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Scarcity of HIV/AIDS Risk-Reduction Materials Targeting the Needs of Older Adults Among State Departments of Public Health

Correspondence: Address correspondence to Nancy A. Orel, PhD, LPC, Gerontology Program, College of Health and Human Services, Bowling Green State University, 218 Health Center, Bowling Green, OH 43403. E-mail: norel{at}bgnet.bgsu.edu

	Abstract

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This study investigated the availability of printed human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) education/prevention materials from state departments of public health within the United States, which specifically targeted the older adult population. Information on HIV/AIDS from public health departments in each of the 50 states was solicited, obtained, and analyzed for applicability to an older adult population. Although all 50 states responded to our request for publications, only 15 states (30%) provided publications that were specifically intended for an older adult audience. The title, date of publication, and publisher of publications that were considered "specific to older adults" are provided. These findings suggest that there is a general lack of HIV/AIDS prevention literature specifically tailored for older adults available through state departments of public health.

Another explanation for the exclusion of older adults in targeted HIV/AIDS education and prevention programs may be existing societal attitudes, myths, and biases concerning elderly populations. Erroneous assumptions that older adults are not sexually active or involved in other risk activities may have acted as obstacles to prevention efforts. Sadly, many older adults may have internalized societal ageist attitudes. CDC Behavioral Risk Factor Surveillance System 2000 Survey data reveal that few older Americans view themselves at risk for HIV. To illustrate, among adult respondents aged 55–64 years, 81% reported no risk for HIV, and 15.1% reported a low chance of getting HIV (CDC, 2003b). These collective misconceptions of HIV risks may contribute to the low numbers of HIV-testing behaviors among older adults. Among respondents aged 55–64 years, only 27.3% reported "yes" that they had ever been tested for HIV (CDC, 2003b). Older adults may discount their own HIV risks and may not seek HIV testing until they experience signs/symptoms of an illness (Mack & Bland, 1999), or they may confuse signs/symptoms of HIV disease with those of a chronic condition (National Institute on Aging [NIA], 2001).

Despite common misperceptions, a large percentage of older adults are engaging in activities that may place them at risk for HIV. Current cohorts of older adults engage in regular, satisfying sexual activity (Gott, 1999), and yet they are less likely to use condoms (Whipple & Scura, 1996). Sexual activity among older adults may have increased with the introduction of prescription drugs that eliminate problems associated with erectile dysfunction and/or enhance sexual performance (e.g., Viagra, Levitra, Cialis). Heightened sexual activity increases the opportunities for older adults to contract HIV/AIDS, if such activity is high risk (e.g., multiple partners, not using condoms).

Most importantly, older adults may be at greater risk of HIV/AIDS because, when compared with younger populations, they are the least knowledgeable about how the HIV virus is/is not transmitted (NIA, 2001). This lack of knowledge may be due in part to the general lack of available HIV/AIDS information tailored specifically for older adults (Klein, Nokes, Devore, Holmes, Wheeler, & St. Hilaire, 2001). Additionally, physiological aging factors that have been linked to decreased immune systems, vaginal wall thinning, and less vaginal lubrication may increase the risk of HIV/AIDS among sexually active older women (Zablotsky, 1998). These age-related risk factors often are not conveyed in health promotional materials aimed at the general public.

	Investigation of Printed HIV/AIDS Materials Targeting Older Adults

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State departments of public health have been instrumental in disseminating accurate and up-to-date information to the public about HIV/AIDS and other sexually transmitted diseases. In addressing the AIDS epidemic, initial efforts focused on gay males, who were the first to show signs/symptoms of HIV/AIDS. With the spread of HIV to all segments of the population, state departments of public health have extended their focus. However, it is questionable whether older adults have been included as a focus for HIV prevention. The purpose of this study was to investigate the number of printed publications specifically targeting older adults that were available through state departments of public health.

	Procedures

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Information on HIV/AIDS from public health departments in each of the 50 states was solicited, obtained, and analyzed for its applicability to an older adult population. The following procedures were conducted over 5 months (June to October 2003):

1. Names, phone numbers, street addresses, and e-mail addresses of key contact people (e.g., HIV/AIDS education/prevention coordinator) at each of the 50 state departments of public health were compiled through state web sites.
   
2. Key contact people were contacted through e-mail or telephone using a prepared script that initially requested "copies of all educational materials related to HIV/AIDS education such as pamphlets or brochures that are distributed to the public" and later requested "any educational materials on HIV/AIDS which are specifically tailored to adults 50 years of age and older."
   
3. Files were created and maintained for each state that indicated (a) name and address of contact person, (b) date contact person was e-mailed and/or phoned, (c) date material was received, and (d) date of follow-up call if material was not received within 2 weeks.
   

Educational print materials received were reviewed and categorized independently by two researchers. The following categories were created: (a) total number of publications, (b) type of publication (e.g., brochure, pamphlet), and (c) number and type of publications that specifically referred to an "older adult population." Operational terms for publication selection criteria included aged, aging, elderly, geriatric, mature, middle-aged, old, older, over 50, senior, and senior citizen.

	Results

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The number and types of HIV/AIDS printed publications received from each of the 50 state departments of public health varied greatly. All 50 states responded to our request for publications. Most states directly mailed the available printed information. Printed materials included brochures, pamphlets, posters, fact sheets, booklets, activity books, laminated information cards, business cards, printed web pages, and magnets. Eight states provided comprehensive listings of available HIV/AIDS printed information and an order form.

A comprehensive and thorough review of the information received revealed that the vast majority of information was intended for a young adult audience. Considering that this age group has been identified as being at greatest risk for HIV/AIDS, this outcome would be expected. Most noteworthy, only 15 states (30%) provided publications that were specifically intended for an older adult audience.

