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Aging and HIV: Meeting the unique care needs of older adults and fighting discrimination

The Bottom Line

  • HIV primarily affects groups that are often stigmatized or marginalized in society. 
  • A greater number of older adults are now living with HIV.
  • The shift in the age profile reveals the need for models of care that are sensitive to the unique needs of older adults living with HIV, addressing HIV-related stigma and discrimination, and strengthening prevention efforts among older adults.

There are approximately 63,100 people living with the human immunodeficiency virus (HIV) in Canada. Six Canadians are infected with HIV each day. Approximately one in seven of those infected with HIV are not aware of their infection.(1; 2)

A greater number of older adults are now living with HIV. Key reasons for this are the improved treatment options that are available and that more people are receiving an HIV diagnosis later in life.(3) However, life expectancy for people living with HIV still lags behind that of people without HIV.(4; 5; 6; 7)

Since there are now more older adults living with HIV, there are also more HIV-positive individuals with multiple chronic conditions such as cardiovascular disease, diabetes and cancer.(8; 9; 10; 11) The association between aging and chronic condition is well known. However, this association is stronger among people living with HIV.(12) This is due to the effects of long-term antiretroviral therapy (known as 'ART'). It is also driven by the negative impact of factors related to the social determinants of health (for example, income, housing, social status, social safety network) that also have an impact on health.(13) This means that the number of people who need complex care and who are living with different disabilities is increasing. As a result, HIV is increasingly seen as a complex condition, which requires better coordinated services that are able to address this complexity.

Bringing about change

Addressing the shift in the age profile of people living with HIV will require a comprehensive strategy, including:

1. new models of care that are sensitive to the unique needs of the increasing number of older adults living with HIV (including integration with long-term care settings);
2. greater efforts towards addressing HIV-related stigma and discrimination (knowing that HIV primarily affects groups that are often the most stigmatized or marginalized in society: 49% of people living with HIV are gay, bisexual and other men who have sex with men, 15% are people who inject drugs, and just under 10% are Indigenous);(14; 15) and
3. greater prevention efforts targeting older adults (such efforts are challenging since knowledge of HIV and uptake of testing among Canadians over 50 is still low).(16)

Change can start with you. Learn about the most recent research evidence regarding HIV and aging available on the McMaster Optimal Aging Portal.

Use this patient decision aid to decide on whether or not to get tested for HIV by comparing the benefits, risks, and side effects of both options.


The content of this blog post is based on a citizen brief prepared by the McMaster Health Forum: Wilson MG, Mattison CA, Gao C, Kendall CE, Lavis JN. Citizen brief: Enhancing the delivery of comprehensive care for people living with HIV in Canada. Hamilton, Canada: McMaster Health Forum, 12 April 2019.


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References

  1. Government of Canada. Surveillance of HIV and AIDS. Ottawa: Government of Canada; 2018. https://www.canada.ca/en/public-health/services/diseases/hiv-aids/surveillance-hiv-aids.html (accessed 13 June 2018).
  2. Government of Canada. HIV in Canada: Infographic. Ottawa: Government of Canada; 2018. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hiv-canada.html (accessed 13 December 2018).
  3. Haddad N, Li J, Totten S, McGuire M. HIV in Canada—surveillance report, 2017. Canada Communicable Disease Report 2018; 44(12): 324-32.
  4. Kendall CE, Wong J, Taljaard M, et al. A cross-sectional, population-based study of HIV physicians and outpatient health care use by people with HIV in Ontario. BMC Health Services Research 2015; 15(1): 63. 26.
  5. Siddiqi AE, Hall HI, Hu X, R S. Population-based estimates of life expectancy after HIV diagnosis: United States 2008-2011. Journal of Acquired Immune Deficiency Syndromes 2016; 1(72): 230-6.
  6. Hogg RS, Eyawo O, Collins AB, et al. Health-adjusted life expectancy in HIV-positive and HIV-negative men and women in British Columbia, Canada: A population-based observational cohort study. Lancet HIV 2017; 4(5): e270-e276. 28.
  7. Kendall CE, Chalifoux M, Manuel D, et al. A population-based study of care at the end of life among people with HIV in Ontario from 2010 to 2013. Journal of Acquired Immune Deficiency Syndromes 2017; 75(1): e1.
  8. Public Health Agency of Canada. HIV and AIDS in Canada: Surveillance report to december 31st, 2013. Ottawa: Government of Canada; 2016. https://www.canada.ca/en/public-health/services/hiv-aids/publications/hiv-aids-canada-surveillance-report-december-31-2013.html (accessed 11 July 2018).
  9. Mahy M, Autenrieth CS, Stanecki K, S W. Increasing trends in HIV prevalence among people aged 50 years and older: Evidence from estimates and survey data. AIDS 2014; Suppl 4: S453-9. 31.
  10. Wong C, Gange SJ, Moore RD, et al. Multimorbidity among persons living with human immunodeficiency virus in the United States. Clinical Infectious Diseases 2017; 66(8): 1230- 1238. 32.
  11. Kendall CE, Taljaard M, Younger J, Hogg W, Glazier RH, Manuel DG. A population-based study comparing patterns of care delivery on the quality of care for persons living with HIV in Ontario. BMJ open 2015; 5(5): e007428.
  12. Justice A. Prioritizing primary care in HIV: Comorbidity, toxicity, and demography. Topics in HIV Medicine 2006; 14(5): 159-163. 34.
  13. Raphael D. Social determinants of health: Canadian perspectives. Toronto: Canadian Scholars’ Press; 2009.
  14. Rapid Response Service. Effective HIV prevention, education and outreach activities in African, Caribbean and Black communities. Toronto: Ontario HIV Treatment Network; 2014. 19.
  15. Ontario HIV Treatment Network. African, Caribbean and Black communities. Toronto: Ontario HIV Treatment Network; 2019. http://www.ohtn.on.ca/research-portals/prioritypopulations/african-caribbean-and-black-communities/ (accessed 8 March 2019).
  16. CATIE. HIV in Canada: A primer for providers. Toronto, Canada, 2018. https://www.catie.ca/en/hiv-canada/7/7-5 (accessed 8 October 2019).

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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