Time for Myself

HIV in the golden years

Goals
Objectives of Program: Lake, DuPage and Will counties of Illinois Disseminate HIV prevention and care information Address the need to increase intervention strategies Increase HIV testing for Latinos 50+

HIV, Latinos & Aging

18 17.5 17 16.5 16 15.5 15 14.5 14 13.5
% of Population % of HIV/AIDS cases

Latinos

In 2006, Hispanics comprised 15% of the U.S. population, yet represented 18% of the HIV/AIDS cases that same year ( HIV/AIDS among Latinos in the U.S., 2010)

HIV, Latinos & Aging (cont.)

More than one in four Latinos (43%) was diagnosed late in the course of their HIV infection, when it may be too late to fully benefit from life-extending treatments ( Latinos Are 18% of Individuals Living with Undiagnosed HIV Infection, 2009) In 2005, individuals of age 50 and older make up 15% of all new HIV/AIDS diagnoses and 24% of persons living with HIV/AIDS (increased from 17% in 2001) ( HIV/AIDS among Persons Aged 50 and Older, 2008) The rates of HIV/AIDS among persons 50 and older were 5 times as high among Hispanics (21.4/100,000) compared with whites (4.2/100,000) ( HIV/AIDS among Persons Aged 50 and Older, 2008)

Aging
The CDC and research literature define the onset of aging as 50 years and older. Majority of research literature defines the samples and populations they are studying and gathering information on as 50 years old and older. Difference between 50-65 year olds and 65+ (retired vs. not retired)

Nursing Homes
There are not high concentrations of Latinos in these facilities: culture and affordability Casa Central: majority of its residents are Latino and its staff is bilingual & growing waiting list Many Latino families are realizing that they cannot consistently supervise or care for older family members. Variety of housing facilities: dependent vs. independent

Assumptions: General Public

Older Latinos do not engage in sexual activity or use drugs HIV/AIDS is a young person s disease Elderly do not have multiple sex partners

Lack of targeted education

Invisible population to AIDS educators and social workers (Junius) Lack of HIV prevention information targeted toward older individuals

Cultural Competency
You hungry ? Dog talking to cat

Cultural Competency
By being culturally competent, service providers will better and more efficiently engage the communities they are working with. Example: service provider may believe Latina women are not concerned with taking care of themselves (Rowan, 2008). Marianismo (sexual communication) Machismo (assimilation vs. acculturation) Personalismo Religiosity
can create communication barriers about sex and sexuality belief that sex for procreation, not pleasure condoms used for protection, not preventing procreation for older individuals

Sexuality as a taboo topic Latinos and alternative therapy (botnicas, natural medicines, amulets, curandero, shamans, santera, etc.)

Latino Cultural Beliefs

Aging protects against the virus (Canessa) HIV only transmitted during the childbearing years or through homosexual contacts (Canessa)

McGorry & Lasker s Study

Susan Y. McGorry s study worked to figure out what the difference in knowledge regarding HIV was between young and old populations of Latinos and Caucasians through the CDC s National Health Interview Survey. The sample included 363 Latinos aged 50 and older, and 1,146 Latinos under 50 years old.

Positive Findings
Ninety-eight percent of young Latinos vs. 92% of older Latinos agreed that AIDS can be passed through heterosexual intercourse (McGorry, 2001) Nearly 100% of both age groups know that HIV can be spread by:
Sexual intercourse between two men Sharing needles Through pregnancy from woman to child

Concerning Findings
Older Latinos were always more likely to believe that a person can become infected from casual contact such as: Using public toilets (26%) Working near someone with AIDS (18%) Sharing utensils (43%) Being coughed or sneezed on by someone (66%) Attending school with someone with AIDS (25%)

Concerning Findings (cont.)

Only 57% of older Latinos believe condoms are somewhat or very effective for preventing transmission of the AIDS virus (McGorry, 2001) 19% of older Latinos did not know that a person can look healthy and still have AIDS (McGorry, 2001)

Depression
Language barrier (do not talk to other people, do not know services in community) Loneliness Companionship False sense of security Affection Elderly Latinos are more at-risk of becoming infected with HIV if they: are living alone or separated from family/supportive network were engaged in a 12-step program at some time of their lives have been in recovery for more than one year are a Medicaid dependent suffer from loneliness and depression (Canessa).

