STDs and the Single Baby Boomer

My last blog was meant to be informational and not to ruin your sex life, but I hope you single Baby Boomers heeded the warning.  Here are more health concerns for you to think about, HIV/AIDS and hepatitis C.

HIV/AIDS

In 2014 people aged 50 and over accounted for 17% (7,391) of an estimated 44,073 HIV diagnoses in the United States. The largest number of the 7,391 infected, 44%, was in the 50-54 age group.  African Americans in that group accounted for an estimated 43%, whites 37%, and Hispanics/Latinos 16%.  Among people aged 50 and over, 40% were diagnosed with AIDS at the time of HIV diagnosis since they were diagnosed late in the course of the infection.

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2014. HIV Surveillance Report 2015;26.

hiv

 

Older people in the U.S. are more likely than younger people to be diagnosed after the infection has progressed resulting in treatment starting later and the possibility or more immune-system damage.  Late diagnoses occur when health care providers don’t test older patients for the HIV infection, older people don’t consider themselves to be at risk or mistake HIV symptoms for those of normal aging.

 

 

Studies show that many Baby Boomers infected with the virus decades ago, do not perceive they are at risk, and have never been screened.  Since single Baby Boomers and those older are sexually active, including those living with HIV, they have the same HIV risk factors as younger people.  They also may lack of knowledge about HIV and how to prevent it.  Older people also face some unique issues.  Women no longer worry about becoming pregnant and are less likely to use a condom and to practice safe sex.  As with all STD’s, age-related thinning and dryness of vaginal tissue raises their risk for HIV infection.  Although they visit doctors more frequently, they’re less likely than younger people to discuss their sexual habits or drug use with them.  Doctors often don’t ask older patients about these issues.  Since single Baby Boomers may already face isolation due to illness or loss of family and friends, the stigma of having HIV/AIDS may negatively affect people’s quality of life, self-image, and behaviors and prevent them from seeking HIV care and disclosing their HIV status.

 

 

Aging with HIV presents special challenges for preventing other diseases because both age and HIV increase the risk for cardiovascular disease, low bone density, and certain cancers.  Older HIV patients and their physicians need to maximize prevention efforts against these conditions, remain vigilant for early signs of illness, and be careful about interactions between HIV medications and those used to treat common age-related conditions such as hypertension, diabetes, elevated cholesterol, and obesity.

 

 

The CDC and its partners are working to advance the goals of the National HIV/AIDS Strategy, maximize the effectiveness of current HIV prevention methods, and improve surveillance among older people in the U.S.  This will be accomplished through support and technical assistance to health departments and community-based organizations to deliver effective evidence-based prevention for antiretroviral therapy adherence for older Americans.  Starting in 2012 the CDC awarded at least $330 million to health departments each year.  In 2015 $343.7 million was given to direct resources to the populations and geographic areas of greatest need and to prioritize the HIV prevention strategies that will have the greatest impact.  They’ve also implemented the following programs that aid Baby Boomers: Let’s Stop HIV Together (approximately 25% of campaign participants are aged 50 and older), Standard Care which encourages primary care physicians to screen patients of all ages for HIV infection, and Prevention IS Care, which provides continuing education and materials for physicians to address the complex issues of those living with HIV infection.

 

The information above is from the CDC blog “HIV Among People Aged 50 and Over” at http://www.cdc.gov/hiv/group/age/olderamericans/index.html.

 

hivHepatitis C

In the U.S. hepatitis C (HCV) chronically infects an estimated 3.2 million.  Approximately 75% are Baby Boomers.  National prevalence data show that people born between 1946-1965 are five times more likely than other adults to be infected.  It’s a leading cause of liver cancer, liver transplants, and accounts for 73% of all hepatitis C associated mortality.  HCV-associated morbidity and mortality increased more than 50% from 1999-2007 for Baby Boomers with hepatitis C.  A high percentage (45%-85%) of people with hepatitis C don’t know that they are infected.

