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Older Women & HIV by Roberta Greenwood

HIV/AIDS is not a topic that middle-age and older women expect to discuss with their medical advisor, but according to the National Institutes of Health (NIH), it should be. Most new human immunodeficiency virus or HIV infections occur in younger people, but women 45 and older are being diagnosed with the virus at an increasing rate, and nationally the heterosexual HIV transmission rate among women older than 50 has doubled in the past 10 years.

Project Inform, providing HIV/AIDS education and advocacy since 1985, estimates that by 2015, half the number of people diagnosed with HIV in the United States will be over 50. Many of those will be “aging HIV patients” — those who contracted the disease when they were younger and have lived into their fifties with the support of treatment. But as the number of single people aged 55–64 in the U.S. has increased, the rate of HIV infection in this group has also climbed.

Fortunately, for now, HIV infection rates in women over 50 in the Seattle area do not seem to be following this national trend, staying steady at about six reported cases per year.

“Seattle is very different from the rest of the country,” says Joanne Stekler, M.D., MPH, deputy director of the Public Health–Seattle & King County HIV/STD program.

However, Dr. Anne Collier, professor of medicine and director of the University of Washington AIDS Clinical Trials Unit, adds that the potential risk is something that all sexually active women should consider. “There are lessons to be learned,” Collier says. “We may be lagging the national trends, but eventually those trends will show up here.”

AN OVERLOOKED POPULATION

Without the risk of an unwanted pregnancy, many older women are not practicing safe sex or even thinking about sexually transmitted diseases (STDs), says Amelia Vader, program manager of BABES Network–YWCA, a local program dedicated to providing peer support, education and advocacy to women and families affected by HIV.

One explanation for this may be a lack of awareness about the risks of contracting HIV/AIDS. Baby boomers, who came of age long before AIDS arrived on the scene in the early 1980s, may have sat out the height of the AIDS epidemic in monogamous relationships. If they have become sexually active later in life with new partners after a divorce or the death of a spouse, they may not be as aware of sexually transmitted diseases as younger adults who grew up with AIDS education.

A lack of basic knowledge about HIV and how it’s transmitted is very common among older patients, explains Collier. The fact that education, research and clinical trials are focused on younger members of society who are much more likely to become infected may contribute to this.

J. Edward Shaw, chair of the New York Association on HIV over 50, wants to see a multigenerational approach to research, education and behavioral coaching, and he encourages people to “speak out, speak up and speak often.” The first National HIV/AIDS and Aging Day held in September last year stressed the importance of education and HIV testing for older adults.

PEOPLE AREN’T TALKING OR TESTING

Often the responsibility to tackle the topic of HIV testing with older female patients rests with the primary care physician, and that conversation doesn’t always occur. Many health-care providers don’t consider HIV when diagnosing older patients who present with flu-like symptoms, says Collier — or they may be unsure of how to begin a discussion of risky sexual practices with a heterosexual older woman.

Vader adds that this delay in testing means older women may not discover they’re HIV-positive until the infection has progressed in their partners. Or their own HIV/AIDS symptoms might be misdiagnosed until the infection has reached later stages.

“If HIV testing was more routine, women would find out earlier,” states Vader. “And their health outcomes would be better.” The Centers for Disease Control and Prevention now recommends routine HIV screening for all adults up to age 64, and repeat screening annually for patients at high risk.

Still, the issue of HIV testing is sensitive and often remains unaddressed between doctor and patient. This reluctance to discuss sexual behaviors is often compounded by guilt, shame and a belief that HIV is a “young person’s disease.”

The lack of straightforward information available to aging women adds to the problem of early diagnosis, according to Barbara C. Phillips, MN, NP, and founder of OlderWiserWomen (www.olderwiserwomen.com). She writes on her website that a survey by Emory University of 514 women over age 50 found that “approximately 50 percent of [the] women believed that vasectomies and diaphragms prevent the spread of HIV.”

“Women also erroneously think they can’t get HIV if they are not engaging in behaviors they deem risky…HIV is a virus. It’s an opportunist. It does not care if you are male or female,” she notes.