Erotic Enhancers
Medication and treatments can create sexual problems, leading to the use of erotic enhancers such as Viagra & Cialis

Lubrication
Due to older age, sexual activity for Latinas can present higher risk for infection when no protection is used. Less lubrication can lead to a higher likelihood of blood exchange and HIV infection (Junius) Latinas are "reluctant to encourage condom use because they are associated with prostitution, poor hygiene, and contraception" (Rowan, 2008)

Transmission
Heterosexually transmitted HIV/AIDS among older adults (individuals over the age of fifty) has increased and now accounts for the largest percentage of AIDS cases among any heterosexual group (Junius) Condom use - historically linked to preventing pregnancy - is often ignored by heterosexual older adults because pregnancy no longer remains a point of concern (Junius) Only 20% of sexually active older adults use condoms (Junius)

Transmission (cont.)
Older injection drug users account for 16% of the AIDS cases of persons over the age of 50 (Altschuler, 2004) Diabetics sharing insulin needles can spread infection Men who have sex with men (MSM) account for 60% of all AIDS infections among older adults (Junius)

Medical Realities
Illicit drug use can mask the effects of the virus Early HIV symptoms, such as:
weight loss fatigue decreased physical activity memory loss

often are mistaken as signs of aging and mistaken for other diseases such as Parkinson's disease, Alzheimer s disease, cancer, and respiratory disease (Junius). Older individuals may be more at risk due to already compromised immune symptoms and multiple medical issues (McGorry, 2001) HIV progresses more rapidly in older individuals than in younger people (McGorry, 2001)

Barriers to treatment
Transportation to doctor Culture and language Possibly dependent on family members for translation; inappropriate/embarrassing to talk in front of family Short term concerns overshadow long term health daily obstacles; caring for sick family members, helping with childcare, etc. and prevent planning (Alegria, 2009) Talking sex is taboo Denial: possibly deny, pray, not seek treatment

Stigma
Stigma and discrimination associated with
Sexism Ageism Classism Homophobia Racism AIDS historically has been associated with disfavored minority groups, and culturally and historically taboo behaviors such as homosexuality, drug use, and commercial sex work (Junius)

Persons may not disclose their HIV status in order to protect self and family from discrimination or embarrassment Cultural stigma vs. mainstream society s view Stigma serves as a barrier to talking about HIV, disclosing HIV status from significant others and may cause the sero-positive individual to delay medical treatment (Canessa) It is stressful to disclose status, emotionally taxing, and financially burdensome Stigma discredits and reduces a sero-positive individual as a person

Prevention
Stress the need to see doctor for care after childbearing years (HPV, pap smears, mammogram, prostate health) Stress the need for them to ask a doctor for annual HIV testing Latino elderly need support resources such as mental health services to create support, positive communication, and involvement within families (Prado, 2010) Possible strategies on how to engage older Latinos in HIV prevention are:
to place HIV information in senior recreational centers, places they frequent (laundromat, grocery store); host outreach programs; health fair (Canessa).

Research Findings
Altschuler s study surveyed 249 ethnically and economically diverse adults, 50 years and older, from 14 organizations in rural and urban settings in California, to determine their interest in participating in HIV/AIDS prevention program. Leading a small discussion or support group can create a sense of community and a safe space to discuss health concerns (Altschuler, 2004). The study that suggested and used this strategy found that participants: generated communication skills learned how HIV/AIDS was relevant to their lives felt empowered to speak to health care providers found it positive to talk about an otherwise taboo topic (Altschuler, 2004). Elderly women were more likely to attend prevention programs (Altschuler, 2004) Moderately to very religious individuals were more likely to attend HIV education programs (Altschuler, 2004) Preferred prevention education through presentations and programs at centers serving older adults from physicians, experts, and other health care providers (Altschuler, 2004)

Support Groups
High attendance due to:
Socialization: be with people they know Food

Separate groups by gender Challenges:

Women s group: stay on topic Men s group: bring them to meeting
Do other presentations and topics

Treatment

Providers need to be aware of their own comfort level before talking with clients Ask clients to be as honest as possible so they understand that it is harder to assess their risk otherwise Communicate about health history that includes:

STIs surgery and blood transfusion before and after 1985 sexual and substance abuse histories and practices

Creates an opportunity to talk with clients about HIV transmission risk Share harm reduction practices about safer drug and alcohol use and safer sex (Junius) At least 30% of all people with HIV/AIDS require mental health services; high rates of depression and co-occurring mental health problems (Crowley, 2003) Need support system, positive outlook, and treatment

Recommendations

Outreach should include:

workshops and trainings ( HIV/AIDS and Aging, 2008) rapid testing and counseling (" Rapid HIV Testing in Emergency Departments - Three U.S. Sites, January 2005-March 2006 " 2007) It demonstrates that medical professionals are invested in this community while providing essential services and eliminating one barrier to getting treatment: transportation.

