FOCUS Aug-99 HIV in persons over 50+

A letter I opened eight years ago profoundly changed my life, transforming me from professional journalist—an interviewer—into media interviewee, from private person to public activist. The letter, from a health insurance company to which I had applied for new medical coverage, announced that I had been rejected because of a “significant blood abnormality” revealed in the routine test required by the company. The “abnormality” turned out to be HIV. Today I am a 64-year-old advocate for the cause of older people who are HIV-infected, people who have been largely overlooked by AIDS policy makers and researchers, health care and social service providers, community leaders, and educators. Isolated and ignored, this senior population faces a double stigma: ageism and infection with a disease that is transmitted sexually or through injection drug use. Adults age 50 and older account for about 11 percent of AIDS cases in the United States, and those numbers are expected to increase as people of all ages survive longer due to combination drug therapy and other treatment advances. Significantly, many more mid-life and older people who are HIV-infected but who have not developed AIDS-defining illnesses are not included in available statistics. Between 1991 and 1996, AIDS cases among people age 50 and over increased by 22 percent compared to an increase of 9 percent among people between the ages of 13 and 49. In addition, while gay and bisexual men remained the largest risk group with AIDS among people age 50 and over, AIDS cases in older women that resulted from heterosexual contact more than doubled during this period.1 Adjusting to Life with HIV After my HIV diagnosis in 1991, my family and the few friends I told were as shocked as I was because I didn’t fit an AIDS stereotype: I was not a gay man, I had never been an injection drug user, nor had I ever had a blood transfusion. I was, at the time of my diagnosis, a 55year-old career woman. I had lived a conventional, traditional life. I had been a virgin on my wedding night in early 1959, and I remained monogamous during 23 years of marriage. But, in the early 1980s, I was divorced and, for the first time in a quarter century, I was dating again. I didn’t consider myself to be promiscuous. I didn’t frequent singles bars. I went out with men my age, men I had known socially for some years and who, like me, had been married and were divorced. In those days, I knew little about HIV, only that a mysterious, fatal ailment was affecting the gay community. It didn’t occur to me that I would put myself at risk by engaging in unprotected sex with an attractive, intelligent, amusing man of many interests, who had been a close friend my entire adult life. But at the end of 1985, at age 50, I became infected with HIV. Following my diagnosis in 1991, I withdrew. I did not have the courage to put myself in situations that might be painful— in which I might experience discrimination, rejection, or prejudice. I lived as a semirecluse, spending time mostly with family and friends, who were supportive, compassionate, and non-judgmental. Four years passed. I took antiviral drugs, and I was blessed: I stayed well and free of opportunistic infections. Yet, I remained shamed and humiliated, still hiding my infection from all but my confidants. During this time, I researched HIV and AIDS and read all I could find on the subHIV in People Over 50