The feeling was unshakable. For two weeks Lee Fischer, then 60, suffered chills and weakness, and watched his rangy frame whittle itself down from 185 pounds to 165. He visited his doctor in Wilmington, Delaware, where he worked as a chemist, and confirmed his suspicion: He was HIV-positive.
Fischer knew all about AIDS — he had delivered meals to people with HIV in the 1990s. Back then he was in a committed gay relationship, and he and his partner got tested regularly, though they used protection. But shortly before his diagnosis in 1997, the now-single Fischer had indulged in a fling while on vacation in Seattle. That one time was enough.
Epidemiologists have long known that sharing needles can transmit HIV. But they have also found that people who use any sort of drug — even, like Fischer, a few too many drinks on vacation — are more likely to take risks that could lead to infection. And infected people don't always protect others. In a study of older HIV-positive people in New York City, one in three sexually active subjects had recently had risky sex.
Gay men remain the highest risk group for HIV overall, says Ronald Johnson of AIDS Action, an advocacy group in Washington, D.C. Men over 50 who were cautious when younger have reported "condom fatigue" — they tire of the decrease in sensation that condoms cause, Johnson adds.
Now 74 and living in Baltimore, Fischer is in good health, thanks to HAART and a regimen that includes yoga, meditation, gym visits, and dog walks. He drinks no alcohol. Micromanaging health can keep people with HIV alive longer. "Taking care of yourself is a 24-hour job," Fischer says.