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More Seniors Crushed by HIV, AIDS
By Kimberly Hayes Taylor, the Detroit News
March 25, 2004
Eighty-year-old Alice Renwick is one of the thousands of seniors who are dealing with HIV, as well as aging. She got the disease when she was in her 60s.
Because she was 65, Alice Renwick thought she was safe from HIV.
An infection control nurse and counselor, the Detroiter could easily describe how to use condoms at the methadone clinic where she worked. But five years into her own relationship with a handsome, flirtatious former heroin user, the couple stopped using condoms. They reasoned that she could no longer become pregnant, and condom use inhibited them. Less than two years later, he learned he was HIV-positive. Heartbroken and devastated when he died, Renwick secretly knew she probably was infected too.
Yet, even with throat infections and other illnesses commonly associated with HIV, no doctor ever suggested that she take an HIV test. She finally insisted that a test be administered and she tested HIV-positive in 1997. The 80-year-old estimates she has lived with the virus for 15 years.
"I have no one to blame," Renwick said. "I was alone, depressed, ego deflated."
The number of people such as Renwick who are 50 and older living with HIV/AIDS has doubled in Michigan in the past five years.
Some with HIV are living to an older age because of more effective drugs that extend lives 20 or more years, while other older adults are becoming infected after age 50.
On Jan. 1 1999, 1,135 Michiganians ages 50 and older lived with HIV/AIDS. By January 2004, that number had climbed to 2,394. They represent 21 percent of the 11,145 of the state's residents living with HIV/AIDS.
An increasing number of single older Americans are maintaining active sex lives because of healthier lifestyles and erectile dysfunction drugs such as Viagra. But those who don't use protection put themselves at risk for HIV.
Doctors and nurse practitioners have been slow to diagnose their gray-haired patients as they experience their first HIV-related symptoms. Uncomfortable with talking to older people about sex, doctors also rarely inquire about their patients' sexual behavior.
And because HIV/AIDS prevention messages are targeted to the young, some older adults assume the disease won't affect them and don't see the need for condoms.
"We have failed to put an older face on HIV/AIDS," said Frances Jackson, associate professor of nursing at Oakland University.
"Many agencies that work with HIV-positive clients have failed to address this."
Because HIV still mostly affects younger people, both the national Centers for Disease Control and Prevention and the Michigan Department of Community Health say they must continue to focus funding and programs on people 40 and younger.
But Stephen Karpiak, director for research at the AIDS Community Research Initiative of America, says HIV infection among older adults is an issue the nation must begin to address.
In New York City, where the initiative is based, people 50 and older represent 26 percent of the HIV population and people 40 and older represent 64 percent. Karpiak predicts that in 10 years, the majority of the city's HIV population will be 50 and older.
"Whatever happens here is going to happen every place else," he said. "We are a bellwether when it comes to the epidemic."
The problem is new even to agencies that work with the aging.
"I was surprised that elderly people were having unprotected sex and contracting this disease," said Paul Bridgewater, executive director of Detroit Area Agency on Aging. "We may have a far greater epidemic than we realize."
Creating awareness
Like Renwick, many older women seek love and affection. But unlike Renwick, many have no idea that men with whom they have sexual relations may also have sexual encounters with men, relationships with two or more women, seek gratification from prostitutes or inject drugs and share their needles. Little do they know that they face the same risks as their younger counterparts and their age doesn't protect them, say health practitioners and HIV/AIDS advocates.
"Older people do more in bed than just sleep and they do more at parties than drink iced tea," said Thea Simmons, director of community health promotion at Adult Well-Being Services in Detroit. "The numbers are not huge, but when you consider also that people aged 50 and up are the fastest-growing population. That's pretty striking and of serious concern."
In fact, the U.S. Census estimates the number of Michiganians 65 and older will increase from 1.2 million in 2005 to 1.4 million in 10 years and 1.8 million in 20 years.
Simmons' group was the first and only in Michigan to receive a federal grant to educate seniors and doctors on HIV/AIDS and substance abuse. Through "Knowledge is Golden," the group used real stories to lecture to more than 800 seniors and their health providers at churches, senior centers and recreational centers around Wayne, Oakland and Macomb counties.
But calls to many Metro Detroit assisted-living facilities about seniors and HIV resulted in abrupt "no's" followed by hang-ups.
Frances Jackson says it reflects the overall attitude about discussing seniors and sex.
"It's still a hidden problem," said Jackson, who researched older adults' knowledge of and susceptibility to HIV in Detroit from 2000 to 2003. "We don't want to think about older people having sex, so we don't want to talk about it."
Jackson's research showed that older adults realize that HIV is serious, but they don't believe it affects them. The men said they refuse to use condoms.
Talking it out
In his internal medicine and pediatrics practice at Wayne State University, Dr. Eric Ayers has become comfortable discussing sex with older patients. But some of his colleagues have trouble broaching the topic.
"Many physicians are not skilled and comfortable in addressing sexual health, and drug use and abuse patterns," he said. "There is a need to get comfortable in addressing and asking about sexual health and preferences. With the advent of Viagra, you have a population that is living their lives like they should. But you also have these older men now going out and engaging in activity with younger women, prostitutes etc. and then going back home."
Dr. Ruth Barnett, another Detroit internal medicine doctor, routinely asks new patients to test for HIV regardless of their age. "Some accept it," she said. "Others refuse."
At the Visiting Nurses Association of Southeastern Michigan, David Perkins said older adults and HIV is a "pretty big issue."
"It's about a fifth of our caseload, with the population increasing," said Perkins, who supervises clients in Wayne and Macomb counties. "We have to get the word out."
The issue has become difficult to ignore at the Oakland-Livingston Human Services Agency.
"We've seen a surprising jump in people over 50 who suddenly realize that their health problems are not aging problems, but they are infected," said Mallory Waldman, the agency's associate director for Home Support Services.
In 1993, when the agency began its HIV/AIDS program, none of its clients older than 50 were HIV-positive. Now, more than 15 percent are. With more frequent testing of older adults who complain of chronic illnesses, she expects to see more HIV-positive clients who are older.
The increase in HIV-positive clients 50 and older bothered her so much that Waldman decided to have a conversation with her own father.
"I had to say, 'Daddy, if you're dating again, you need to use condoms,' " Waldman said.
She encourages people to face this issue.
"Men and women are embarrassed to have white or gray hair and still be sexually active. There's a stigma there and it's more than the usual stigma of having HIV," she said.
Stigmas are barriers
The stigma is real, said Jane P. Fowler, founder of HIV Wisdom for Older Women.
"We face a double stigma. The stigmas: ageism and the idea that seniors should not be having sex or that seniors should not be injecting drugs," said Fowler, 68, a longtime journalist who contracted the virus after she began dating following a divorce from her husband of 23 years.
"We know that if someone has injected drugs in the past, just because a person turns 50, he or she is not going to stop. The problem is a myth that seniors aren't sexual beings anymore. So when they come up HIV-positive, people say, 'Oh, that can't be.' "
Fowler, who also co-founded the National Association on HIV Over 50, said she hears all kinds of stories about seniors in her travels around the nation. She hears about wives who remain disinterested in sex after their husbands took Viagra. He goes out with someone else and brings home HIV.
"You'd better demand it (condom use) unless you are in a mutually monogamous relationship where you know neither you or your partner has a sexually transmitted disease."
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