “I think there is very little publicity around HIV in Europe
now that prevalence and incidence have gone down.”
The new infections were more often caused by heterosexual sex, she
thought, because the gay community was far more aware of the risks. “Men
of that particular age have gone through quite a lot themselves,” she
said. It would be naive to expect governments to do anything about
increasing awareness among the over-50s, given the pressures on health
services, she acknowledged, but the study should encourage big
campaigning groups – in particular the Terrence Higgins Trust, which had
been working on the issue. “It is a very difficult group to reach,” she
said. “It is very heterogeneous. If someone is going for a well-man or
well-woman check up, it could be something the GP could mention.” It is
difficult to ask people if they are having unprotected sex in a new
relationship, but few people took notice of leaflets because they didn’t
think they were relevant to them, she added.
Tavoschi
says that HIV services need to be geared up to the needs of this age
group. “Our findings illustrate a clear need to provide comprehensive
HIV prevention programmes, including education, access to condoms,
better testing opportunities, and treatment, targeted towards older
adults across Europe,” she said.
“We need to make both healthcare workers and the general population
aware of this issue to reduce stigma and inform people about HIV risks
and prevention methods. Testing in healthcare settings and innovative
HIV test approaches – such as self-testing – need to be more easily
accessible to older people to improve early diagnosis and fast-track
treatment initiation. When achieved, this should help to prevent further
transmission and lower the risk of severe health complications, which
is of utmost importance among older adults living with HIV as their risk
of mortality is higher as compared to younger individuals.”
Under
this programme, pregnant and breastfeeding mothers will be given one
full meal during the day consisting of rice, dal, lentils, vegetables,
boiled egg, peanut (chikki) and milk for a minimum of 25 days every
month. The women will also be given iron, folic acid and calcium tablets
along with the meal. The one meal will be of 1,342 calories and will
meet up to 45 per cent of the recommended daily nutritional need. The
meal will be served at local anganwadis. Similar schemes are already
being implemented in Telangana, Andhra Pradesh and Maharashtra.
