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Illicit Drug Use in Older Adults with HIV/AIDS

The prevalence of HIV infection in older adults is increasing; by 2015, over half of adults living with HIV/AIDS in the United States will be over 50.

HIV/AIDS has been widely regarded as a young person’s disease since its recognition as a major public health problem in the 1980s. First, young gay men and then intravenous drug users and their sexual partners were identified as selectively vulnerable to infection. Both sexual activity and drug use were generally associated with youth or the middle ages of adulthood.

 Only recently has attention been turned to the prevalence of HIV/AIDS among older adults, defined as aged 50 years or above, comprising 23% of the total Unites States population. Recent data from the Centers for Disease Control and Prevention indicated that approximately 11% of Americans with HIV infection are at least 50 years old, including both those infected years ago who are still alive and others who were infected recently.

The CDC also reported persons aged 50 and older accounted for approximately:

  • 17% of new HIV/AIDS diagnoses,
  • 36% of persons living with AIDS,
  • 24% of all AIDS diagnoses, and
  • 45% of all deaths of persons with AIDS

These are the reported cases, but there are many, many cases that been unreported or misdiagnosed in the age 50 and over group because:

  • Health care providers do not always test older people for HIV/AIDS and may miss diagnosis during routine checkups.
  • People who are 50 years or older may mistake signs of HIV/AIDS for the aches and pains of normal aging.

·   They are less likely than younger people to get tested.

·   Older adults know less about HIV/AIDS than younger people and may not know how it spreads or the importance of using condoms, not sharing needles, and getting tested for HIV.

  • Older people are less likely than younger people to talk about their sex lives or drug use with their health care providers.
  •  Health care providers may not ask older patients about their sex lives or drug use or talk to them about risky behaviors.
  • The stigma of HIV/AIDS may be more severe among older persons, leading them to avoid getting tested or hide their diagnosis from family and friends.

 Aging is associated with biomedical and psychosocial changes, and HIV infection can exacerbate these challengesWith limited social and institutional support, they may experience an increased mental health burden, including depression and loneliness, psychiatric Comorbidity.  In the absence of social support, one may seek cognitive escape via substance use and/or sexual risk.

The prevalence of illicit drug use in persons living with HIV/AIDS is disproportionately high.

In several nationally representative empirical of patients receiving care for HIV, half reported illicit drug use in the past 12 months. Drug use among HIV-infected individuals is problematic for a number of reasons.

First, injection drug use contributes directly to the spread of HIV and non-injection drug use may contribute indirectly to the transmission of HIV through its association with high risk sexual behavior. Second, drug use is associated with non-adherence to antiretroviral treatment, which increases HIV viral load and transmissibility and disease progression. Third, drug use is associated with suboptimal virologic and immunologic responses to antiretroviral therapy. The issue of drug use in older adults living with HIV is of particular concern because prior research suggests it does not decline with age as it does in the general population

In a recent systematic empirical study review, it concluded that the prevalence of illicit drug use is increasing among older adults, and that it contributes to cognitive decline, limitations in social life, and impairment in normal functioning.  According to the National Survey on Drug Use and Health, the use of any street drug or nonmedical use of a prescription drug in the past year jumped from 9.7% in 2007 to 15.9% in 2014 in adults age 50 and older.  Furthermore, the prevalence of older adults with a substance use disorder is projected to double from 2.8 million (annual average) in 2002-06 to 5.7 million in 2020.

The prevalence of HIV infection in older adults (50 years or older) is projected to escalate from 25% in 2007 to 50% by 2015. This trend is largely the result of two factors. First, the number of new infections in older persons is increasing and secondly, highly effective antiretroviral therapies and improved clinical care are increasing the life expectancies of HIV-infected persons, allowing many of them to survive into old age.

However, HIV is believed to accelerate the aging process. As a result, HIV-positive older adults are prescribed high amounts of medications and live with an elevated level of comorbid health conditions, including opportunistic infections, hypertension, and dementia.

Furthermore, older HIV-positive adults report higher levels of depression and anxiety, smaller social networks, and less utilization of community health organizations than their younger counterparts. Thus, the burden of drug use may be magnified in older HIV-infected adults.

Despite accumulating evidence that older adults with HIV infection are more likely to continue using drugs, studies have not yet examined psychosocial correlations with drug use in this population.

Living with HIV is associated with high levels of stress, including disclosure concerns, HIV-related neurocognitive impairment, and stigmatization. The positive association between depression and drug use disorders is well-established in the general population and in HIV-positive samples.

 It has been suggested that the principle motivation behind drug use is to escape or avoid experiences of negative affect or HIV-positive adults also report using drugs to cope with stressful situations and with emotional distress.

Depression, quality of life, and the ways in which individuals cope with stressful situations are important to consider in HIV-positive older adults for several reasons.  First, rates of depression are nearly two-times higher in HIV-positive individuals than the general population.  

Second, although depression is generally lower in older adults than their younger and middle-aged counterparts, it remains elevated in older individuals infected with HIV. Third, studies comparing older adults in the general population to younger adults suggest that older adults may employ different coping strategies than their younger counterparts, typically opting for more avoidant than active approaches.  

Finally, health related quality of life may play a particularly prominent role in the lives of HIV-infected older adults, whose physical health declines both as a function of one's age and disease status.

Despite the fact that the HIV-positive population in the USA is aging, the health needs of this group remain understudied and likely underserved. Older HIV-positive individuals may continue to engage in use of substances evidencing patterns of use that vary by demographic characteristics, which likely reflect norms around substance use within the subpopulation.

If we are to effectively serve this generation of older adults, and specifically older HIV-positive adults, we must further understand risks and resiliencies, and recognize variations within the population of older HIV-positive adults in order to reduce health disparities.



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