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HIV
Up among People Over 50
By
Jung Eun Lee,
The Atlanta Journal-Constitution
June
29,2008
US
Dr. Veronika Steenpass recalls the time two years ago when an 81-year-old woman arrived at Grady Hospital complaining of unexplained weight loss.
The woman had lost 20 pounds in six months. A thorough round of lab tests was ordered. When the results of the tests came back, Dr. Steenpass had to tell a woman old enough to be her grandmother that she was HIV-positive.
In the last 10 years, the number of newly diagnosed HIV/AIDS cases in Georgia in people over 50 has nearly doubled, according to data from the state Department of Human Resources (DHR) Division of Public Health. In 1998, there were 189 new cases of HIV/AIDS in that age group and by 2007, the number was 341, which was 15 percent of all newly diagnosed HIV/AIDS cases in Georgia.
"What accounts for these numbers is a mixture of patients infected previously who are presenting late in the course of the disease as well as patients with high-risk activities who are getting infected later in life," said Dr. David Rimland, chief of infectious diseases at the Atlanta VA Medical Center and a professor of medicine at Emory.
At the Atlanta VA Medical Center HIV Clinic, which serves a predominantly male population, Rimland said in the last few years patients over 50 have accounted for about two-thirds of new HIV/AIDS cases.
Similarly, in the first three months of this year, 38 patients at Grady Hospital were newly diagnosed with HIV/AIDS. Fifteen of these patients, nearly 40 percent, were over 50.
"In this age group, they get very little information about HIV and how to protect themselves," said Steenpass, who is finishing her residency at Emory.
That might be changing. AID Atlanta, a nonprofit that offers HIV/AIDS services, is getting more calls for educational programs for seniors at high-rises, nursing homes and church settings, said Neena Smith-Bankhead, director of education and volunteer services.
The CDC currently recommends HIV screening in individuals up to age 64. However, a study published in this month's Annals of Internal Medicine found that screening may be cost-effective up to age 75.
"Age alone should not be a contraindication for HIV screening," said the study's author, Dr. Gillian Sanders, associate professor of medicine at Duke University.
She said increased screening in older adults could reduce the stigma of getting tested and reduce transmissions by allowing affected individuals to modify their behaviors.
Some patients who know they are HIV-positive may continue to participate in high-risk activities, Rimland said. "You'd like to think that everyone who is HIV-positive would be careful with their actions, but unfortunately that's not true." He stressed the importance of safe-sex practices in any age group.
When it comes to HIV screening, seniors are the least likely of all age groups to get tested.
"They may not realize that unless they ask specifically for the HIV test, they won't get the test done nor will they know their HIV status," said Teresa Kochinsky-Bell, health program representative for the Fulton County Health Department's Communicable Disease Prevention Branch. "Just because the doctor draws your blood doesn't mean they're testing you for HIV."
The state of Georgia requires patients to sign a formal written consent form before they can have HIV testing, with the exception of pregnant women.
The CDC HIV testing guidelines, however, recommend "opt-out" HIV screening, which means health care providers don't need separate consent to test for HIV. The patient still has a right to decline.
"A lot of times, HIV and other STDs (sexually transmitted disease) just aren't discussed between older patients and their doctors," Steenpass said. "It may be from a stereotype that older people are not sexually active."
Like many stereotypes, this one is not true. Almost three-quarters of 57- to 64-year-olds reported that they were sexually active, according to a study published last year in the New England Journal of Medicine. As people aged, sexual activity did decline, though even up to age 85, a quarter of individuals in the study reported being sexually active.
Media advertising of erectile dysfunction treatments such as Viagra and Cialis has brought the subject of sex and older people into mainstream conversation.
"When you're already talking to your 75-year-old patient about erectile dysfunction, wouldn't that be a great time to talk about their sexual behavior and assess their risk for STDs," said Dr. Ted Johnson, a geriatrician at the Atlanta VA Medical Center and an associate professor of medicine at Emory.
Johnson's average patient is 80; few studies characterize sexual behavior in this patient population.
"There is still no good national campaign out there to alert older people they're at the same risk for contracting HIV if they don't understand transmission and prevention," said Jane Fowler, 73, a retired journalist and founder of the advocacy organization HIV Wisdom for Older Women, based in Kansas.
Fowler, like many in her age group, was already in a committed relationship when the first cases of HIV/AIDS were reported. After the end of a 24-year marriage, Fowler began a relationship with a friend she had known and trusted her entire adult life, and from whom, she later found, she contracted HIV.
"The fact is that none of us know the sexual history of anyone but ourselves," Fowler said. "Older people think this is just a disease of young people, but that's not the case."
Several studies of women performed at Grady Hospital found that older women knew less about HIV/AIDS than their younger counterparts and had little interest in knowing their HIV status.
"Because older women are postmenopausal, they know they can't get pregnant, but they also think they can't get anything," said Lisa Bernstein, assistant professor of medicine at Emory University, who authored the studies. "We as health care providers are not educating this population, so their perceived risk is very low compared to the reality."
Barbara Revell, 53, of Cobb County, however, said many people over 50 do know a lot about HIV/AIDS and do take precautions if they decide to engage in sex.
"I saw people I knew die from HIV at the start of the epidemic, and that's the best education a person could get on the need to protect themselves," she said.
Revell has been on the dating scene in Atlanta for nine years and heads a social club for singles over 40. She said she has been tested in the past and sees it as something that should be as routine as having a mammogram.
Last year's DHR state data from newly diagnosed patients over 50 showed that twice as many men as women were infected.
The majority of these people, of either sex, could not identify any behavioral risk factor in themselves or their partners, meaning they did not know how they got the virus.
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