U.S. Health Watch

Entering her second year as a widow, my dear friend Rachael was past the several stages of grief and closing that chapter of her life; not an easy task but necessary for anyone who has survival instincts. She began dating again and I couldn?t have been happier for her. Sam was like a brother in a sense; a long time friend from our college days. At first it was dinner and theater tickets but soon developed into weekends at his Lake house.

Post menopausal, it didn?t occur to Rachael to consider condoms. And in retrospect, she would not have asked Sam about his sexual activities ? there were things our generation didn?t talk about. Therefore when her physician put her through a battery of tests because of her complaints regarding sudden weight loss and fatigue, she was shocked when she tested positive for HIV.

How does this happen at age 64, she wanted to know. But it?s a fact: anyone can get HIV/AIDS regardless of age from having unprotected sex, or sharing needles with an infected person. Latex condoms can help prevent, but not insure an infected person from transferring the virus to another. Because she did not know her partner?s drug and/or sexual history, she was at risk!

Best friends since high school Rachael confided in me. We decided to do an in-depth study of patients 55 years and older with HIV/AIDS. But we were immediately at a disadvantage because many, or should we say most, older people often mistake signs of this virus for the normal aging complaints — exactly as Rachael had and they are less likely to get tested. Besides, what patient in their senior years wants to discuss their sexual activity with a physician that?s probably half their age? Not!

We soon realized the myths and misconceptions regarding all elderly citizens help put the barriers in the way of diagnosis and treatment of HIV/AIDS. It is still assumed that old people live a life of celibacy and sobriety. Unfortunately, senior adults do not always conform to public images any more than teens do. Adding to this the doctor?s ?Don?t ask, don?t tell? posture and we?re at an impasse.

Statistics do confirm that older women are becoming infected at a higher rate than older men. Without the fear of pregnancy, the post-menopausal woman who is uninformed of the dangers may become more sexually active with more partners. Even her biology increases her risk as the vaginal walls thin and lubrication decreases; thus, the membranes are more likely to tear during intercourse, providing access for the virus.

But whatever the reasons? failure to communicate leads to failure of diagnosis in its early, most treatable stages. In many ways, HIV and old age converge and aggravate each other rather than conflict. For instance, memory loss may indicate AIDS-related dementia or Alzheimer?s disease. This distinction is important because dementia can be reversed; Alzheimer?s cannot.

As if the social isolation among senior citizens who have lost a spouse is not enough, it is multiplied many times over if their families realize they have HIV/AIDS. Shamefully, this virus entered a society already having little respect for its seniors. Most adult children lack the patience, and precious few want the burden of caring for their parents in their final years.

While it is common knowledge that the face of AIDS is changing with the greater proportion being people of color, women, children and heterosexuals — what we never hear is that the face is also aging.

2006 ? Esther Smith