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Raising
Awareness About AIDS and the Aging
By
LINDA VILLAROSA
New York Times, July 8, 2003
When
Jane Fowler made her way back into the dating scene in the early 1980's
after her 23-year marriage ended in divorce, using a condom was not on her
mind. She barely knew the word. "Being
from the 1950's, women like me thought condoms were only used for birth
control," said Ms. Fowler, 68, a retired journalist and the director
of the H.I.V. Wisdom for Older Women program in Kansas City, Kan. "We
didn't call them condoms anyway. If you said the word at all, you
whispered `rubber.' " In
1986, Ms. Fowler spent New Year's Eve with a longtime friend, an evening
she described as "fun and exciting, filled with laughter, dancing,
Champagne and sex, unprotected sex." Several
years later, after applying for new medical coverage, she learned that she
had contracted H.I.V. She was 55. "It
didn't occur to me to talk to him about his sexual history," Ms.
Fowler said, adding that she did not know how her friend, who died in
1995, had contracted the virus. "I had no reason to fear becoming
pregnant, so using a condom didn't occur to me. Maybe I was hopelessly naïve,
but somehow the whole idea of sexually transmitted diseases had missed me.
I was seeking companionship with a nice single man, and I wasn't prepared
for the new reality." From
1990 to 2001, the last year with complete numbers, the cumulative number
of AIDS cases in adults age 50 and older has more than quintupled, to
90,513 from 16,288, represented largely by people infected early on who
are surviving longer because of improvements in antiviral medication. But
experts who study aging and AIDS are becoming increasingly concerned that
the problem of new infections in older adults may be more serious than the
statistics reflect. In September, the National Association on H.I.V. Over
50, an advocacy group in Boston, will hold its fifth conference, which is
expected to draw several hundred doctors, researchers, educators and
people living with the virus. The
topic is addressed in the current issue of The Journal of Mental Health
and Aging and in a special issue of The Journal of Acquired Immune
Deficiency Syndromes. Women
of all ages represent the fastest-growing segment of new cases of H.I.V.,
and the number of infections among older women is also rising rapidly,
authorities say. Though older women contracting H.I.V. are greatly
outnumbered by younger women, some experts and advocates are worried that
traditional attitudes about older women are keeping public health
officials, doctors and women themselves from understanding that the virus
does not discriminate by age. "Older
people are living longer and living healthier, and naturally that also
means that they will be entering the dating scene and participating in
some kind of sexual activity," said Jim Campbell, the president of
the National Association on H.I.V. Over 50. "But the older generation
has never been targeted for sex education, except for Viagra. You've got
Bob Dole talking about sex, but you never see a gray-haired person on a
prevention poster. No one wants to imagine their mother or grandmother
having sex. It's really frustrating, and it's ageism at its worst." Sexual
desire and activity do not end with a membership in AARP. But like Ms.
Fowler, many women who are in midlife or older were married and monogamous
during the 80's and 90's, when AIDS changed the rules of dating and sexual
relations. Even
when they are aware of H.I.V. and know to protect themselves, some older
women may be reticent to initiate a conversation about safer sex, much
less demand that a partner use a condom. Older
women may also be more vulnerable to infection than younger women, once
they are exposed to H.I.V. Physical changes that occur with menopause,
like vaginal dryness and thinning of the vaginal walls, can lead to
abrasions and tears that increase the risk of infection during unprotected
sex. After
an older woman contracts the virus, she may not receive a diagnosis for
years, until she develops a serious AIDS-related infection, like a deadly
form of pneumonia. But often, H.I.V. symptoms can seem similar to the side
effects of menopause and diseases related to aging, like diabetes and
Alzheimer's. Often it does not occur to doctors to inquire about an older
woman's sexual practices, much less test her for H.I.V. "Physicians
don't view middle-aged or older women as being sexually active, and as a
consequence, they miss symptoms and signs that may be indicative of H.I.V.
and don't bother ordering blood tests," said Dr. Sidney M. Stahl,
chief of the Behavioral and Social Research Program at the National
Institute on Aging in Bethesda, Md. "I
wouldn't want to lay full blame at the feet of the practicing
doctor," Dr. Stahl said, "but it's an opportunity for patient
education and treatment that is being missed." A
small group of organizations and advocates are trying to increase
awareness of H.I.V. and AIDS in men and women over 50, to prevent new
cases from creeping up each year. The Senior H.I.V. Intervention Project
in Fort Lauderdale, Fla., was created in 1997 to help bring H.I.V. and
AIDS awareness and education to those 50 and older in Palm Beach, Broward
and Miami-Dade Counties, where large numbers of older people live. Tens of
thousands have attended seminars and workshops conducted by the project's
volunteers. Miriam
Schuler, 83, began working with the project six years ago, handing out
condoms in malls, condominiums and at the beach and health fairs. "In
my old age, I have become known as the Condom Grandma," said Ms.
Schuler, who lives in Tamarac. "When I first found out that H.I.V.
could affect someone my age, my jaw dropped. But now my mission is to save
lives because I know that this disease is deadly and there is no cure,
whatever your age." Copyright
© 2002 Global Action on Aging
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