HIV RATES CLIMBING AMONG OVER-50S IN UK AND EUROPE 

Older people more likely to be infected through heterosexual sex and to have more advanced disease when it is finally diagnosed, new study reveal

HIV rates are climbing in the over-50s in the UK and across Europe, while the rate of new infections among younger people is dropping, according to new research which warns that the epidemic may be taking a new direction.

The study, from the European Centre for Disease Prevention and Control in Sweden, says that older people are most likely to be infected through heterosexual sex. They are also likely to have more advanced disease – which will be harder to treat and could be life-threatening – when it is finally picked up.

The study’s authors suggest that the over-50s may be either complacent or ignorant of the risks of HIV, which has dropped out of the headlines since it became a treatable disease. Their doctors also tend to assume that older people are not running risks through unsafe sex.

The study, published in the Lancet HIV journal, has found that one in six new cases of HIV are in people over the age of 50. Between 2004-2015, the rate of diagnosis in older people increased in 16 countries. That included the UK, where the rate of new diagnoses went up from 3.1 per 100,000 to 4.32. Belgium, Germany and Ireland also saw rises in the rate of infection among older people. By 2015, the rate in over-50s was highest in Estonia, Latvia, Malta, and Portugal.

While the rate of newly reported cases remained steady in those aged 15 to 49, it grew by 2.1% each year overall in older people across the 28 European nations, increasing from 2.1 people in every 100,000 in 2004 to 2.5 per 100,000 in 2015.

Infection through sex between men increased in both age groups between 2004-2015. Cases due to heterosexual sex reduced in younger people and remained stable in older people, while those attributable to injecting drug use also reduced in younger people but increased in older people.

The National Aids Trust said they had been aware of the rising rates in older people in the UK for some time and that action was needed to prevent these infections, such as targeting different age groups – not just the young – with information about their risks and offering HIV tests in places other than sexual health clinics, such as GP surgeries.

In recent years there has been a steady increase in HIV diagnoses amongst people over the age of 50 in the UK, accounting for 9% of new diagnoses in 2006 and 17% in 2015,” said Kat Smithson, director of policy and campaigns. “The trend is not limited to, but is more prominent, in the heterosexual population. This presents a challenge to think about whether our prevention efforts meet the needs of changing demographics.”

Government cuts to public health budgets were damaging local authorities’ capacity to offer prevention and testing to older people,” she said. “High prevalence areas are spending a third less on HIV prevention than they were two years ago, and it’s targeted services that are suffering most. We are concerned that generalised health promotion around sexual health and HIV may not reach some smaller but growing areas of need, such as in the older heterosexual population. We have the tools to reverse this trend, but without investment we cannot use them.”

Professor Janet Seeley from the London School of Hygiene and Tropical Medicine, who wrote a commentary in the Lancet on the study, said that many older people did not think they were running a risk. “The main thing is complacency, and also they are in relationships where pregnancy is not a problem, so contraception isn’t something people consider,” she said. “I think there is very little publicity around HIV in Europe now that prevalence and incidence have gone down.

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.

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