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AIDS: A THREAT TO ELDERLY, TOO MANY DISREGARD HAZARDS OF UNPROTECTED SEX
By Stan Grossfeld, Globe Staff
June 4, 2001
Reprinted with permission of the Boston Globe
Evey Richardson is a Dorchester grandmother who used to think AIDS was for other people.
"When we were going together, I always used condoms," she said of her second husband, Edner Fleurinor, who died seven years ago. "But when we got married I felt, well, husband and wife, I didn't think he could've had the virus." Richardson was infected by Fleurinor, who succumbed to the disease. Now she is spreading the word: Older people must be as HIV aware as younger people.
Infection rates are growing rapidly among older Americans, but because doctors often don't associate AIDS and seniors, cases of HIV infection often are not diagnosed until the disease has progressed to AIDS.
"It took about six years to figure out what I had because I had diabetes, and some of the symptoms are the same," said Richardson, 56, who had a monogamous relationship with Fleurinor. "The doctor never asked me about my sex life when I was married or after I got divorced. In fact, I've never had a doctor ask me about my sex life. My husband was infected four years before we met. He never told me."
Twelve hundred miles to the south, in the senior haven of Deerfield Beach, Fla., 70 older men and women gathered at a senior center last month were asked to raise their hands if a doctor had ever asked if they were sexually active. No hands were raised.
That is the reason Sue Saunders, a 69-year-old grandmother living with AIDS, began speaking out for the Senior HIV Intervention Project, which attempts to educate older people in South Florida about the disease. When Saunders began experiencing chronic fever, sore throat, and rashes 12 years ago, she sought medical help. Doctors at first diagnosed a thyroid problem. She was finally tested for HIV two years later.
She has since found out that misdiagnosis happens all the time.
"A lot of these doctors see these women like their mothers. The idea of wrinkled people having sex just throws them for a loop," says Saunders. "They can't imagine it. They think we are dead from the neck down."
According to the Centers for Disease Control, the incidence of AIDS has been growing twice as fast among people 50 and older as among those under 50. Although nationally seniors aged 50 and older account for only 13.4 percent of all reported AIDS cases, that number has been rising for the past six years. Specialists say those figures are probably conservative because of a lack of AIDS testing of seniors.
"In the last 10 years, there has been a tenfold increase in the numbers of persons diagnosed at 65-plus with AIDS," according to a report by Marcia Ory of the National Institute on Aging and Karin Mack of the CDC. The report said about 10,000 people 65 and older had AIDS.
"Those numbers are relatively small, but to ignore small numbers is tragic," Ory said in a telephone interview. "Remember, in 1981-82 people weren't really aware of what was happening in the gay, white community."
People infected in their 30s and 40s are also living longer with the disease thanks to "cocktails" of antiviral drugs, and AIDS deaths have been declining since 1996, according to the CDC. About 80,000 people 50 and older have been diagnosed with the disease so far.
The agency does not keep national HIV statistics. It can take 10 years or longer to develop AIDS after contracting HIV.
Several factors are contributing to the increase in AIDS among the elderly, specialists say.
"With the popular use of Viagra, more seniors are sexually active," said Donna Gallagher, director of the New England AIDS Education and Training Center. "But several studies conclude older Americans don't use condoms. We've approached Pfizer about including information about safe sex, and they haven't done anything yet. We're still hounding them."
In South Florida, public health workers have noticed a new phenomenon: elderly men cruising for prostitutes. "It's true. They do that pretty much the first to the fifth of each month when their Social Security checks and pensions come in," said Gloria Scott, who works for the Florida Department of Health.
"Viagra has played a big role. It's why there's more out there. And the men don't like to use condoms," she said.
Although the virus is spread mostly through homosexual contact, young gays buoyed by the success of the AIDS cocktail are still taking risks selling sex to older men who don't use protection, Scott said.
Intravenous infection is also a problem among seniors, partly because of aging baby boomers still doing drugs, but also because of diabetics sharing insulin needles.
For five years, Saunders traveled South Florida giving speeches about AIDS and seniors until she fell ill and her weight plummeted to 96 pounds. Saunders, who was involved for 20 years with "the love of my life" in what she thought was a monogamous relationship, was exposed to the disease by him in 1989.
"It never ever even dawned on me that I might be exposed," she said. "No way. Never even thought about it. Safe sex. Oh, you never even think about that. It just never occurred to me."
She said that there has been little research on senior citizens and AIDS and that seniors face more complications because they are taking other medications.
"I was just skin and bones and I wanted to die," she said. She has since rallied and continues to speak out. "Now I tell physicians to put `Are you sexually active? Have you ever been tested for HIV?' on the first page of their questionnaire."
Marilyn Brand is a spunky 72-year-old HIV/AIDS health educator who is called the "Dr. Ruth of Palm Beach County." She recently gave a talk to single seniors over coffee and Danish at the Jewish Community Center in Boynton Beach, Fla. At one point in her talk, she held a sign that read, "Women want affection, not just erection." The AIDS rate for seniors over 50 in Palm Beach County is 16 percent of all reported cases.
As the seniors listened attentively, Brand told a cautionary tale: "They had a whorehouse across the street from Century Village," a huge retirement community in West Palm Beach. "A man went over there and had relations with a prostitute, didn't use a condom, and then came back and infected his wife. They both died."
Brand had brought props to her talk: female condoms, dental dams for oral sex, and OraSure, a toothbrush-like test to the gums for HIV that does not require a needle or a blood test and is both confidential and free in Florida.
"You go to the Health Department, they give you a toothbrush, swish it around your gums, and in three days you get the confidential results," she said.
