Chapter 32: HIV Prevention and Care for the Older

. How might an older adult contract an HIV infection? Select all that apply.

a. Using infected needles

b. Unprotected penetrative anal intercourse

c. Unprotected penetrative vaginal intercourse

d. Vertical transmission during pregnancy

*a. Using infected needles

*b. Unprotected penetrative anal intercourse

*c. Unprotected penetrative vaginal intercourse

Rationale: The modes of transmission of HIV in older adults include unprotected penetrative

anal or vaginal intercourse and blood transmission (including infected injecting needles).

Vertical transmission during pregnancy, delivery, and/or breastfeeding is not a mode of

transmission in older adults.

How can HIV be prevented in older adults? Select all that apply.

a. Practicing fidelity

b. Properly using condoms

c. Identifying early non-symptomatic infections

d. Decreasing the impact of the disease

*a. Practicing fidelity

*b. Properly using condoms

*c. Identifying early non-symptomatic infections

Rationale: HIV prevention programs in adults usually focus on primary and secondary

preventions. Primary HIV prevention in adults involves lifestyle modifications that aim at

avoiding infection with the virus, such as sexual abstinence, fidelity to sexual partner, or proper

use of condoms. Secondary HIV prevention involves screening to identify early nonsymptomatic

infections in order to begin early treatment. Decreasing the impact of the disease

among those in whom the disease is already advanced is a tertiary HIV prevention strategy.

An older adult who is sexually active was never screened for HIV infection. Which of the following might explain why this older adult never opted for HIV screening during his routine checkups? Select all that apply.

a. He did not know he was at risk at his age.

b. He was not aware of the risk factors.

c. He did not have enough money to receive HIV screening.

d. He was not aware he needed screening for HIV.

*a. He did not know he was at risk at his age.

*b. He was not aware of the risk factors.

*d. He was not aware he needed screening for HIV.

Rationale: Older adults tend to have less knowledge of risk factors for HIV transmission

compared to younger persons. Many older adults incorrectly assume that HIV and other sexually transmitted infections are a phenomenon for the younger generation. Because of this lack of

awareness, older adults often do not consider the key secondary prevention method of screening for HIV as part of routine care even if they are sexually active. The cost of screening is not a known reason for sexually active older adults to opt out of HIV screening. Additionally, since the older adult was attending routine check-ups, money was not likely a factor.

A person living with HIV has progressed from acute HIV infection to clinical latency, but has not yet progressed to AIDS. What factors may have helped slow down this progression? Select all that apply.

a. Was diagnosed and started treatment early

b. Took HIV medications on time

c. Followed a healthy lifestyle

d. Genetic makeup of patient and virus

*a. Was diagnosed and started treatment early

*b. Took HIV medications on time

*c. Followed a healthy lifestyle

*d. Genetic makeup of patient and virus

Rationale: People living with HIV may progress through these stages (acute HIV infection to

clinical latency to AIDS) at different rates depending on a variety of factors, including: their

genetic makeup; how healthy they were before they were infected; how much virus they were

exposed to and its genetic characteristics; how soon after infection they are diagnosed and linked to care and treatment; whether they see their healthcare provider regularly and take their HIV medications as directed; and different health-related choices they make, such as decisions to eat a healthy diet, exercise, and not smoke.

A 55-year-old living with HIV is engaging in risky behaviors such as being physically inactive, abusing substances, and not socializing. How can risky behavior impact the patient?

a. Reduce length of life

b. Delayed diagnosis

c. Delay treatment

d. Reduce response to treatment

*a. Reduce length of life

Rationale: Life expectancy has become similar between people living with HIV and those who are HIV negative. However, engaging in risky behaviors such as being physically inactive,

abusing substances, and having a poor social network may cause reduced life expectancy. Delay in diagnosis and treatment and reduced response to treatment is not because of risky behavior.

