HIV/AIDS, Domestic Violence, and Aging: Recognizing National HIV/AIDS and Aging Awareness Day
September 16, 2016
By: Ashley Slye, National Network to End Domestic Violence (NNEDV), and Bonnie Brandl, National Clearinghouse on Abuse in Later Life (NCALL)
It’s remarkable how far we have come in the fight against HIV. Medical advances have given people living with HIV the ability to live long, healthy lives, and have given us a reason to have National HIV/AIDS and Aging Awareness Day. On this awareness day, the National Network to End Domestic Violence (NNEDV) and the National Clearinghouse on Abuse in Later Life (NCALL), call attention to the unique needs of an aging society. While it is necessary to continue to educate younger generations on HIV, it is also important to note the changing face of those living with HIV.
Each day, an average of 10,000 people turn 65 in the United States, including people that are living with HIV. Older adults still lead active sex lives and due to divorce, death of a spouse, or other reasons, they may be engaging in sexual behaviors with multiple partners. Unfortunately, the erroneous belief that a condom is not needed due to the inability to bare children persists. Additionally, sexual health materials are typically not marketed to the older population and their unique needs. This has led to an increase in sexually transmitted infections for adults over the age of 65. Between 2007 and 2011 the reported cases of chlamydia in adults over 65 increased by 31.5% and the number of reported syphilis cases increased by 51.6%.  For individuals who get syphilis, gonorrhea, and herpes, this increases their chance of acquiring HIV. 
As the U.S. population ages, our attention to the healthcare of older individuals must change. It is critical that physicians have the training and knowledge to work with older adults living with HIV, but also the confidence to discuss sex, condom use, domestic violence, and elder abuse with all older patients regardless of age, marital status, gender identity, or sexual orientation. One 2007 study in New York City found that 69% of women over the age of 50 acquired HIV through heterosexual contact. While the indicators of HIV may be similar to the effects of aging, it is important not to write them off.  The Global Study of Sexual Attitudes and Behaviors found that only 9% of men and women aged 40 to 80 years old had been asked about their sexual health in the past three years. A study in the United States found that older women were extremely unlikely to ask for an HIV test without a prompt from their physician, increasing the time between acquiring HIV and being diagnosed, leading to an increased likelihood of death due to AIDS.  In 2013, 18% of new HIV diagnoses were in adults 50 and older.  The solution to this is not telling older adults to abstain from having sex, but instead providing educational materials that address sexual pleasure past reproductive age and ways adults can still engage in safe sex. Addressing and dismantling stigma behind sex in later life will open doors for older adults to receive information, testing, and care related to HIV.
Additionally, for HIV service providers, it is important to understand the dynamics of domestic violence and sexual assaults for older adults. Asking about domestic and sexual violence should not be reserved for younger individuals accessing your services. For older adults, they may be experiencing violence from a partner, a family or community member, or caregiver. Due to the unique barriers to accessing care that older adults may face, meetings with physicians and other providers of care, including HIV organizations and domestic/sexual violence organizations, should be used as opportunities to discuss physical, psychological, and sexual violence as well as sexual health. Women experiencing domestic violence have a four times greater chance of acquiring STIs, including HIV. For this reason, we must continue the conversation around sexual health with women, and all adults, regardless of age.