The title, date of publication, and publisher of publications that were considered "specific to older adults" are listed in Table 1 and categorized by state. One publication entitled "Dating an Older Guy" (Channing L. Bete Co., 2001) was offered by numerous states. However, this publication was not included in the table because this publication targeted young adults instead of elders. It should be noted that two state departments of public health (i.e., Kansas and Illinois) developed specific publications aimed at HIV and older adults. The two most frequent publications from state departments of public health included the pamphlet titled "What People Over 50 Need to Know About HIV and AIDS" (Channing L. Bete Co., 1995) and the brochure titled "HIV & STD Prevention After 50" (ETR Associates, 2001). These two publications included information on the myths and stereotypes surrounding HIV/AIDS, basic facts about HIV/AIDS, and HIV/AIDS/sexually transmitted disease (STD) prevention strategies.

	Discussion

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This study's main limitation was its reliance on the efficiency of a key contact person at each of the 50 state departments of public health to provide the requested information. It should be noted that staff members from these agencies offered much assistance. In most cases, states that did not provide specific HIV/AIDS prevention materials aimed at older adults would refer researchers to local community agencies or to publishing companies that provided age-specific prevention publications. This study did not investigate specific reasons why HIV publications aimed at older adults were not available through state health departments. However, one HIV prevention specialist mentioned that this state department of public health "hasn't targeted older adults due to CDC's prevention based priority populations."

Study results reveal that state departments of public health offer few HIV/AIDS education publications aimed at older adults. Another concern is that the specific HIV risk-reduction needs of older gay men and culturally diverse elders also were overlooked. Additionally, the appropriateness of available HIV risk-reduction materials for older adults should be investigated. Of interest, many state departments of public health utilize educational material review committees that approve/endorse HIV-prevention materials for distribution to the public. These committees must give greater attention to developing HIV/AIDS education publications specifically for older adults.

Recommendations to Reduce the Rising Rates of HIV/AIDS in Older Adults
State departments of public health are not the only professional agencies that should address HIV risks among older adults. In addition to health department personnel, all agencies that provide services to older adults must educate their elder clientele on HIV transmission, behavioral risks, and prevention. Although a comprehensive discussion of the strategies needed for all providers of services to the aged is beyond the scope of this article, the following are suggested strategies for public health agencies:

1. Develop and/or provide age-sensitive HIV/AIDS educational materials tailored for broad and culturally diverse elder populations.
   
2. Offer HIV/AIDS web sites that provide links to existing organizations/agencies that address HIV/AIDS among older adults (e.g., National Association on HIV Over Fifty, Senior Action in a Gay Environment, American Association of Retired Persons, NIA, and Administration on Aging).
   
3. Sponsor research to study older adults' sexual and drug-using behaviors, including sexual enhancement drugs.
   
4. Encourage distribution of HIV/AIDS risk reduction materials with sexual enhancement drugs.
   
5. Sponsor educational programs that address HIV/AIDS/STD using older adults as peer educators.
   

	Conclusions

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HIV/AIDS prevention strategies and programs are rarely targeted or tailored to the needs of individuals over the age of 50. Despite the increasing number of older adults being diagnosed with HIV/AIDS, older adults, health care providers, and society at large continue to view this population as being "sans risk." Currently, antiretroviral therapies, where available and accessible, are enabling greater numbers of people to live longer lives with HIV, including into later adulthood. However, until a cure is found, prevention and education will continue to be the most effective strategies in combating HIV/AIDS. Given that older adults statistically compose a substantial number of HIV-seropositive individuals, greater attention must be given to addressing the societal attitudes, myths, and biases concerning older adults.

	Footnotes

 
¹ Gerontology Program, College of Health and Human Services, Bowling Green State University, OH.

² Geriatric Education Center, College of Health and Human Services, Bowling Green State University, OH.

Decision Editor: Linda S. Noelker, PhD

Received for publication October 13, 2003. Accepted for publication February 17, 2004.

	References

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• Centers for Disease Control and Prevention. (2003a). Cases of HIV infection and AIDS in the United States, 2002: Table 10. Estimated numbers of persons living with AIDS, by year and selected characteristics, 1998–2002—United States. HIV/AIDS surveillance report edition, 14(2). Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.
• Centers for Disease Control and Prevention. (2003b). Behavioral risk factor surveillance system survey data 2000. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.
• Channing L. Bete. (1995). What people over 50 need to know about HIV and AIDS. South Deerfield, MA: Author.
• Channing L. Bete. (2001). Dating an older guy. South Deerfield, MA: Author.
• ETR Associates. (2001). HIV and STD prevention after 50. Scotts Valley, CA: Author.
• Gott, C. M., (1999). Sexual risk-taking in later life. Reviews in Clinical Gerontology, 9, 139-150.
• Klein, S. J., Nokes, K., Devore, B. S., Holmes, J. M., Wheeler, D. P., & St. Hilaire, M. B., (2001). Age-appropriate HIV prevention messages for older adults: Findings from focus groups in New York State. Journal of Public Health Management Practice, 7, 11-18.[Medline]
• Mack, K., & Bland, S., (1999). HIV testing behaviors and attitudes regarding HIV/AIDS of adults aged 50–64. The Gerontologist, 39, 687-694.[Abstract]
• National Institute on Aging. (2001, June). Older Americans and HIV policy facts. Washington, DC: Author.
• Whipple, B., & Scura, K., (1996). Overlooked epidemic: HIV in older adults. American Journal of Nursing, 96, 23-29.
• Zablotsky, D., (1998). Overlooked, ignored, and forgotten: Older women at risk for HIV infection and AIDS. Research on Aging, 20, 760-775.[Abstract]

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