OVER THE PAST 12 years, there has been an increase in the rate of new cases of HIV in older people in Ireland.
A European Centre for Disease Prevention and Control (ECDC) study has found that rates of the infection have increased in 16 countries in Europe and decreased in only one – Portugal.
Researchers believe this may point to a low level of awareness among people aged 50 and over of HIV and how it is transmitted, which in turns leads to misconceptions and an incorrect perception of their own risk.
Between 2004 and 2015, the rate of diagnosis in older people in Ireland increased by 5.4% (from 1.41 new cases per 100,000 to 3.33).
The other European countries where the disease increased for older people are Belgium, Bulgaria, Czech Republic, Estonia, Germany, Greece, Hungary, Latvia, Lithuania, Malta, Norway, Poland, Romania, Slovakia and the UK.
In Europe, almost half (47%) of all newly reported HIV diagnoses are made at a late stage of infection for people of all ages.
The study, which was published in The Lancet HIV journal, found that older people (aged 50 or older) were more likely than younger people (aged 15-49) to be diagnosed with advanced HIV disease, and acquire HIV through heterosexual sexual contact.
‘HIV epidemic evolving’
In 2015 around one in six (17%) of new cases of HIV diagnosed in Europe are among people aged over 50.
Rates were highest in Estonia, Latvia, Malta and Portugal (7.50, 7.17, 7,15 and 6.0 new cases per 100,000 older people, respectively).
European Centre for Disease Prevention and Control (ECDC) lead author Dr Lara Tavoschi said:
Our findings suggest a new direction in which the HIV epidemic is evolving. This potentially is a result of older people’s low awareness of HIV and how it is transmitted, leading to misconceptions and low perception of their own risk.
“This perception of older people not being at risk is shared by some healthcare providers, and HIV-related services focus more on younger people. Our study shows the need to ensure all ages are appropriately targeted by sexual health services.”
The study includes all new cases of HIV in the European Economic Area (the 28 countries of the European Union, and Iceland, Liechtenstein, and Norway) between 2004 and 2015.
During this time 54,102 people over the age of 50 were diagnosed with HIV, compared to 312,501 cases in people aged 15-49 years.
The study showed that among younger people, rates of HIV infection decreased significantly in six countries (Austria, France, the Netherlands, Norway, Portugal and the UK), and increased significantly in 12 countries (Bulgaria, Croatia, Czech Republic, Germany, Greece, Hungary, Latvia, Lithuania, Malta, Poland, Romania, and Slovakia) between 2004 and 2015.
The mode of infection varied for older and younger people over time, with infection through sex between men increasing in both age groups between 2004-2015, while cases due to heterosexual sex reduced in younger people and remained stable in older people.
Cases attributable to injecting drug use also reduced in younger people but increased in older people.
Dr Tavoschi said: “Our findings illustrate a clear need to provide comprehensive HIV prevention programmes, including education, access to condoms, better testing opportunities, and treatment, targeted towards older adults across Europe.
“We need to make both healthcare workers and the general population aware of this issue to reduce stigma and inform people about HIV risks and prevention methods.
Testing in healthcare settings and innovative HIV test approaches – such as self-testing – need to be more easily accessible to older people to improve early diagnosis and fast-track treatment initiation.
“When achieved, this should help to prevent further transmission and lower the risk of severe health complications, which is of utmost importance among older adults living with HIV as their risk of mortality is higher as compared to younger individuals.”
The authors note that delays in some countries’ reporting may mean that not all cases were included in the 2015 figures. As a result, these figures are likely to increase slightly in future years. For this reason, increasing trends are likely underestimated and decreasing ones may be overestimated.
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