Senior centers in New York City and parts of South Florida have added something new to their activities menus—talks on safe sex and condom giveaways. As growing numbers of older adults are diagnosed and living with HIV/AIDS, prevention and counseling services now are being aimed at the 50+ crowd. "It's about time," said Jane Fowler, a 72-year-old Kansas City, Mo., grandmother, who was infected with HIV in her 50s. HIV, short for the human immunodeficiency virus, is the virus that causes AIDS. After a long marriage ended, Fowler dated and became involved with a male friend, and had unprotected sex. Since being diagnosed in 1991, Fowler has been on a mission to educate older folks about safe sex and HIV/AIDS prevention.
"The lack of education is my biggest concern—the fact that older people aren't aware of (HIV/AIDS)," said Fowler, who founded HIV Wisdom for Older Women. "How often do you see a HIV prevention poster with an older face?"
Her concern is justified. Nearly one-third of all people living with HIV/AIDS are aged 50 and older. According to the Centers for Disease Control and Prevention, 115,000 of the 475,000 people living with HIV/AIDS in the United States are 50+. That's nearly double the number in 2001. The real numbers are likely higher because many people with HIV/AIDS remain undiagnosed, according to the CDC.
Much of the reason HIV/AIDS is appearing in the older population relates to antiretroviral drugs and improved treatments, allowing people to live longer with the virus and disease. Still, the rising rate of new infections among those 50 and older is of concern.
Nearly one of every six new diagnoses of HIV is in someone aged 50 and older. "The primary mode of transmission among [the older] population is sex," said Stephen Karpiak, associate director for research at AIDS Community Research Initiative of America (ACRIA). The group conducted the biggest study ever done on HIV/AIDS and older adults. It found that heterosexual sex is the mode of transition in more than 60 percent of those over 50 infected during the last five years with HIV.
It shouldn't be a surprise. "Many older adults are sexually active," concluded an August 2007 study of sexuality among older adults that appeared in the New England Journal of Medicine. The problem: many older adults don't think HIV/AIDS affects them. Older adults are less likely to use protection because pregnancy is not an issue post-menopause. Doctors do not always test older people for HIV/AIDS. Also to blame, noted Fowler, is the lack of education and prevention directed at older adults.
"We need to move beyond the late-night jokes on Viagra and recognize that sexuality and intimacy continue to be an important part of everyone's lives, even after someone turns 60," according to Edwin Mendez-Santiago, commissioner of New York City's Department for the Aging. Home to the largest population in the nation living with HIV/AIDS, New York City recently launched a $1 million prevention and HIV education campaign in the city's senior centers.
About one-third of New York City residents with HIV/AIDS are 50 or older. Within seven years, a majority of people living with HIV/AIDS in New York City will be 50 and older, according to the ACRIA study.
"People are at risk; it doesn't matter who you are," said Karpiak. Among older people, post-menopausal women are especially at risk, he says. And women of color are particularly vulnerable. Most got the virus from sex with infected partners, while many others got HIV through shared needles.
"We call it our life savers when we talk about condoms," noted Edid Gonzalez, outreach coordinator with Senior HIV Intervention Project, an effort by Florida's Broward and West Palm Beach counties to provide HIV/AIDS prevention and education. The program taps retirees, including an 86-year-old known in area senior centers as "Condom Grandma," to become "safe sexperts" to convince their contemporaries to get tested for HIV/AIDS.
Unfortunately, the lack of awareness about HIV/AIDS among older adults poses other risks. Typically, it takes about 10 years for someone infected with HIV to develop AIDS. Older adults exposed to HIV are also at greater risk because of weakened immune systems. Some 40 percent of people develop AIDS within one year of diagnosis, meaning they have delayed getting an HIV/AIDS test and therefore delayed seeking treatment. "It's quite common for older people to be diagnosed later," said Dr. Timothy Mastro, deputy director for science in CDC's division of HIV/AIDS prevention.
That's too bad, because education and a simple blood test can reverse that trend. "We'd like to see everyone get tested, at least one time," said Mastro. If someone is infected and remains undiagnosed, "that person can't get care and their immune system is being compromised." Testing can also help prevent the spread of HIV/AIDS. For example, two-thirds of infections are caused by individuals unaware they are infected.
"People can live decades now with HIV treatment," Mastro added.
But doctors and health care providers need to talk to older patients about their sex lives, drug use, and HIV/AIDS prevention, said Fowler, who has not developed AIDS and considers herself otherwise healthy. She said, "I expect to die from something else when my times comes."