The reasons. The sexually transmitted disease that is growing among those over 50 years of age, especially in womenBy Gabriela Navarra

Tomorrow is the International Condom Day, which in the country is better known as a condom. Despite his proven level of protection against HIV and other Sexually Transmitted Infections (STIs)In Argentina, the proportion of sexually active people who use them in all their sexual encounters is low.

“In 2020, only 3% of adolescents and 10% always used them; In 2021, its use was 5% and 13% in both age groups. It may be that due to the pandemic there was less access to free condoms due to mandatory isolation – says Natalia Haag, director of HIV Testing and Prevention at the NGO Americas Health Foundation (AHS) Argentina. The problem does not occur in younger age groups. Among those over 55, only 17% always use condoms, which explains an increase in new HIV infections starting in the fifth decade of life, and they are diagnosed at a later age. Furthermore, at that age there is no concern about pregnancy, because women are in menopause.”

The December 2023 HIV and Sexually Transmitted Infections (STI) Response Bulletin indicates that in 2020 (first year of the pandemic) the rate of new HIV diagnoses among men aged 55 to 64 was 7 per 100,000. ; while in 2021 it is 12.8/100,000 and in 2022 it is 14/100,000. In women, these new diagnoses in the same age group were 3.3/100,000 in 2020, 4.7 in 2021 and 5.9/100,000 in 2022.

However, there is a bigger problem: that both men and women reach the late or advanced diagnosis: The average for late diagnosis is 44.5% for all ages, but in the 55 to 64 age group it rises to 58% in men and 55.6% in women, that is, more than half. Women, on the other hand, are already late for detection in the immediately preceding age group: between 45 and 54 years old, almost 58% receive a late diagnosis.

“Young people are more targeted but we forget that after 50 we are also sexually active,” adds the AHF doctor. However, in an anonymous survey we conducted, almost 40% of those over 50 did not want to answer whether or not they used a condom. There is a misconception that only the youngest are at risk.”

The graph shows how infections increased among those over 50National Health Surveillance System

AHF periodically organizes HIV detection campaigns in different cities of the country and in places of mass attendance (squares, clubs, festivals). “It’s not that people especially come to get tested,” says Natalia Haag. The most common thing is that they are there and take advantage of the opportunity, since it is a quick test. Last year we did almost 25,000 tests and 50% of the people had never been tested. The elderly experienced the onset of HIV more closely, but for many of them it remains a taboo subject. In Argentina we have a large number of late diagnoses, people who have been living with HIV for years and do not know it, with weakened immune systems. That is why our association does not wait, it does an active search.”

In the aforementioned Bulletin, an increase in new HIV diagnoses in men and women between 55 and 64 years old is evident. “In Argentina there are around 140 thousand people with HIV and 13% are unaware of it. Every year, there are around 5,300 new diagnoses – says Carina César, infectious disease doctor and researcher at Fundación Huésped. The majority of these new diagnoses are in cis men and what is seen is that from 2012 to 2022 they decreased. But there is a segment of 55 to 64 years old, especially women, where there is an increase in new diagnoses in the last two or three years, although it is lower than in 2012. It is a population that does not follow the downward trend of the rest. of the groups.”

Regarding the educational level, the Bulletin indicates that “the diagnosis of men improves as the level of education increases. However, this relationship does not occur in the same way in women. Among them, the best situation is among those who have completed secondary education (secondary) but have not started higher education, and once again access to timely diagnosis worsens among those who have completed higher education,” although these data – it is noted – may be influenced by the lack of information load.

The risk of being late

José Luis Ippólito, president and founder of the Latin American Group of Chronic Diseases (Glec) states that approximately 10% of new HIV diagnoses occur in people over 55 years of age. But the biggest concern is that between the ages of 55 and 64, more than 58% of men and 55% of women are not diagnosed in a timely manner. The percentages derive from adding late diagnosis (15.8% men; 15.7% women) or advanced diagnosis (42.6% men; 39.9% women). In the case of trans women of that same age group, they all receive their diagnosis in an advanced stage.

Late diagnosis occurs when the person’s defenses are low (CD4 less than 350); Advanced disease is when the CD4 is less than 200 and marker diseases occur. The number of CD4 cells in the blood is crucial to fighting infections. The smaller the amount, the greater the difficulty for the immune system to defend the body.

“The initial symptoms of the infection are not always clear: a person may not develop symptoms, but still transmit the virus,” says Ippólito. Perhaps it presents with weakness, some low-grade fever and not much more than that and that is why it is not given importance. But if the problem progresses and is not attended to, certain clinical manifestations may develop more frequently, such as chronic diarrhea, candidiasis, tuberculosis, toxoplasmosis, pneumonia. pneumocysti carinii and that once antiretroviral treatment is started they have a smaller response: at that age, the immune system is more worn out.”

Late diagnosis is a missed opportunity to access a timely treatment which today allows the virus to become non-transmissible through sexual means after at least six months. In addition, there is currently the possibility of performing Pre-exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PPE) that allow the implementation of medication regimens before or after a possible exposure to HIV. “But there is no extensive knowledge about these resources or how to access them,” remarks the president of Glec.

Carina César considers that the longer life expectancy generates more sexual activity among older adults, who, however, “have received little sexual education and therefore in the case of heterosexual relationships, since there is no possibility of pregnancy and there is no perception of the risk of STIs are not used to talking to their partner or requesting the use of a condom: younger girls are more empowered in this sense.”

The Huésped Foundation researcher also warns that there should be specific prevention policies for this population of adults over 50 years of age to motivate them to inform themselves and take an HIV test. “There is a general conception that older people do not have sex and doctors tend not to ask older people about their sexual lives. They have no training to talk about these topics with patients, it is uncomfortable for them, or perhaps there is no time in the consultation.”

“The best thing that can happen to a person who has the virus is to know it,” says Natalia Haaf. The rapid test takes about 15 minutes and although we do not have false positives, the diagnosis is preliminary: it must be confirmed through the detection of viral load and CD4. The idea is to advance the ‘test and treat’ strategy, that is, testing, diagnosing, receiving medical attention and indicating antiretroviral treatment immediately, on the same day, something that AHF offers in its community centers in Caba (San Martín 899). and Rosario (Avda. Pellegrini 341), completely free of charge.”

Gabriela Navarra

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