infection and AIDS, surveillance of HIV infection provides a clearer picture of the pandemic in
young people than surveillance of AIDS cases. From the States for which HIV is a reportable
condition, young people ages 13 to 24 accounted for a much greater proportion of HIV than
AIDS cases (17 percent versus 4 percent). Of these HIV infections, 38 percent were reported
among young females, and 56 percent were among African Americans (CDC, 1999b).
Adolescents may benefit from treatment that is developmentally appropriate and peer oriented.
Addressing educational needs may be particularly important as well as involving family
members in the planning of treatment and therapy.
Substance abuse among adolescents is frequently associated with depression, eating disorders,
and sexual abuse history. Histories of familial sexual and substance abuse are predictive of
serious adolescent substance involvement and subsequent treatment needs. For a discussion on
adolescents and substance abuse disorders, see TIP 31, Screening and Assessing Adolescents for
Substance Use Disorders (CSAT, 1999A), and TIP 32, Treatment of Adolescents With Substance
Older adults
The last few years have witnessed greater increases in the number of HIV/AIDS cases among
middle-aged and older individuals than in those under 40 years of age. Through June 1999,
people over the age of 50 account for 11 percent of cumulative AIDS cases and 5 percent of
cumulative HIV cases in the United States. Women comprise a greater percentage of all AIDS
cases as age increases, ranging from 13 percent of AIDS cases among people aged 50-59, 15
percent of AIDS cases among those aged 60-69, and 21 percent of those 65 and over. For women
with HIV, 22 percent of this group is in the 50-59 age bracket; 24 percent is aged 60-64; and 31
percent aged 65 and older. The rate of HIV infection in older women reflects the greater
incidence of surgeries (such as hysterectomy) that require blood transfusions.
Although many of these AIDS cases are the result of HIV infection at a younger age, many
people become infected after age 50. Rates of HIV infection among older adults are difficult to
ascertain because very few people over 50 years of age routinely test for HIV. Because older
adults are diagnosed with HIV/AIDS at advanced stages, older adults are less amenable to
treatment, become sicker, and die faster than their under-50 counterparts. In addition, retroviral
treatments and opportunistic infection prophylaxis may interact with medications the older
person is taking to treat other preexisting chronic illnesses and conditions. Also, the vast majority
of medication studies are done on much younger subjects. There is little research on the
metabolism of anti-HIV drugs in older adults.
There is, as well, little research on the substance-abusing behavior of older adults, and very few
substance abuse treatment programs address the needs of older adult substance abusers (see TIP
professionals do not consider older patients to be at risk for either substance abuse (with the
exception of alcohol use) or HIV infection. A study in Texas found that most doctors never
asked patients older than 50 years questions about substance abuse or HIV/AIDS or discussed
risk factor reduction. Doctors were much more likely to rarely or never ask patients over 50
