Older Americans and AIDS: Some Guidelines for Prevention
Williams, Edith, Donnelly, Jerre, Social Work
It has become increasingly apparent that social workers who provide services to elderly people (defined by the Centers for Disease Control and Prevention [CDC] as 50 years or older) must pay greater attention to HIV/AIDS prevention with this population. Americans generally are living longer and baby boomers are standing at the threshold of senior citizenship. The CDC (1997, 1998) reported that during 1997 people over the age of 50 accounted for 10 percent of all new AIDS cases in the United States. These figures suggest that older adults are not protecting themselves from AIDS, possibly because they do not perceive themselves to be at risk.
Unfortunately older people often are not provided with the knowledge needed to protect themselves against infection (Linsk, 1994, 1997). A study of primary care physicians found that most were less likely to discuss HIV risk reduction with patients over 50 than with patients under 30 (Skiest & Keiser, 1997). Social workers, whose professional education may not have provided them with training in human sexuality counseling, often are uncomfortable discussing sexual matters with clients (Shernoff, 1988). The difficulty is compounded when these clinicians are much younger than their clients (Puleo, 1996). This article identifies the major HIV/AIDS risk behaviors among elderly people and provides some guidelines that can help social workers provide primary prevention (the prevention of HIV/AIDS transmission) education to this population.
Social workers interact with older adults in diverse ways and therefore are in a position to assume leadership in slowing the spread of AIDS among this age group. Caseloads can include a variety of age groups, and social workers who may not see themselves as specialists in gerontology nevertheless interact with senior clients on a more or less daily basis. Therefore, it is essential that all social workers have an understanding of risks unique to both the heterosexual and homosexual elderly population. These risks include not using condoms (Ferro & Salit, 1992); not using sterile equipment when injecting drugs (Stall & Catania, 1994); being the recipient of a blood transfusion before 1985, the year blood screening was implemented (Linsk, 1994); and misdiagnosed opportunistic illness (Garvey, 1994).
Sexual Activity without Using Condoms
The prevailing stereotype, that older people are not sexually active, has contributed toward making older adults an invisible population to many social workers and AIDS educators. Yet a study of older adults in community living reports that up to 65 percent of residents ages 60 to 71 engaged in sexual intercourse and up to 20 percent of those age 78 and older continued to engage in some type of sexual activity (Whipple & Scura, 1996).
Male-to-male unprotected sex with an infected partner accounts for about 60 percent of all AIDS infection among older adults and is the chief risk behavior associated with HIV infection in elderly Americans (Ferro & Salit, 1992; Linsk, 1997; Stall & Catania, 1994). However, heterosexual AIDS transmission among older adults has increased dramatically since the mid-1980s and now accounts for the largest percentage of AIDS cases among any heterosexual age group (Puleo, 1996; Stall & Catania, 1994). Condom use, historically linked to preventing pregnancy, is often ignored by heterosexual elderly people for whom pregnancy is no longer a concern. Age-related reduced vaginal lubrication and thinning of the vaginal walls resulting from estrogen loss coupled with a decline in the immune system place older women at a greater risk of HIV infection during intercourse than younger women (Catania et al., 1989; Whipple & Scura, 1996).
Alcohol and Drug Use
People who use alcohol place themselves at a higher risk of contracting AIDS. …