Section Two: Special Situations
Part Two of Three in Project Inform's "What You Should Know About When to Start and What Meds to Use" Booklet
Today, many more people in their 50s and 60s and even 70s are finding out they have HIV. Many HIV-positive people are also growing into older age. The US Guidelines recommend that all people over 50 be on HIV meds. And although older adults tend to respond a little slower to HIV meds, they can nevertheless improve their health and wellness.
Aging and HIV
The older you get, the more important it is to keep up with a healthy lifestyle and notice medical issues as they develop. The health changes that people typically see as they get older -- diabetes, bone loss, heart and other organ disease, cognitive problems and cancer -- sometimes show up sooner in HIV-positive people.
It may be more difficult to assess your health, because these conditions could be from aging, HIV, HIV meds, other meds, or a combination of them. Be alert on how your health changes and be diligent about reporting them to your doctor and following treatment plans.
What also can help you stay healthy -- and what you can control -- is staying active and challenging your mind. Talk often with friends. Read or fill out puzzles. Take walks or exercise within your limits. These all can help maintain your bone, brain and heart health.
HIV Meds and Older Adults
If you started HIV meds as an older adult, it may take a little longer to see your CD4 count increase compared to someone in their 20s or 30s. However, it's very likely you'll continue to see these improve over time, which is one of the main goals of treatment. In fact, older adults seem to do better with taking HIV meds. The downside of that, however, is that people over 50 tend to have more side effects and drug interactions.
It's common for older adults to take a lot of prescriptions, so your HIV regimen may be just one of several doses of pills you have to remember every day. How many medicines do you take? Which are taken or not taken with food? Has forgetfulness or depression become an issue?
Don't feel embarrassed to ask for help from your nurse or doctor around ways to take your pills on time. Also, every now and then review all the meds you take with your pharmacist or doctor to make sure drug interactions aren't overlooked so that all the meds you take are working as well as they can.
Sex and Transmision
Protecting sex partners from getting HIV is an issue that people over 50 are dealing with more today. In some ways, unprotected sex seems like a natural thing to do after 50 since pregnancy becomes less of an issue. For others, they may stop using condoms because they're mentally fatigued from a lifetime of safer sex. Sometimes, people just don't see themselves at risk.
As more men use erection drugs later in life, there's been a marked increase in sexually transmitted infections in people over 50. This may be due, in part, to subtle changes in the moist areas of sex organs as people age that can make transmission easier. For all of these reasons, it's important to continue protecting sex partners from getting HIV.
Vaccines and Other Prevention
As you get older, several serious illnesses can be prevented by getting routine vaccines. The yearly flu vaccine and the one for pneumococcal pneumonia are safe to get, as are those used to prevent hepatitis A and B. Don't forget your booster tetanus shots. As well, recent information shows that the shingles vaccine is safe for HIV-positive people.
As you probably know, aspirin can help with heart disease and perhaps other inflammatory conditions. So discuss this with your provider if you have hypertension. Make sure you get routinely screened for various cancers as well, such as cancers of the mouth, throat, lung, cervix, anus, liver and skin.
Main Points to Remember
HIV meds have helped people go back to work, volunteer, travel and continue loving relationships. For some couples where one is negative and the other is positive (mixed status), they also want to raise families. It's very possible for couples to conceive while greatly lowering the chance of passing HIV to the negative partner during sex.
Couples should consider the emotional effects of trying to conceive. If both partners are not fully informed or able to speak up for themselves as they make decisions, then it might be better to wait for another time to try.
Getting Expert Medical Help
Before you start, get informed medical support from friendly doctors and nurses. This may not be easy, as some do not agree with mixed status couples trying to conceive. You may need to keep looking, use the resources at http://hiv.ucsf.edu/care/perinatal.html, or find HIV-experienced doctors. Doing this on your own could increase the risk of transmission.
Staying on a Stable HIV Regimen
Keeping viral load undetectable can reduce transmission by up to 96%. Therefore, the HIV-positive partner should be taking HIV meds as prescribed every day and getting more regular viral load tests done.
Having Timed Intercourse
Conception doesn't happen every time sex does. Therefore, to reduce the risk of HIV as much as possible, restrict sex only to when there are no genital infections present and only to her most fertile days. A doctor can help determine this.
Taking PrEP (Pre-Exposure Prophylaxis)
PrEP is when an HIV-negative person takes an HIV pill daily to prevent HIV, which reduces this risk by up to 90% when used with condoms. PrEP can also be used by couples who are trying to conceive, but there may be unknown risks for the baby if the woman takes PrEP. Talk to your doctor about PrEP as part of all family planning decisions.
If he is negative, the woman could use a plastic baby's syringe (found in drug stores or doctor's office) to insert his semen near her cervix. To collect the semen, he should ejaculate into a plain condom or clean container. Read "Home Insemination" at http://hiv.ucsf.edu/care/perinatal/resources.html.
Having a Foreskin Vs. None
During unprotected sex, having a foreskin can make it easier for the man to get HIV. There's about a 60% lower risk of transmission when the male partner is cut.
Though assisted reproduction services are quite expensive -- and not available everywhere -- some people turn to fertility specialists who can help them with in-vitro fertilization (IVF) and sperm washing, which are often used together. Sperm washing is a process that "cleans" HIV away from sperm.
Couples may also want to consider other choices, such as adoption or donor sperm. These may be appropriate for certain couples wanting to raise children.
Other Things to Consider
Even if the positive partner is on stable HIV meds, genital infections and other infections like the flu could temporarily increase viral load in genital fluids and blood, perhaps to an infectious level. Getting a vaccination can do the same. Avoid unprotected sex during or shortly after these times.
More From This Resource Center
This article was provided by Project Inform. Visit Project Inform's website to find out more about their activities, publications and services.
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