Are We Thinking About HIV and Older Adults?

Much of the information for this article was taken from the Educational Tip Sheet: HIV/AIDS and Older Adults, compiled for the National Association on HIV Over Fifty by Jane P. Fowler, and from an article by Cindra Feuer. Thanks to Jane Fowler for inspiring me to write this article.

I am just going to start with the blunt truth -- seniors, older adults, grandmothers, grandfathers, great aunts, great uncles, etc., have sex. I will say it again but in a different way ... people who are over fifty have sex!

Consequently, people over fifty get HIV. I have come to the realization that society doesn't think that this age group is having sex or could possibly be at risk for HIV. But the truth is that they are. I can't understand why people think that your sexual desires magically stop at 49, or that there is no way that grandma could get HIV. (I am not implying that everyone over 50 is a grandma!)

The thing is that I do remember worrying about my grandmother after my granddaddy died in 1989. I knew that my grandfather had a number of blood transfusions due to a long-term illness and wondered if he could have been infected with HIV. Interestingly, I didn't even really connect the possibility of infection until after I had read And the Band Played On by Randy Shilts. (This was my first recognition that the Ronald Reagan era did "jack crap" about encouraging the testing of the national blood supply or anything else to do with HIV!) I worried about her again when she started dating. I was hoping she heard me when I talked about HIV. I hoped that she recognized that everyone was at risk. I eventually learned that she heard me because she told me that she had gone to get tested because "granddaddy had blood transfusions." I was relieved and proud that I had such a progressive/intelligent grandmother.

In spring 2000, I attended the National Social Work and AIDS Conference in San Diego and was surprised to learn that between 11 and 15% of U.S. AIDS cases occur in people over age 50. The saddest part of all this information was that most older persons are not routinely tested, so they are much more likely to be diagnosed with HIV at a later stage of infection. This population often becomes sick and dies sooner. The gerontologist or primary care physician may never think to suggest an HIV test (again, not taking a sexual and drug using history because they do not recognize the risk of this population), thus leaving the person open for misdiagnosis and missed opportunities for early care. (A recent survey of doctors in Texas showed that the vast majority rarely or never asked patients over 50 questions about HIV/AIDS or discussed risk factor reduction.)

I mention misdiagnosis because HIV symptoms are often similar to those natural aging symptoms. Symptoms like fatigue (misdiagnosed as depression), tuberculosis, shingles, weight loss (commonly misdiagnosed as depression), dementia (which is commonly misdiagnosed as Alzheimer's disease), skin rashes, swollen lymph nodes and pneumonia (PCP can look like bacterial pneumonia, bronchitis and even congestive heart failure when there is undiagnosed HIV) are often common to aging but could actually be signs of HIV.

The CDC recently reported that a higher proportion of HIV-infected people over 50 die within one month after their AIDS diagnosis as compared to folks under the age of 50. Dr. Robert Kalayjian of Metro Health Medical Center in Cleveland also concluded that the older a person is when initially infected, the more rapid disease progression will be. He stated, "There is no concrete evidence as to why this happens. In the aging immune system, T-cells may not be replaced as rapidly or may be nonfunctional. We know that age does some of the same things the virus does to the immune system."

When we look at the older person's risk for HIV, a couple of unique factors should be considered. They include: inconsistent use of condoms due to generational mindsets and unfamiliarity with HIV/STD prevention methods, possible prescription and other substance use, the thought that condom use for birth control after menopause is unimportant, and that the developmental process of normal aging brings a decrease in vaginal lubrication as well as a thinning of the vaginal walls.

Because of our advances in treatment, the "older person" living with HIV includes a generation of people who were originally diagnosed in their 30s and 40s. Due to triple-combination drug therapy and other treatment advances, we can expect the number of cases to increase in this population. This "sub-community" will also bring their own unique set of needs as they continue to live longer lives with the advancement in HIV treatment.

So, what can you do to advocate for older adults and HIV?

1. Demand that specific programs be implemented for older adults who need to be informed about the transmission and prevention of HIV.

2. Recommend that outreach initiatives include workshops and trainings devoted to basic HIV/AIDS information, "safer" sexual and drug-using practices, testing, negotiations skills -- all in relationship to aging.

3. Demand that research be initiated to study seniors' sexual and drug-using behaviors as well as looking at how HIV disease progression and treatments are affecting the over 50 positive community. (Write a letter to the National Institute on Health or your local AIDS research consortium stating that research needs to be done on older adults with HIV. Contact Judith Levy, Ph.D. at 312-996-5701, who is doing research on HIV and older injecting drug users.)

4. Demand that health care and service providers on all levels become educated on HIV risk behaviors and symptoms of HIV infection and that they conduct thorough sex and drug-use risk assessments with their older clients/patients despite their age.

5. Demand that programs created for health care and service providers cover misdiagnoses, testing technologies, treatment, support groups, case management and the importance of being actively involved in the health and well-being of their older clients/patients.

6. Demand that media and social marketing campaigns include awareness of HIV/AIDS in older people and reinforce the need for educational programs, while promoting respect and validation for the elderly as a group.

7. Join HIV Wisdom for Older Women and/or the National Association on HIV Over Fifty.

8. Always use a condom when engaging in sex -- anal, oral, or vaginal! After all, your life is at stake. You are worth it!

9. Ask to be tested for HIV. It is not part of routine blood work done at your doctor's office.

National and Local Resources

National:

HIV Wisdom for Older Women
Contact: Jane P. Fowler
816-421-5263
www.hivwisdom.org
jane@hivwisdom.org

National Association on HIV Over Fifty
Contact: Jim Campbell
617-233-7107
www.hivoverfifty.org
jcampbell@hivoverfifty.org

New York Association on HIV Over Fifty
Contact: Katy Nokes, Ph.D.
212-481-7594
www.nyahof.org
kathynokes@aol.com

Chicago Association on HIV Over Fifty
Contact: William W. Rydwels
773-283-0101

Senior HIV Intervention Project (SHIP) in three Florida counties
Broward: 954-467-4779
Dade: 305-377-5022
Palm Beach: 561-586-4843

The American Association of Retired Persons
Social Outreach & Support
Washington, DC
202-434-2260

The National Institute on Aging
www.nih.gov/nia/