 

 

One-time testing of those born from 1945-1965 is estimated to identify 800,000 infections and with linkage to care and treatment avert more than 120,000 HCV-related deaths.  This strategy is estimated to save $1.5-$7.1 billion in liver disease-related costs. Testing based solely on elevated ALT levels, which measures the amount of this enzyme in the blood, is estimated to miss 50% of chronic infections.  ALT is found mainly in the liver, but also in smaller amounts in the kidneys, heart, muscles, and pancreas.

 

 

New therapies, including interferon-free regimens, can halt disease progression, cure most infected with hepatitis, increase the effectiveness, and reduce the duration of therapy for many patients.  Those who are chronically infected require clinical preventive services which include regular medical monitoring, hepatitis A and B vaccinations, behavior changes like alcohol reduction/cessation, and achieving and maintaining a healthy BMI to improve their health outcomes.

Information is taken from the CDC Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease (MMWR 1998;47(RR19).

 

 

The CDC Know More Hepatitis website offers more information and help, including a new online Hepatitis Risk Assessment tool to help people determine their risk for viral hepatitis.  New funding will focus on groups that are disproportionately affected such as Asian-American Pacific Islander communities who have the highest rates of hepatitis B, injection drug users, and individuals born from 1945–1965. These efforts align with the U.S. Department of Health and Human Services’ Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, which was released in May 2011.  See more at http://www.cdc.gov/nchhstp/newsroom/2012/heptestingrecspressrelease2012.html “CDC Announces First Ever National Hepatitis Testing Day and Proposes that All Baby Boomers Be Tested Once for Hepatitis C”.

 

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Don’t keep your head in the sand.  If you’re too embarrassed to go to you long-time family doctor for testing, go to the health department.  If your HIV test is positive, all 50 states require the testing site to report the results to your state health department so that public health officials can monitor what’s happening with the HIV epidemic in your city and because federal and state funding for HIV/AIDS services is often targeted to areas where the epidemic is strongest.  Your state health department will remove all of your personal information from your test results and send the information to the CDC.  They don’t share this information with anyone, including insurance companies.  However, many states and some cities have partner-notification laws.  This means that if you test positive for HIV, you or your healthcare provider may be legally obligated to tell your sex or needle-sharing partner(s). If you’re HIV-positive and don’t tell your partner(s), in some states, you can be charged with a crime.  Some health departments require healthcare providers to report the names of your sex and needle-sharing partners if they know that information even if you refuse to report it.  Some states also have a “duty to warn” law that requires clinic staff to notify a third party if they know they have a significant risk of exposure to HIV from a patient the staff member knows is infected.  The Ryan White HIV/AIDS Program requires health departments receiving money from them to show “good faith” efforts to notify the marriage partners of a patient with HIV/AIDS.  The AIDS.gov website https://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/your-legal-rights/legal-disclosure/ offers information on this and many other HIV/AIDS related issues.

 

 

Many states have regulations that require laboratories to report all anti-HCV positive results to local health departments. Although there are limitations to the use of anti-HCV positive laboratory reports to conduct surveillance for hepatitis C infections, these reports can provide information to state and local health departments so they can identify HCV-infected persons who need counseling and medical follow-up.  Also determining the frequency and characteristics of persons reported as anti-HCV-positive can describe who and where infected persons are being identified, help in developing minimum estimates of infection burden, identify gaps in current testing practices and direct and evaluate prevention activities.  See “Guidelines For Viral Hepatitis Surveillance And Case Management” at http://www.cdc.gov/hepatitis/statistics/surveillanceguidelines.htm.

 

 

This may disturb you, but don’t you owe it to your partners to let them know that they have been infected or at least give government agencies the information they need to get funding for education, prevention, and cures.  You can see by the statistics that you’re not alone and having HIV/AIDS or hepatitis C is often not your fault.  After all, wouldn’t you want someone to tell you?

 

Continue the adventure safely!

 

Linda Lea

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