In the world of HIV prevention, persons over the age of 50 have been considered an invisible population. Sept. 18 is National HIV/AIDS Aging Awareness day, a time when HIV/AIDS workers focus on the unmet needs of the more than 1.1 million people living with HIV in the United States.

By 2015 it is predicted that half of those living with HIV in the country will be 50 years or older. However, few prevention campaigns have focused their messages on older adults and their concerns.

As a greater proportion of older individuals live with HIV infection, a greater proportion of new infections will also occur in this age group. Healthcare must begin to prepare now to care for these individuals, who are likely to experience a greater burden of disease from HIV infection, toxicity from HIV treatment and other co-occurring HIV and aging-associated conditions.

“I am one of the lucky survivors who has benefited from great successes with HIV care and treatment,” said Matt Sharp, who was diagnosed with HIV in 1988.

Sharp has a long history of advocacy for AIDS treatment and currently is the Director of Treatment and Education for Project Inform. Project, a San Francisco-based organization known for its advocacy and education around HIV/AIDS and Hepatitis.

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“The fact that people with HIV are living into their 50s, 60s, and 70s is testament to the amazing success of HIV treatment,” said Sharp.

HIV positive elders face the same challenges of aging as anyone else. In addition, they confront unique barriers, such as stigma. With aging comes pressure from a perceived role in the family and can lead to feelings of shame in discussing their status around family members, thus ending up with no family support.

Other challenges are lack of knowledge of agencies and available services, and embarrassment to enter a place associated with HIV/AIDS. Physical disabilities and limitations also become a factor in accessing care, as people age.

For older adults, many of the risk factors for HIV infection are the same as those for younger persons. Many who are not infected, especially those resuming sexual relations after a divorce or the death of a partner, may not perceive themselves as at risk for HIV and may not take preventive measures such as using condoms or getting tested for HIV.

Some older persons may be less knowledgeable about HIV/AIDS and therefore less likely to protect themselves. Older people who are infected with HIV can spread the disease to their sex partners.

In addition, older women may be at higher risk for HIV infection because of age related vaginal thinning and dryness that can lead to tears in the vaginal area.

After being in a monogamous relationship, some older women find it awkward to initiate discussions about potential risk and preventive measures such as condom use. Some older persons inject drugs or smoke crack cocaine, which can contribute to risky behavior.

Health care professionals may not consider discussing HIV/AIDS with older patients and thus may miss opportunities to deliver prevention messages, offer HIV testing, or make an early diagnosis that could help their patients get early care.

Healthcare professionals may misdiagnose HIV infection symptoms in aging persons because some of the HIV symptoms can mimic those of normal aging, for example fatigue, weight loss and mental confusion.

African Americans have a high incidence of receiving a late HIV diagnosis. In older African Americans, their immunological response to treatment may be less than of a younger person, because aging affects the immune system.

The aging population affected and infected by HIV/AIDS must not be left out and forgotten, nor be denied the right to age with dignity, respect, and the highest quality of care.

HIV care and prevention must now become a part of aging in America.

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