Educational Gaps for Health Care Providers 

September 18th is National HIV/AIDS and Aging Awareness Day – a day to shed light on the unique challenges faced by older adults living with HIV/AIDS. In South Carolina, where AIDS cases have been reported since 1981, recent data from SC DHEC reveals that there are an estimated 19,872 South Carolinians currently living with diagnosed HIV infection (including AIDS) - approximately half being people aged 50+. Despite the progress in treatment, with antiretroviral therapy (ART) enabling many to live longer and healthier lives, it is important to note that younger adults aged 20-29 still represent the largest growing population of newly diagnosed cases. 
 
College of Nursing’s Dr. Sabra Custer specializes in HIV-related research, including prenatal care and prevention, intimate partner violence, and post-exposure preventative care, while also enhancing interprofessional education in HIV care. We spoke with Dr. Custer to shed light on these critical issues and the evolving landscape of HIV care for older adults. Here's what she had to say: 

With so many South Carolinians who are HIV-positive being 50+, how should care plans differ for older adults living with HIV/AIDS compared to younger patients? Does aging impact the progression and management of HIV/AIDS? 

Dr. Custer: For nurses and other health care workers caring for people who are HIV-positive and 50+ years old, care plans must include awareness of other chronic conditions that are likely to affect the person’s health. Many older adults who are HIV-positive also have hypertension, diabetes, heart failure, or have had some type of cancer. Sometimes medications to treat these other chronic conditions common with older age can conflict with HIV medications or cause immunosuppression, on top of the effects of HIV on the immune system. There is increasing evidence and understanding that being HIV-positive can impact the progression of other chronic diseases and likely increase the risk of heart disease, due to the chronic inflammatory nature of HIV infection.

How can we, as a nursing community, better address the stigma associated with HIV/AIDS in older populations? 

Dr. Custer: Combatting stigma surrounding being HIV-positive and the elderly starts with reducing stigma towards the HIV-positive community in general. When providing direct physical care, use standard precautions on every patient, don’t use “extra barriers” just when you know a person is HIV-positive, for example. For interactions that don’t predict exposure to blood or other body fluids, general hand hygiene is necessary as always, but past that, show comfort with a patient by appropriate, gentle touch on an arm or shoulder. Ask questions about someone’s HIV medications and treatment just as you would ask about blood pressure medications or pain medications – make sure you approach the topic with neutrality, respect and openness. Don’t grimace or whisper, as if you anticipate they will be ashamed to discuss their HIV status or care. 

What are some effective strategies for increasing HIV/AIDS awareness among older adults?

Dr. Custer: Many nurses and other health care providers forget or avoid asking about sexuality and sexual activity with older adults, either due to general discomfort or assumptions about reduced sexual activity with aging. This stereotype is not true at all, based on evidence of continued STI infections, including HIV, in older adults. Asking about sexual activity, partners, and use of barrier protection even in older adults provides an opening to ensure older adults know they are also at risk of acquiring HIV through sex or IV drug use – the two most common ways people are exposed to HIV.

What role does routine screening play in managing HIV/AIDS in older populations, and how can it be improved?

Dr. Custer: Because older adults may not perceive that they are at risk of HIV infection, they are even less likely than younger individuals to seek out HIV testing. Nurses are often the best-positioned member of a health care team to initiate the conversation with an older adult by asking if they’ve ever been tested for HIV. The major public health expert groups recommend that up to around age 65, everyone should have at least one lifetime HIV test, and those at increased risk, such as people with multiple sexual partners, those not using barrier protection consistently, or those with other STI infections, be tested annually. If an older adult has never been tested for HIV, suggest it to them, the same way we remind people to stay up to date on mammograms, testing for diabetes mellitus, or vaccinations. 

How can social determinants of health (SDOH) impact the care for older adults living with HIV? 

Dr. Custer: The stigma surrounding being an older adult living with HIV and media images that usually portray younger adults with HIV impact social determinants of health for older adults who are HIV-positive. These individuals are at even higher risk of social isolation and shame related to their HIV status than older adults in general. Also, older adults may be living on limited incomes and eventually be unable to drive themselves, which can make it difficult for them to attend regular appointments with an HIV provider. For privacy reasons, a person may not want their family members to know about their HIV status, yet need help getting to medical appointments or to the pharmacy to pick up medications. These challenges to receiving health care and keeping up with treatment may impact older adults more than younger ones.