• About 18% of AIDS cases in the U.S. female population are said to be in women older than age 50, and numbers of cases are expected to increase as women of all ages survive longer due to improved drug therapy and other treatment advances.

• In the last decade, AIDS cases in women over 50 were reported to have tripled, while heterosexual transmission rates in this age group may have increased as much as 106%.

• "Older women," according to UNAIDS, "appear to have higher incidence than older men, and during a recent five-year period the number of new cases in this group increased by 40%. More than half of the infected over 50 are of African-American and Hispanic origin, indicating greater risks among minority groups."

• In the U.S., older African-American women are disproportionately affected; in 2001 they comprised 11% of the population of women older than 50 but accounted for more than 50% of the AIDS and 65% of the HIV cases in this age group.

• While all older individuals with HIV infection or AIDS usually are invisible, isolated, and ignored, this is particularly true of women, who are often unable to disclose their HIV status even to family and friends and, certainly, their community.

• Despite myths and stereotypes, many senior women are sexually active, and some are drug users; therefore their behaviors can put them at risk for HIV infection.

• Healthcare and service providers -- and older women themselves -- do not realize that they are at the same risk as other age populations; professionals often are reluctant to discuss or question matters of sexuality with their aging patients/clients.

• Most women (and all older persons) are first diagnosed with HIV at a late stage of infection, and often become ill with AIDS-related complications and die sooner than their younger counterparts; these deaths can be attributed to original misdiagnoses and immune systems that naturally weaken with age.

Special Considerations

• HIV/AIDS educational campaigns and programs are not targeted at/to older women (and men); how often does a wrinkled face appear on a prevention poster?

• Rates of HIV infection (not AIDS) in all seniors, including women, are especially difficult to determine because older people are not routinely tested

• Older people, especially women, with HIV/AIDS face a double stigma: ageism and infection with a sexually or drug-injecting transmitted disease; in addition, they are sensitive to a cultural attitude that assumes "Elderly people have lived their lives -- so what if they die from AIDS?"

• Seniors of both sexes are unlikely to use condoms consistently during sex because of a generational mindset and unfamiliarity with HIV/STD prevention methods.

• For older women, there are special considerations: After menopause, condom use for birth control becomes unimportant, and normal aging changes such as a decrease in vaginal lubrication and thinning vaginal walls can put them at higher risk during unprotected sexual intercourse.

• As HIV symptoms often are similar to those associated with aging (fatigue, weight loss, dementia, skin rashes, swollen lymph nodes), misdiagnosis is frequent in older women/people who are, in fact, infected.

• Women and older males may confront social and professional bias regarding the allocation of limited healthcare services and resources available to the AIDS community (i.e., "why waste money on the elderly?")

• Because the aging process itself lowers energy levels and results in restrictions in social routines that can cause emotional/psychological problems, the older woman/adult additionally infected with HIV may feel another "loss" and endure more severe depression.

• Senior women often are less likely to find support and comfort among family and friends, and because they are traditionally not comfortable in support groups, they may be less inclined to join them, citing lack of shared experiences concerning different issues.

• Due to the general lack of awareness of HIV/AIDS in older adults -- in particular, women -- this segment of the population, for the most part, has been omitted from research, clinical drug trials, educational prevention programs, and intervention efforts.

Necessary Actions

• Specific programs must be implemented for older adults, especially women, who need to be informed about the transmission and prevention of HIV.

• Outreach should include workshops and trainings devoted to basic HIV/AIDS information, "safe" sexual and drug-using practices, testing, negotiation skills -- all in relationship to aging.

• More research is needed to study seniors' sexual and drug-using behaviors and to determine HIV disease progression and treatments in the over-50 population.

• Healthcare and service providers on all levels should be educated on HIV risk behaviors and symptoms of HIV infection; they need to conduct thorough sex and drug-use risk assessments with their older clients/patients.

• Programs aimed at reaching healthcare and service providers should cover misdiagnoses, testing technologies, treatments, support groups, case management, and the importance of being actively involved in the health and well-being of their older clients/patients.

• Successful media and social marketing campaigns can raise 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.

Jane P. Fowler compiled much of this tip sheet, based primarily on personal perspectives and experiences of consumers and professionals, while she was co-chairperson of the National Association on HIV Over Fifty. Now director of the national HIV Wisdom for Older Women program, she can be reached at: jane@hivwisdom.org. The website is www.hivwisdom.org.