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Focus on care of HIV-positive seniors
HIV isn't contained to one age bracket. Many patients diagnosed with HIV in the 1980s and 1990s have survived and now are entering their golden years. The cumulative number of AIDS cases in adults ages 50 years or older jumped from 16,288 in 1990 to 90,513 by the end of December 2001, according to the Centers for Disease Control and Prevention.1
With the increase in lifespan comes a need for new public health strategies. According to a survey of 260 HIV-positive older adults conducted by Ohio University researchers, one out of three sexually active older adults infected with HIV reported unprotected sex.2 The Ohio University researchers are planning to develop risk reduction interventions for HIV-infected older adults, reports Travis Lovejoy, a graduate student who is jointly enrolled in the university's clinical health psychology doctoral program and its public health master's program.
Traditionally, HIV prevention efforts have targeted younger risk populations such as men who have sex with men and intravenous drug users, says Lovejoy, who led the survey research. "Few interventions have been adapted or created that are appropriate for older adults," he says. "Our intention is to design and test the efficacy of age-appropriate sexual risk reduction interventions for this population."
Researchers also plan to corroborate their findings with more detailed lines of sexual behavior questioning, states Lovejoy. "For example, though we know that illicit drug users are more likely to engage in unprotected sex, we are unable to determine from our data whether persons are 'under the influence' during or prior to their sexual encounters, thus impairing their decision-making processes," Lovejoy notes. "We hope to clarify these points in future research."
Why take risks?
Why do HIV-positive seniors choose to have unprotected sex?
Some HIV-positive seniors may practice safe sex most of the time; however, as with many people, there are rare occasions when condoms are not used, says Timothy Heckman, PhD, professor of psychology and presidential research scholar at Ohio University. Heckman recently received a $1.5 million, four-year grant from the National Institute of Mental Health and the National Institute of Nursing Research to nationally test the effectiveness of a telephone support group for older adults with HIV.
Some seniors may not use condoms during intercourse due to mutual agreement with their sexual partner; the HIV-seronegative sex partner may see having unprotected sex as the ultimate sign of love and commitment, he states. Others may not use condoms because their sexual partners also are HIV-seropositive; this scenario is troublesome because risks are increased for the acquisition of other sexually transmitted diseases, such as syphilis or gonorrhea, states Heckman. For some older women, particularly those who are post-menopausal, concerns are no longer present when it comes to pregnancy, so they perceive little need to use condoms, he observes.
"Finally, many older adults living with HIV/ AIDS have undetectable viral loads and, as a result, may believe that they are incapable of transmitting their HIV to others," says Heckman.
Reach out via phone
Younger people with HIV may have several available resources when it comes to support and education. Seniors, however, often may feel embarrassment when attending traditional AIDS support groups. Heckman, who has spent the past eight years conducting AIDS research among the elderly and in rural populations, sees the telephone as a viable tool for delivering support to this group. The telephone support group is meant to bring patients together for a 12-week coping intervention to improve quality of life, Heckman said. A small group of six to eight participants call in toll-free at a certain time each week. Two facilitators help generate discussion relevant to reducing depression and improving quality of life.
"A separate study we conducted of older adults found that support groups that are designed to teach them skills to handle stress, obtain social support, and cope more adaptively are more effective than brief therapy sessions initiated by the person or support groups where participants only discuss problems but do not receive what is called coping intervention treatment," Heckman says.3
Heckman now plans to expand the geographical scope of the original study and increase the number of participants. Nearly 400 participants of the project will be divided among three therapy models, ranging from a 12-week telephone-delivered support group with sessions designed to improve the participants' coping skills to less active therapy sessions in which participants receive individual guidance only upon request. The project began in August 2006 and will end in July 2010.
"If successful, the research will identify a telephone-delivered intervention that can improve life quality in HIV-infected older adults who might otherwise lack access to mental health support services due to geographic isolation, physical limitations, and confidentiality concerns," Heckman states.