HIV Prevention and Testing Is Not Bound By Age

HIV Prevention and Testing Is Not Bound By Age Posted By:
...

In 2006, the CDC updated the HIV testing guidelines to recommend routine opt-out testing for people aged 13-64 years. Similarly, the US Preventive Services Task Force recommends HIV testing for those aged 15-65 years.

Although routine screening is important, these guidelines may have inadvertently created a barrier to HIV testing, prevention, and early diagnosis for older adults. By having specified age parameters for routine HIV testing, healthcare professionals may neglect to screen or offer HIV prevention services to people older than 64 or 65 years of age.

Older adults are at risk for HIV. Between 2000 and 2021, among those aged 65 years and older, rates of primary and secondary syphilis increased substantially, as did rates of gonorrhea and chlamydia. Data from 2021 indicate that of the 36,136 new HIV diagnoses, 9% of males and 16% of females were older than 55 years of age. Of these new diagnoses, up to 34% met the criteria for advanced HIV disease.

This suggests that these individuals did not receive routine HIV screening when their degree of immune suppression was less severe. They were diagnosed only once they had more advanced HIV. This has ramifications not only for the individuals who were diagnosed, but also from a public health perspective, we know that people who have undiagnosed HIV can unknowingly transmit HIV.

How can this be fixed? First, all persons, regardless of age, should be routinely asked about sexual activity and drug use. Do not assume that because someone is older than 65 they are not having sex or using drugs. Studies show that most older adults are not screened for sexually transmitted infections (STIs) and are not having conversations about HIV or STI prevention with their providers.

We must remember that older adults may be embarrassed or hesitant to bring up these topics during an office visit. It is our responsibility to address this by being proactive in our assessment and asking patients about these issues. By inquiring about these topics, we open the door for conversations that may allow patients to share concerns sexual health or substance use. For people who could benefit from HIV pre-exposure prophylaxis (PrEP), we should prescribe it. Current guidelines advise that healthcare professionals should prescribe PrEP to anyone who requests it, even if no identifiable risks are disclosed.

Finally, we can advocate for removal of the HIV testing guideline’s upper age limit. New York state revised its guidelines in 2017. It simply states that those 13 years of age and older should be screened for HIV. There is no upper age limit. By working with policymakers and public health systems to make these changes, we can help expand access to HIV prevention and treatment. If the national HIV “End the Epidemic” initiative is to succeed, all of us must work together to screen and prevent HIV. We must remember that HIV treatment and prevention are not bound by age.

For additional information on HIV screening, treatment, and prevention, please visit the CDC’s HIV Nexus website.


Share

Filed under: Infectious Diseases , Preventive Medicine , Public Health , NPs & PAs

Related
Addressing ASCVD Risk in HIV: An Update to the DHHS HIV Guidelines

Addressing ASCVD Risk in HIV: An Update to the DHH ...

The incidence of atherosclerotic cardiovascular disease (ASCVD) is estimated to be twice as high in ...

Filed under: Infectious Diseases, Preventive Medicine, Public Health, Cardiometabolic, NPs & PAs


Continue Reading
Doxy-PEP: A New Opportunity to Reduce STIs

Doxy-PEP: A New Opportunity to Reduce STIs

According to CDC data from 2022, more than 2.5 million cases of chlamydia, gonorrhea, and syphilis w ...

Filed under: Nurses Week, Infectious Diseases, Urology, Preventive Medicine, Public Health, Substance Abuse, NPs & PAs


Continue Reading
Treatment of COVID-19: Practical Questions and Insights for NPs and PAs

Treatment of COVID-19: Practical Questions and Ins ...

Is it reasonable to prescribe a 5-day supply of an oral antiviral to people traveling abroad with ri ...

Filed under: Infectious Diseases, Public Health, NPs & PAs


Continue Reading
Assessment of COVID-19: Practical Questions and Insights for NPs and PAs

Assessment of COVID-19: Practical Questions and In ...

How long should people isolate when they test positive for COVID-19?The CDC recommends that one shou ...

Filed under: Infectious Diseases, Public Health, NPs & PAs


Continue Reading
Tackling Disparities in HIV Prevention

Tackling Disparities in HIV Prevention

Racial and ethnic disparities have been a problem in the HIV epidemic since the very beginning. Rece ...

Filed under: Infectious Diseases, Women's Health, Preventive Medicine, Public Health, NPs & PAs


Continue Reading
How HIV-ASSIST Can Support NP and PA Management of Newly Diagnosed People Living with HIV

How HIV-ASSIST Can Support NP and PA Management of ...

Each year, the number of people living with HIV increases while the available HIV workforce decrease ...

Filed under: Infectious Diseases, NPs & PAs


Continue Reading