June 5, 2008
The over-50 crowd relearns the ‘facts of life’
But Jane Fowler, retired journalist and now HIV/AIDS prevention educator, waves a red flag of caution for older singles. As founder and director of the national HIV Wisdom for Older Women, Fowler says that older single people -- "the fastest-growing segment of the dating services" -- may put themselves at risk by engaging in new relationships.
"The perception among both the older, public population and providers of health and social services is that seniors are not at risk for sexually transmitted disease, and as a consequence they have low awareness about HIV," Fowler said.
While HIV can pose health problems at any age, there is additional risk of having the virus as an older person. People 50 and older have less vigorous immune systems, and studies report that a majority of older adults have at least one or more chronic, age-related condition such as diabetes, arthritis or heart disease.
Fowler, a vibrant and active senior, has a personal commitment to HIV awareness for women older than 50: She was diagnosed HIV positive in the mid-1980s, having been exposed to the virus from an unprotected, heterosexual contact following her divorce.
"I am very concerned about women who, like me years ago, may be re-entering the dating scene after an absence of several decades," she said.
The Myth of Age-Related Immunity
According to Fowler, AIDS cases in women over age 50 are reported to have tripled in the last decade. Furthermore, the findings of the recent landmark ROAH ("Research on Older Americans With HIV") study by AIDS Community Research Initiative of America reported conclusive evidence that heterosexual contact is now the predominant mode of virus transmission.
"It is important to get the message out," Fowler said, "to both women and men over age 50, that unprotected sexual contact is a risk."
She said physicians do not typically discuss sexual behavior with their older patients, and this fosters a false sense of security that age imparts "some special kind of immunity." Plus, as people age and their immune systems weaken, many of the symptoms of age-related conditions, such as fatigue, dementia, weight loss and skin rashes, are very similar to those of HIV.
"When these symptoms are overlooked and attributed to natural aging, people who are HIV positive end up walking out the door," she said. "By the time they are diagnosed, they may be very ill and the window of opportunity to begin a therapy that helps prevent the virus from progressing to AIDS has already passed."
However, the problems of older people affected by HIV are "much more than physical ones and a regimen of taking pills," said Dr. Stephen Karpiak, lead investigator of the ROAH study. While the latest antiretroviral drug therapies allow people to live longer and healthier, their research data on the quality of life "paints an unsettling picture of the older person with HIV."
"More often than not, these older, HIV-positive adults are not only alienated by friends and family, they are afraid to disclose their status and have few places to turn to for help," said Karpiak, who described "help" as "the little things that make the big difference."
"We're talking about having someone to help buy groceries, take you to the doctor or to church," he said. "Our study reported just how disconnected these people are from society -- not just from their disease and its stigma, but also because they are old with this disease."
There's a stereotype of older people as being no longer productive, with failing mental competency and low value to society.
"There is this prevailing cultural attitude," Fowler recounted, "of 'so what if old people get HIV and die?' -- the assumption being that they have already lived their lives and are no longer productive contributors."
Need for Community Involvement
Dr. L. Jeannine Burkhardt-Murray, medical director of Harlem United Community AIDS Center, who helped Karpiak write the spirituality component of the ROAH study questionnaire, adds another dimension to the picture of social disconnection.
"Informal caregiving by friends and family is provided to millions of people in this country who have chronic illness, disability, are elderly or just need some day-to-day maintenance help," she explained. "But older people with HIV are often stepped over from potential sources of assistance because of persistent stigma and lingering misconceptions about virus transmission."
"[It is] so unfortunate because we know that people who have outside contact with the community -- not just the health arena of their doctors and nurses but with friends and family members -- these are the ones who do the best," she added.
Burkhardt-Murray said she has spent time over the years trying to engage local leaders of religious communities into supporting people with AIDS.
The dilemma, said Burkhardt-Murray, who lives and works in the largely African American community of Harlem, is that this is a population largely estranged from their family and friends who would turn to their church but find themselves unwelcome.
"For many years our clergy would not acknowledge this disease," she said. But after more then a decade of advocacy, she sees things changing and the church is now more willing to talk openly about HIV with its constituency.
This is good news since one of the ROAH findings, she said, is that many older HIV-positive people "expressed a positive benefit from a religious or spiritual affiliation."
An Intergenerational Approach to Breaking Barriers
For Ed Shaw, a tireless, 60-something HIV educator and chair of the New York Association of HIV Over 50, just "getting people to talk about this disease is an important step and can make a difference, one person at a time, to overcoming barriers."