In ''AIDS among Persons Aged Greater Than or Equal to 50 Years--United States, 1991-1996'' (Morbidity and Mortality Weekly Report, vol. 47, no. 2, January 23, 1998), the Centers for Disease Control and Prevention (CDC) reports that most older people infected with HIV early in the epidemic were typically infected through contaminated blood or blood products. Through 1989 only 1% of HIV/AIDS cases of people aged thirteen to forty-nine was due to contaminated blood. However, in this same period 6% of cases of people fifty to fifty-nine, 28% of cases of people sixty to sixty-nine, and 64% of cases of those seventy and older resulted from contaminated blood or blood products.

In 1985 changes introduced to improve the safety of the nation's blood supply, including routine screening of blood donations for HIV, sharply reduced the risk of contracting the virus from contaminated blood or blood products. Subsequently, the proportion of people aged fifty and over who acquired HIV from other types of exposure increased. Even though male-to-male sexual contact and intravenous drug use remain the primary means by which HIV is transmitted among all age groups in the United States, heterosexual transmission of HIV is steadily increasing in people more than fifty years old.

According to the CDC, in ''Questions and Answers for the General Public,'' 15% of AIDS cases reported in the United States occur in people over age fifty. This proportion did not vary much between 1991 and 1999. However, it is expected to increase as HIV-infected people of all ages live longer as a result of effective drug therapy and other advances in medical treatment.

Through 2005 an estimated 221,102 cases of AIDS in people over age forty-five had been reported. Of these reported cases, 102,732 (46% of the cumulative total) were among people aged forty-five to forty-nine, 56,950 (26%) were among people aged fifty to fifty-four, 30,424 (14%) were among people aged fifty-five to fifty-nine, 16,493 (7%) were among people aged sixty to sixty-four, and 14,503 (7%) occurred in people aged sixty-five and older.

Many older adults do not seek routine screening for HIV infection because they do not believe they are at risk of acquiring HIV. Among women older than fifty, the absence of the risk of pregnancy may lead to a false sense of security and the mistaken belief that they are at less risk for sexually transmitted diseases, including HIV. HIV-infected people aged fifty and over may not be tested promptly for HIV infection. As a result, opportunities to start these patients on therapies quickly to slow the progression of the disease are often lost. The failure to test or the late testing of older patients may be because:

-           Physicians are less apt to look for HIV in people of this age group.

-           Some opportunistic AIDS illnesses that occur in older people, such as encephalopathy and wasting disease, have similar symptoms to other diseases associated with aging, such as Alzheimer's disease, depression, and malignancies.

It is vitally important to overcome older adults' reluctance to seek testing and other delays to diagnosis because recent research shows that age speeds the progression of HIV to AIDS and blunts CD4 response to highly active antiretroviral therapy. Equally important is continuing the research to improve the treatment of HIV-infected older adults and the development of effective education programs to prevent infection in this population.

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