An elderly man raised his hand. "At what point in the relationship do you give her a toothbrush?" he asked.
Brand said that in some retirement communities the ratio of women to men is 7-1. "The women like to go out and dance and go to dinner and a movie. If you are a man that can drive at night, you can have a smorgasbord of women. And a lot of women are having facelifts and getting gigolos.
"My biggest surprise is how innocent and naive the senior citizen popuation is," said Brand. "They don't realize that protection is the way they can avoid the HIV virus. They think that if they can't become pregnant, they don't need devices. And then they get tested for everything but HIV."
Lisa Agate, HIV/AIDS program director for the Broward County, Fla., Health Department said things need to change. "I think it's a health care emergency for health care professionals to wake up." Doctors, she said, "don't take full sexual histories, and you can't just write them off as an aging issue."
Because they have a lot of free time, Agate said, seniors are more sexually active than most people think. "The nursing home staff say, `You wouldn't believe how many times we have to pull people out of their rooms. They're in their rooms having sex.' It's a very big issue nursing home staffs have to deal with."
Data on sex among seniors are spotty, Agate said. Few surveys have been done. But from what she and other public health workers have witnessed she is "certain the numbers have gone up."
At the North East Focal Point Senior Center in Deerfield Beach, Broward County outreach worker Alyx Schaffer never says the word sex to the elderly, but she shows them something they've probably never seen. "I present to you reality, the female condom. Voila," she said to a group of seniors. "All human beings are all affected by AIDS."
Still, acknowledgement of a problem has been slow to emerge, which angers Saunders. "We're going to be in the same situation as Africa is in right now. We won't have any drugs. The government isn't going to have the money to pay for us. Why they won't put money in prevention is beyond me."
Richardson, the Dorchester grandmother of five, agrees. She has joined New England AIDS Education, a Brookline-based nonprofit advocacy group that will convene an HIV Over Fifty conference at the Newton Marriott on June 22-23.
"I talk to my girlfriends till I'm blue in the face about using condoms," she said. "I say, `See me. I got that through my husband.
"What I am angry about is I didn't have a chance to make a decision about safe sex. That grim reaping son of a gun had the virus for four years before he met me. I asked him about it and he said, `You're not gonna die, you just get sick once in a while.' "
Now, said Richardson, she is determined that her friends practice safe sex.
"I need to depend on you so that when I kick off you can make sure my hair's done right, my nails done right," she tells them. "I want balloons. I don't want anybody wearing dark clothes."
For more articles on the risk of HIV/AIDS to senior citizens, please visit:
Sex Medications Fuel HIV in the Elderly
The Beaumont Enterprise
By Kristina Herrndobler, The Enterprise
08/27/2006
While drugs such as Viagra and Cialis have rejuvenated sex lives, they also have helped usher the AIDS epidemic into a relatively untouched population segment: senior citizens.
Southeast Texas HIV/AIDS awareness workers say they have grown increasingly concerned about the virus - as well as other sexually transmitted diseases - spreading among seniors, including those in retirement communities and nursing homes…
http://www.southeasttexaslive.com/site/news.cfm?newsid=17115633
Older Women's Attitudes, Behavior, and Communication about Sex and HIV: A Community-Based Study
By Stacy Tessler Lindau, M.D., M.A.P.P., Sara A. Leitsch, Ph.D., Kristina L. Lundberg, B.S., And Jessica Jerome, Ph.D.
Journal of Women's Health
Volume 15, Number 6, 2006
Although older women in this community based sample were sexually active, engaged in potentially risky sexual behavior (i.e., the majority did not use condoms), and believed that physicians should address issues of sexuality, insufficient attention was paid to their sexual health… This community-based study corroborates findings from the clinical setting and begins to address the lack of knowledge about older women's sexual behavior, attitudes, and interaction with physicians about sex and sexual risks. Download PDF
Sex Ed for Seniors: You Still Need Those Condoms
U.S. News & World Report
http://health.usnews.com/usnews/health/articles/070805/13senior.htm
HIV Over 50
AARP
http://www.aarpmagazine.org/lifestyle/relationships/hiv_over_50.html
Greatest Generation Learns About Great Safe Sex
The New York Times
http://www.nytimes.com/2007/02/14/nyregion/14sex.html
NYC Offers Condoms, AIDS Education to Seniors
WCBS-TV
http://wcbstv.com/topstories/condoms.aids.new.2.245979.html
More Seniors Needing Assistance in Living With HIV
The Body
http://www.thebody.com/content/art40432.html
Challenging HIV and AIDS
AARP
http://www.aarpsegundajuventud.org/
Seniors Keep Romance Alive
CBS News
For more information on HIV/AIDS and senior citizens, please visit the following organizations' websites:
Centers for Disease Control and Prevention (CDC) National AIDS Hotline
1-800-342-AIDS (operates 24 hours a day, 7 days a week)
1-800-344-7432 for Spanish
1-800-243-7889 (TTY)
http://www.cdcnpin.org/scripts/population/elderly.asp
Senior HIV Intervention Project (SHIP)
http://www.browardchd.org/AIDS/ship.htm
National Association on HIV over Fifty
http://www.hivoverfifty.org
National Institute of Allergy and Infectious Diseases (NIAID)
301-496-5717
http://www.nia.nih.gov/HealthInformation/Publications/hiv-aids.htm
AIDSinfo
1-800-HIV-0440 (1-800-448-0440)
Monday to Friday, 12:00 p.m.
to 5:00 p.m. Eastern Time
1-888-480-3739 (TTY/TDD)
http://www.aidsinfo.nih.gov
Senior Action in a Gay Environment (SAGE)
212-741-2247
http://www.sageusa.org
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