The Graying HIV Epidemic:

Evolution Requires Revolution

ACRIAAIDS Community Research Initiative of America

New York City

Dr. Stephen KarpiakResearch Director

ACRIAAIDS Community Research Initiative of America

New York City

Mortality (x 1000)

HAART

Impact of HAART

Source: NYC Dept of Health & Mental Hygiene, 2004

PLWHA(x 10,000)

0

1

2

3

4

5

6

7

8

9

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02

USA AIDS Cases Over Age 50 - CDC

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

110000

120000

130000

1995 2005

The Aging of the HIV NYC Population (OVER 50)

0

5000

10000

15000

20000

25000

30000

2001 2002 2003 2004 2005

New Diagnoses People Living with HIV

Today in NYC there are approximately

120,750120,750 known people living with

the HIV

New York City is the US HIV Epicenter

2007 NYC HIV Epidemiology (NYCDOH)

38 %

of people with HIV/AIDS in NYC are Over 50

74 %

of people with HIV/AIDS in NYC are Over 40

Over 50Over 50 Over 40Over 40

SanFranciscoSanFrancisco 35 %35 % 76 %76 %LosAngelesLosAngeles 33 %33 % 77 %77 %

MissouriMissouri 35 % 35 % 76 %76 %IllinoisIllinois 32 %32 % 74 %74 %Wisconsin*Wisconsin* 38 %38 %Michigan* 38 %

AIDS Cases 2006 / 07AIDS Cases 2006 / 07

* HIV/AIDS

Concurrent HIV/AIDS among persons diagnosed with HIV in 2006by age group, United States

Source: CDC HIV/AIDS Surveillance Report, 2006. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm

ConcurrentHIV/AIDS

Excerpt from a training video developed byThe AIDS Community Research Initiative of America

ACRIA’s Center for HIV and Aging ACRIA’s Center for HIV and Aging Funded by the NYC City Council

Research on Older Adults with HIV

Stephen E. Karpiak, PhD Director for ResearchCo-Principal InvestigatorACRIA

Research on Older Adults with HIV

Stephen E. Karpiak, PhD Director for ResearchCo-Principal InvestigatorACRIA

ROAH Research Collaborators/Advisory Group

Chairperson: Marjorie Cantor, Emerita Fordham U & Brookdale Scholar

Stephen Bailous Office of AIDS Policy, NYC DOH

J. Bookhardt-Murray, MD Medical Director Harlem United & AIDS Institute NYS

David Dorfman, PhD Mt. Sinai School of Medicine

Arlene Kochman, MSW Yale University School of Medicine

Allen Matthews, Mardi Fritz NYC DOH

Douglas Mendez, MD Dominican Medical Association

Peter Nwakeze, PhD NYC Association for HIV Over 50 and Hunter College

Jeffery Parsons, PhD CHEST & Hunter College

Cynthia Poindexter, PhD Fordham University Graduate School of Social Service

Bobbie Sackman, MSW NYC Council of Senior Centers, Director of Public Policy

J. Edward Shaw NYC Commission on AIDS

J. Lee Westmaas, PhD SUNY, Dept of Psychology

Desieree Byrd, PhD NeuroAIDS, Mt Sinai

Richard Havlik, MD NIA/NIH Section Chief

Religiousness & Spirituality

Social Networks

ROAH ModulesROAH Modules

ROAH Study Design

Purpose: A ProfileTo establish empirically valid normative data describing the growing and changing population of older adults with HIV

Participants (total N = 1000)NYC community-dwelling, HIV-positive adults over 50

ProcedureParticipants completed a self-administered survey after giving informed consent

HIPAA Compliant and IRB Approved

Male 69 %

Female 31%

Black 44 %

White 21 %

API / Am. Indian 3 %

Latino 32 %

2004/2007 NYC HIV Epidemiology

Sexual Self-Identification

ROAH Demographics

Employment Status Working 8.3 Retired 6.9 Unemployed 20.1 Disability 64.2

Country of Birth USA 83.5 Other nation 16.5

Education___________________________________ Less than high school 20.4 High school graduate 58.6 College graduate 21.5

