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HIV in People Over 50: A Growing Concern
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HIV in People Over 50: A Growing Concern

Anyone can be at risk for contracting HIV and AIDS, but many older people aren't aware of the risks.

Sparks of sexual desire strike singles of all ages, but before the smooching segues into something more intimate, people need to stop and think about HIV and AIDS, say the experts.

"Older people tend to believe, wrongly, that they aren't at risk and don't need to hear this message," says Jane Fowler, co-chair of the National Association on HIV Over Fifty.

The possibility of becoming infected with an incurable disease never occurred to Fowler when, after her divorce, she had a sexual relationship with an old family friend. A blood test for an insurance policy alerted the 55-year-old journalist from Kansas City, Missouri, that she was infected with the human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS).

What Is HIV/AIDS?

The HIV virus weakens the body's immune system, leaving patients vulnerable to infections, cancers, and other diseases. People infected with HIV may not appear ill or suffer from any serious symptoms for years, and may, in fact, appear perfectly healthy. But people with HIV can pass the virus to others through sexual activity or sharing of needles. Blood transfusions done between 1979 and 1985 also pose a risk, because blood was not screened for HIV prior to 1985.

Casual contact, however, does not increase risk. The virus lives in bodily fluids, not on things, so activities such as sharing silverware, hugging, using a public toilet, or shaking hands do not increase your risk of contracting the virus.

Older Adults Less Knowledgeable of the Risks

Most older adults contract the virus through sexual contact—about half the men do so through homosexual encounters. But more older adults contract the disease through heterosexual contact than do their younger counterparts. In general, this mature group remains less knowledgeable than teens and young adults about the virus, its risks, and the ways to prevent it.

During the 1990s, the number of AIDS cases in older adults increased twice as fast as in younger populations. Among women, the upward trend is even more dramatic. While the number of actual cases remains low—only about 10% of AIDS cases are first diagnosed in those over age 50—Fowler finds the increases frightening and has taken to the road, sharing her story in the hopes that other middle-aged and older adults will realize that if HIV happened to her, it could happen to them. It is also quite likely that the number of new HIV cases in people over age 50 is actually higher than we know due to under reporting.

Unique Risks for Older Adults

While the majority of older Americans do not participate in behaviors that increase their risk for contracting HIV, many do. Unprotected sex is the most common cause. A few physical and social factors also add to older adults' risk, including:

  • Menopausal and postmenopausal women can experience vaginal dryness and thinning, which can lead to cracks that allow easier access for the virus to enter the body.
  • Older adults may associate condoms with pregnancy prevention, which is not a concern after menopause, rather than with disease prevention.
  • Divorced or widowed adults who are new to the singles scene may be naive to the risks of unprotected sex and may be less likely to bring up the subject.
  • Lonely adults may seek out sex with promiscuous mates or prostitutes.
  • Some people may think, mistakenly, that current drug treatments are a cure. "Don't take a risk," Fowler says. "The drugs don't always work. They can stop working. They are very expensive and produce undesirable side effects."
  • Some may view the golden years as a time to enjoy themselves and ignore the dangers, not realizing how the disease could devastate their quality of life.

Prevention

Many successful prevention programs have been administered to people living in retirement communities and those attending health fairs, congregate meal sites, social events and other places older adults gather. The programs use age-appropriate materials and adapt public outreach messages to address the needs of an older audience. They also recruit mature adults to pass along the message.

"We make the presentations fun," says John Gargotta, of Florida's Senior HIV Intervention Project. "Older volunteers and staff are what make our program work so well. They create a dialogue and atmosphere where people are comfortable asking questions."

There are several ways to reduce risk for contracting HIV, including:

  • Keep condoms handy and always use a latex condom or a female condom during sex with someone whose disease status you do not know. Think of it as having sex not just with this person you trust and think you know, but with everyone your partner has had sex with in the past 10 years.
  • Learn how to talk about sex and to negotiate protective barriers with potential partners.
  • Don't share any kind of needles.

"If you engage in risky sexual behaviors, your age isn't going to make you immune," says Marcia Ory, PhD, of the National Institute on Aging. "If exposed, you're at risk for infection, regardless of your age."

Get Tested

"If anybody has put him or herself at risk, [he or she] ought to be tested," Fowler says. "I feel like I was blessed I 'flunked' the insurance company blood test when I did and found out I was infected. Had I not, I might be dead of AIDS today."

Early treatment improves the odds of living with the disease. Some data indicate that older adults die more quickly after diagnosis than younger people. "Older people are much more likely to be diagnosed later. Thus, they tend to be less likely to be on aggressive drug treatments," says Dr. Ory. In addition, aging may diminish the immune system's ability to fend off the virus.

Talk to Your Doctor

Routine blood tests do not include an HIV test, and many doctors don't consider ordering an HIV test when older patients complain about early, nondescript symptoms, such as fatigue or malaise, which many attribute to aging. Therefore, older adults often are misdiagnosed.

Research indicates that you shouldn't wait for your doctor to introduce the subject. A University of Texas Southwestern Medical Center study found that most physicians rarely, if ever, discussed HIV with patients over 50.

If you think you may be at risk, ask for an HIV test and discuss the risks with your physician. If you'd like anonymity, consider getting an anonymous test, which many public health departments offer.

Know the Risks

"I'm healthy, and the drugs are working, but why take a risk?" Fowler asks. The side effects of medications are multiple and it is quite likely that older adults will not be able to tolerate them as well as younger patients. Also, the HIV medications interfere with many other pharmaceuticals, which makes treatment of other chronic and prevalent diseases—e.g. congestive heart failure—quite challenging. "The transmission of HIV does not depend upon age. HIV can infect any person of any age. We all need to know what's out there, and how to prevent it."

RESOURCES:

Center for AIDS Prevention Studies
http://www.caps.ucsf.edu/

National Association on HIV Over Fifty
http://www.hivoverfifty.org

National Institute on Aging
http://www.nih.gov/nia

CANADIAN RESOURCES:

Canadian AIDS Society
http://www.cdnaids.ca/

Canadian HIV/AIDS Information Centre
http://www.aidssida.cpha.ca/

References:

El-Sadr W, Gettler J. Unrecognized human immunodeficiency virus infection in the elderly. Arch Intern Med. 1995; 155:184.

Levy, JA, Ory, MG, Crystal, S. HIV/AIDS interventions for midlife and older adults: current status and challenges. J Acquir Immune Defic Syndr. 2003; 33 Suppl 2:S59.

Mack, KA, Ory, MG. AIDS and older Americans at the end of the Twentieth Century. J Acquir Immune Defic Syndr. 2003; 33 Suppl 2:S68.

Schable B, Chu SY, Diaz T. Characteristics of women50 years of age or older with heterosexually acquired AIDS. Am J Public Health. 1996; 86:1616.

Skiest DJ, et al. Human immunodeficiency virus infection in patients older than 50 years: a survey of primary care physicians' beliefs, practices, and knowledge. Archives of Family Medicine. 1997;6:289-294.



Last reviewed May 2008 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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