8. An older adult living with HIV has two caregivers—one who handles the person's cooking, laundry, and cleaning and another who takes care of the person's bathing. What type of caregivers is looking after this person?

a. Only formal

b. Formal and informal

c. Only informal

d. Family members

*b. Formal and informal

Rationale: This person is being looked after by both formal and informal caregivers. Informal

community-based care is usually offered by relatives and friends of the affected person mostly on a voluntary basis—that is, without a salary. Informal caregivers typically perform housekeeping tasks such as cooking, doing laundry, cleaning, and so on. Formal communitybased care is provided by professionals as a means to earn a living. Formal caregivers usually perform personal care tasks such as bathing and counseling. Such professionals may be nurses, psychologists, or social workers.

An older adult patient living with HIV skips an appointment. At his next appointment, the nurse discovers that the patient has missed taking some of his pills. How will this patient be

managed now?

a. He will be referred for outreach services.

b. He will be referred for hospitalization.

c. He will be assigned an informal caregiver.

d. A family member will be trained to give him medicines.

*a. He will be referred for outreach services.

Rationale: Outreach referrals are done for patients who have defaulted on appointments, have

missed laboratory tests, or need any form of medical support. Outreach workers assist patients with HIV in making and adhering to their medical appointments, understanding the importance

to adhere to their medications as prescribed, and accessing other support services. Informal

caregivers including family are not able to provide this type of support. Also, the patient is not sick enough to need hospitalization.

An older adult patient living with HIV is very anxious and feels he is unable to enjoy life since the diagnosis. The patient's suffering can be mitigated through what type of service? apparently this is a select all that apply

a. Outreach care

b. Family support

c. Counseling

d. Palliative care

*c. Counseling

*d. Palliative care

Rationale: Ideally, patients with HIV should be enrolled into palliative care as soon as they are

diagnosed. Palliative care is care aimed at preventing and relieving the suffering of patients

afflicted with chronic or life-threatening diseases in order to improve their quality of life.

Palliation should be considered an important aspect of care, especially for older adults living

with HIV. Formal counseling care will also help reduce the patient's anxiety and fears. Outreach care is used for patients who have defaulted appointments, have missed laboratory tests, or need any form of medical support. Family support is important for patients living with HIV, but this is

not directed at mitigating suffering and may not help alleviate the patient's particular concerns.

Why is treating AIDS difficult in older adults? Select all that apply.

a. Low CD4 counts

b. Quicker disease progression

c. Delayed diagnosis

d. Poor response to treatment

a. Low CD4 counts

b. Quicker disease progression

c. Delayed diagnosis

d. Poor response to treatment

Rationale: Persons over 50 years of age who acquire HIV usually have persistently low CD4counts (little immunity strength) and thus respond poorly to treatment compared to youngerpersons. Even when older adults have initiated treatment for HIV, they maintain a lower CD4count for a sustained period of time before any improvement is noticed, putting them at higherrisk for disease progression and death. In older adults, there is a delay in diagnosis, and course oftreatment due to several reasons. Often care and treatment is started when the immune systemhas been substantially damaged yielding a diagnosis of AIDs (CD4 counts so low that there is nodefense for opportunistic infections).

An adolescent living with HIV in Africa is not adhering to medications. What could be thereasons? Select all that apply.

a. Did not disclose HIV status to relatives

b. Could not find a clinic to access medication

c. Found it difficult to take medicines in school

d. Faced guardianship issues

a. Did not disclose HIV status to relatives

b. Could not find a clinic to access medication

c. Found it difficult to take medicines in school

d. Faced guardianship issues

Rationale: In Uganda, adolescents living with HIV reported a number of barriers to adherence ofHIV medications. One barrier waTs EkeSeTpiBngANanKdStaEkLinLgEthRe.aCntOi-Mretroviral therapy (ART) pillswhile at school, because frequently taking pills among classmates and friends could createdifficulties in preserving confidentiality. Adolescents whose HIV-positive parents had diedstruggled to deal with the loss and also had to face frequent change in guardianship, contributingto problems with adherence to ART. Also, individuals who failed to disclose their HIV status totheir relatives had difficulties in adhering to ART as they attempted to conceal their HIV status.Despite the increasing availability of ART, accessibility and acceptability is still a major concernin some areas, and it is possible that the adolescent could not find a clinic to access themedication.