% with AIDS Diagnosis

40

45

50

55

60

65

70

White Black Latino

ROAH HIV Care

Currently Taking ARVs

Black 87.3 Latino 84.8 White 85.3

Male 86.0 Female 83.0

ROAH HIV Care

83% Medicaid Dependent

Treatment facility %

Private physician 21.9

Public clinic / hospital 58.7

VA Hospital 4.9

ASO / day program 17.0

ROAH Demographics

Living Arrangement %

Partnered/Married 14.1

Proportion Living Alone: ROAH vs. Community-Dwelling NYC Elderly

Years Since HIV Diagnosis by LGBT Status

11 11.5 12 12.5 13 13.5 14

Heterosexual

LGBT

Transmission Mode in ROAH: The Changing HIV Population

0%

20%

40%

60%

> 10 years 6-10 years 1-5 years

Unprotected Vaginal

SharingNeedles

Unprotected Anal

ROAH: Disclosure of HIV Status

0 10 20 30 40 50 60 70 80 90 100

Place of Worship

Co-Workers

Drug buddies

Social groups

Friends

Family

Sexual partners

Healthcare

Richard Havlik, MDRet. Section Chief NIA

ACRIA Consultant and Collaborator

Average Number of Comorbidities

ROAH: Tobacco Use

Current % History %

57 84

ROAH: Substance Use

Substance Current % History %

Tobacco 57 84

Alcohol 38 81

Marijuana 23 71

Cocaine 15 63

Crack 16 47

Heroin 7 44

Crystal Meth 2 9

ROAH: Substance Use Recovery

Recovery Status of Substance Users %

Ever enrolled in 12-step 62

Currently in recovery 54

No substance use in past 3 months 48

In recovery for more than 1 year 44

And other outlandish lies about getting

older

Center for HIV/AIDS Educational Studies and Training (CHEST) @ Hunter College, City University of New York

Sexual BehaviorSexual Behavior

Prevention for Positives

Does prevention information target older adults?

Do you receive HIV prevention information?

ROAH: First Data on Risk Behavior in Older Adults

Substance use impact - Significant

Viagra and other ED Drugs Impact - None

Of those who are sexually active

16% engaged in high risk sexual behavior in the last 3 months

$2 Million NYC Council Initiative 2007

NYC Council Initiative to support an HIV prevention and education program targeting older adult communities and providers

ACRIA and the worked as partners with:

Council of Senior Center Services (CSCS)

Services & Advocacy for GLBT Elders

Gay Men’s Health Crisis Griot Circle

Jamaica Service Program for Older Adults

Latino Gerontological Center Institute for Puerto Rican &

Hispanic Elderly

ROAH: Social Networks

CAREGIVERSare derived from

SOCIAL NETWORKS

ROAH: Informal Network Composition

0 20 40 60 80

Parent

Child

Sibling

Other Relative

Friend

Living

ROAH: Informal Network Composition

0 20 40 60 80

ParentChild

SiblingOther Relative

Friend

Living Functional

Mark Brennan, PhDSenior Research Scientist ACRIA

ROAH: Prior History of Depression

ROAH: Symptoms of Depression

CES-D: Level of Depression Symptoms

16

17

18

19

20

21

22

Women Men Black White Hispanic

ACRIA Study Using the MacArthur Model Intervention for

Depression

Dr Marlena VegaStudy Clinician

Funded by the Robert Mapplethorpe and Keith Haring Foundations

Interim Follow-up Results

Change in CES-D Scores Over 20 Weeks; All weeks significantly lower than baseline

Week of Assessment

ROAH Collaborative Efforts

Center for HIV Educational Studies and Training (CHEST)

NYU School of Nursing & CFAR (Dr. Valentine) Fordham University, Dept. of Economics Syracuse University, Dept. of Sociology Columbia University School of Social Work University of Alabama Chelsea Westminster Hospital, London UK (Dr. Youle) American Academy of HIV Physicians University of Ohio at Miami American Geriatrics Society

ACRIA’s HIV Older Adults Booklet

Research on Older Adults with HIV: An In-depth Examination of an Emerging Population

Editors: M. Brennan, S. E. Karpiak, M. H. Cantor & R. A. ShippyNova Science Publishers,

•Table of Contents

•The Emerging Population of Older Adults with HIV and Introduction to ROAH the Research Study

• S. E. Karpiak & M. Brennan

•Health Status, Comorbidities, and Health-related Quality-of-Life; R. J. Havlik

•Mental Health; A. Applebaum & M. Brennan

•Substance and Alcohol Use; A. Applebaum & M. Brennan

•Sexual Behavior among HIV+ Older Adults; S. A. Golub, C. Grov, & J. Tomassilli

•HIV Stigma and Disclosure of Serostatus; M. Brennan & S. E. Karpiak

•Social Support Networks of Older People with HIV; M. H. Cantor, M. Brennan, & S. E. Karpiak

•Loneliness among Older Adults with HIV; M. Brennan & A. Applebaum

•Psychological Well-being; M. Brennan & S. E. Karpiak

•Religiousness and Spirituality; M. Brennan

•Aging with HIV: Implications and Future Directions; S. E. Karpiak & M. Brennan

•About the Authors

•Appendix: Methodology of the ROAH Study