CARNAL NATION

The latest issue of the Bulletin of the World Health Organization (Vol. 87, Number 3, March 2009, pp. 161-244) includes an article and an editorial on the surprisingly high prevalence and incidence of HIV among individuals aged 50 and over.

In her article "Unprotected Sex Has No Age," Claudia Jurberg reports that the over-50 population in Brazil has become the target of a new campaign to increase awareness of the risks of becoming infected with HIV. According to official government figures, the rate of infection among Brazilians aged over 50 more than doubled between 1996 and 2006, rising from 7.5 to 15.7 cases per 100,000 inhabitants.

It is unclear whether the increase in reported infections is due to easier and more accessible diagnosis in recent years or to a real increase in the actual number of infections. However, Ivo Brito, a technical adviser for the Sexually Transmitted Diseases and AIDS program at the Brazilian Ministry of Health, believes that changes in the sexual behavior of older individuals may be one of the factors behind this alarming increase.  While older individuals may always have been more sexually active than most people realize, it has been suggested that the availability of drugs treating erectile dysfunction may have contributed to an increase in sexual activity among this population. Drug companies have rejected this claim of a causal link as lacking evidence. There are, of course, a number of possible factors for the increased incidence of HIV among older Brazilians. Brito notes, “Older people became sexually active in a world where there was no AIDS. They were not accustomed to using condoms.” The Ministry of Health, therefore, launched a new public health campaign on World AIDS Day (December 1, 2008) with the slogan: “Sex has no age. Nor has protection.” The campaign targets the newest at-risk population: senior citizens.

In their editorial “The Unexplored Story of HIV and Ageing,” George P. Schmid et al. present a grim scenario of increasing infection rates among the under-studied and under-tested senior population worldwide. They cite increased incidence in industrialized cases using case reporting, serologic incidence, and modeling. For example, case reporting in the U.S. from 2003 to 2006 shows that the proportion of HIV-positive individuals aged 50 and over increased from 20% to 25% during that time period. The authors point out that aging itself increases the possibility of infection due to factors ranging from the age-associated thinning of the vaginal mucosa, thus making viral transmission easier, to the continuation of long-term risky sex practices. Age-associated decline in immune responsiveness can also speed the progression from HIV infection to AIDS, with life expectancy declining to 4 years in those infected at age 65 or older. The authors further note that older individuals are rarely included in demographic surveys and are not widely screened for HIV when presenting with illnesses. Ultimately, they call for more epidemiological study of the aging population to combat the alarming increase in HIV infection rates worldwide among senior citizens.