An Overlooked HIV Population
Who do you think of when you think of people infected with HIV?
Gay men? Youths? Small children infected by their IV-drug-using mothers and fathers? Maybe. Do you think about grandparents? Men in their 60s? Heterosexual women in their 50s? Maybe not.
The fact is that growing numbers of older adults are infected with HIV.
According to the Centers for Disease Control and Prevention, in 1995 about 10% of all people who received a diagnosis of AIDS were older than 50. Of these individuals, 14% were older than 65. (There may be a larger number of undiagnosed HIV infections among seniors than among any other age group, experts say.)
Seniors themselves do not think they are at risk for HIV, nor does society at large.
Adults older than 50 tend to use condoms less frequently than do younger adults, are less likely to test for HIV, are mistakenly perceived as sexually inactive or non-drug taking, and their physicians may miss the connection between their reported symptoms and AIDS. Yet AIDS prevention efforts consistently overlook seniors as a population to target. They are a forgotten segment in HIV prevention.
In a discussion of HIV and older adults, it is also imperative to give special attention to women. Post-menopausal women are at higher risk for HIV because the thinning of the vaginal lining produces a greater potential for infection during heterosexual intercourse.
Some older women also feel that, since they cannot become pregnant, using condoms is unnecessary. They do not consider themselves at risk for HIV or any other sexually transmitted disease.
While older adults with HIV face many of the same challenges as others with the disease, there are some differences. Older adults are more isolated. Friends die, decreasing their social circle, and it becomes difficult for them to find the support of others in their age group.
And because there are few support services that address the needs of the senior population, people without social support must carry the stigma of being HIV-positive alone, negatively impacting an already vulnerable immune system.
The shame here is the proof that psychosocial support extends life and lowers mortality rates in people with terminal illnesses.
In addition to the isolation faced by seniors with AIDS, there are other challengers unique to this age group. Disclosure of HIV status is difficult for almost all infected individuals, and this is no different for seniors. Some older adults with HIV may have to disclose their status to their parents, as well as their adult children. For some, this disclosure also means coming out as gay.
Others find that being HIV-positive is not their primary health concern. Some seniors have already been found to have cancer, heart or kidney disease, or may have suffered strokes. Obviously, this increases the complexity of their medical care and, once again, narrows their choices in finding experienced providers.
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Seniors may also struggle with the “issues of entitlement” and guilt. These individuals feel they are “taking” services from a more deserving younger population who have not yet “had a life.”
We must increase our efforts to reach out to older adults. To those at risk, it must be through our efforts in HIV prevention. To those who are already infected, it must be through community outreach to educate them about the support services available.
After six years of facilitating a support group for older adults with HIV--and seeing hundreds of individuals with HIV in all age groups--I have observed that seniors cope with their HIV diagnosis with more courage than their younger counterparts. Seldom have I seen seniors with a new diagnosis of HIV stop their lives, quit their jobs or enter deep depression and denial.
They grieve, of course, but they shoulder the burden, they adapt, adjust and move on. Perhaps this is because they have already started to address issues related to the acceptance of life and have begun to develop a point of view about death.
It is our obligation to rededicate our commitment to outreach and education for these courageous seniors who are confronting AIDS. Older adults carry our history, and our society is judged by how we treat our elders. We must not allow this segment of the HIV population to be forgotten.
* Joni Lavick is the clinical director of mental health services at the L.A. Gay & Lesbian Center.
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Information on Aging
* Los Angeles County Department of Community and Senior Citizen Services (Older Workers Program): (213) 738-2624
* Adult Protective Services (to report elder abuse or self-neglect abuse): (800) 992-1660
* National Council on the Aging
(800) 375-1014 (213) 365-0700
* California Department of Aging
(916) 322-3887
* UCLA Center on Aging
(310) 794-0676
* Administration on Aging
Department of Health and Human Services
330 Independence Ave. S.W.
Washington, D.C. 20201
* National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
* American Parkinson’s Disease Assn.
(800) 223-2732
* Alzheimer’s Assn.
(800) 272-3900
(213) 938-3370