INCREASED RISKS FOR OLDER WOMEN?

“Women need to be careful at viewing themselves at no risk,” cautions Collier. “We see some denial in older women — for instance, a ‘one-night stand’ years ago might carry a risk they’re unaware of. They might feel fine, but unless they’re tested, they won’t know if they’ve contracted the virus.”

While having unprotected sex puts women at high risk for HIV, so does a lack of knowledge when it comes to a partner’s sexual history. Many women don’t ask prospective partners about their past sexual experiences; newly single women often make the mistake of assuming the older men they are dating are “safe.”

Postmenopausal women may be more susceptible to infection when exposed to the virus because of changes in their tissues. The dryness and thinning of the vaginal walls and oral and anal cavities, due to reduced estrogen, provides increased opportunities for small tears and abrasions to occur, allowing the virus to enter the bloodstream during sexual activity.
Since HIV is a virus that damages the immune system, infected older women are not only likely to suffer from conditions directly associated with HIV, including AIDS, they are more susceptible to a host of other diseases.

The U.S. Department of Health and Services encourages women who test positive for HIV to be aware of other potential health problems such as heart disease, osteoporosis, cancer and autoimmune diseases, and to consult with their medical practitioners for appropriate and timely screening and treatment.

HAVE THE DISCUSSION

Just as older women may not be thinking about the risks of unprotected sex, many may not realize that HIV often presents no symptoms during the first stages of infection. According to the NIH, it may take as little time as a few weeks for minor symptoms to appear — or as long as several years for more serious indicators.

Often beginning as minor, flu-like symptoms, signs of HIV can include cough, diarrhea, swollen glands, lack of energy, fevers and sweats, repeated yeast infections, pelvic and abdominal cramps, sores in the mouth or vagina and short-term memory loss. Many women and their medical care providers mistake these symptoms as part of normal aging, and as a result are less likely to ask for testing or be advised to test for HIV.

Seattle resident Elizabeth, (name changed to protect her identity) was 45 when she was diagnosed with HIV in 2003. “I had been sick for a long time,” she explains. “I couldn’t sleep, had trouble breathing, had strange rashes. I’d gone to several doctors and specialists and never once was it suggested that I test for HIV. Finally my doctor put my symptoms together and scheduled a chest X-ray. I ended up in the critical care unit; I thought I was going to die.”
And while it’s true that health-care workers and educators sometimes fail to talk with older patients about HIV, women themselves appear even more reluctant to discuss an HIV concern or diagnosis with family members or friends.

“I don’t know to this day how I got HIV,” Elizabeth continues. “All the time I was sick, they told me I wasn’t at risk. I had been in a monogamous relationship. I only told my sister about my diagnosis and I’m still worried about how I’ll be judged by others. I’m still frightened I’ll lose my job.”

Once a diagnosis is confirmed, older women also tend to isolate themselves more than younger HIV-positive patients, and may struggle with severe depression, writes Phillips on www.olderwiserwomen.com. “Education is the key to break the stigma of this disease, regardless of age,” she adds. “It’s up to women to learn how to protect themselves.”

Elizabeth credits her “wonderful group of doctors” for the health she enjoys today. Still, living with HIV is a challenge and she encourages all women, regardless of age, to ask every sexual partner…have you been tested? “Women need to take care of themselves,” she warns. “Don’t take anything for granted.”

Roberta Greenwood is a frequent contributor to Seattle Woman.

TO LOWER YOUR RISK OF CONTRACTING OR SPREADING HIV:

• Use condoms (latex or polyurethane).
• Make sure you know your partner’s sexual history. Don’t assume — ASK!
• Don’t share needles or any other equipment used to inject drugs.
• Get tested if you or your partner had a blood transfusion between 1978 and 1985.
• Get tested if you or your partner at any time had an operation or blood transfusion in a developing country.
• Get tested per CDC recommendations if you are 64 years or younger.

Guidelines taken from www.AIDS.gov and www.cdc.gov.

©Copyright 2010, Caliope Publishing Company