Health care and service providers on all levels should be educated on HIV risk behaviors and symptoms of HIV infection; they need to conduct thorough sex and drug-use risk assessments with their older clients/patients ( HIV/AIDS and Aging, 2008) Medical staff need to communicate with patients concerning risk behaviors, sexual behaviors, and drug/prescription related behaviors as well as testing them for HIV. Support groups and mental health services need to be recommended or created specifically for older individuals and minorities. Public service announcements and educational campaigns ( HIV/AIDS and Aging, 2008)

Sources

Alegria, Margarita. "Training for Research in Mental Health and HIV/AIDS Among Racial and Ethnic Minority Populations: Meeting the Needs of New Investigators." American Journal of Public Health 99.S1 (2009): S26-30. Print. Annan, Kofi. "El VIH/SIDA Y Las Personas De Edad." Una Sociedad Para Todas Las Edades : Segunda Asamblea Mundial Sobre El Envejecimiento, Madrid. (12 Apr. 2002). Print. Altschuler, Joanne, Anne D. Katz, and Margaret Tynan. "Developing and Implementing an HIV/AIDS Educational Curriculum for Older Adults." The Gerontologist 44.1 (2004): 121-26. Print. Canessa, Patricia. Latino Culturally Effective Training On HIV and Aging. Rep. Print. Centers for Disease Control and Prevention. New Analysis Provides More Detailed Picture of Population Living With Undiagnosed HIV Infection in the United States: Suggests Significant Gaps in Knowledge of Infection Across Multiple Risk, Racial, and Age Groups. Web. Crowley, Jeffrey S. HIV/AIDS Care and Treatment: Are Public Policies Keeping pace with an Evolving Epidemic? Issue Brief no. 2. Georgetown University, 19 June 2003. Web. 12 Jan. 2010. <http://ihcrp.georgetown.edu/agingsociety/pubhtml/HIV/HIV.html>. "Fact Sheet: HIV/AIDS among Hispanics/Latinos in the United States." Centers for Disease Control and Prevention. 21 Aug. 2009. Web. 22 Apr. 2010. <http://www.cdc.gov/hiv/hispanics/resources/factsheets/hispanic.htm>. "HIV/AIDS among Latinos in the U.S." Latino Commission on AIDS. Web. 13 May 2010. <http://www.latinoaids.org/hivlatinos.php>. "HIV/AIDS among Persons Aged 50 and Older." Centers for Disease Control and Prevention. 28 Feb. 2008. Web. 22 Apr. 2010. <http://www.cdc.gov/hiv/topics/over50/resources/factsheets/over50.htm>. "HIV/AIDS and Aging." National HIV/AIDS and Aging Awareness Day: September 18. The AIDS Institute, 2008. Web. 13 May 2010. <http://www.theaidsinstitute.org/downloads/HIV%20AIDS%20and%20Aging%20Facts.pdf>. Junius, Jermaine. "The Aging of HIV." Ed. Evelyn P. Tomaszewski. National Association of Social Workers. Print. "Latinos Are 18% of Individuals Living with Undiagnosed HIV Infection.[1] As National HIV Testing Day Nears, the Launches a New Website to Link People to Testing and Care." Latino Commission on AIDS. 22 June 2009. Web. 13 May 2010. <http://www.latinoaids.org/news_detail.php?cat=pr&id=73>. McGorry, Susan Y., and Judith N. Lasker. "Elderly Latinos in the U.S.: What Do They Know and Think About HIV/AIDS?" Journal of Nonprofit & Public Sector Marketing 9.3 (2001): 89-103. Print. Montoya, Isaac D., and Donna D. Whitsett. "New Frontiers and Challenges in HIV Research Among Older Minority Populations." Journal of Acquired Immune Deficiency Syndromes 33 2003): S218-221. Print. " Persons Tested for HIV - United States, 2006." Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 57.31 (2008): 845-49. Print. Prado, Guillermo, Shi Huang, Mildred Maldonado-Molina, Frank Bandiera, Seth J. Schwartz, Pura De La Vega, C. H. Brown, and Hilda Pantin. "An Empirical Test of Ecodevelopmental Theory in Predicting HIV Risk Behaviors Among Hispanic Youth." Health Education & Behavior 37.1 (2010): 97-114. Print. " Rapid HIV Testing in Emergency Departments - Three U.S. Sites, January 2005-March 2006." Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 56.24 2007): 597-601. Print. "Rapid HIV Testing in Outreach and Other Community Settings - United States, 2004-2006." Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 56.47 (2007): 1233-237. Print. Rowan, Diana, Rich Furman, April Jones, and Kevin Edwards. "Social Work Practice with Latinos Living with HIV/AIDS." Advances in Social Work 9.2 (2008): 142-56. Print.

Thank you for your time!

If you have any additional questions after the presentation, please feel free to contact us:
Carley Bran cbran@salud-latina.org Oscar B. Chacon ochacon@salud-latina.org (312) 913 3001