The first two times he went to the emergency ward suffering from shortness of breath, he was given a puffer. The third time, the 71-year-old was admitted and treated for a chronic lung disease. When he didn’t get better, medical staff performed a bronchial exam. Only then did they realize he had PCP – a type of pneumonia that is a hallmark of AIDS.
“Because he was over 65, I guess the doctors and nurses didn’t consider that he was gay, or at risk, or even sexually active,” says Dr Gordon Arbess, who presented his patient’s case to HIV rounds at St Michael’s Hospital.
The man hadn’t considered himself at risk for HIV and in hospital ha his first-ever HIV test. (Needless to say, he tested positive.)
“We health-care providers have to learn to take proper sexual histories of our older patients, and teach safer sex. We also have to inform patients about the importance of testing, where to get tested and the symptoms of HIV,” says Arbess.
As the AIDS epidemic wears on, HIV and aging is an emerging concern that raises troubling issues about treatment and prevention. For one thing, lack of awareness means people are going without treatments that prevent opportunistic infections like PCP. Studies indicate that of those people over 50 who test HIV-positive, more than a third had already progressed to AIDS at the time of diagnosis, compared to only five per cent of those under age 50, Arbess says.
Their condition is not identified earlier in large part because doctors and nurses just aren’t asking the right questions, probably because of stereotypes that older people are monogamous, or don’t have sex or don’t do drugs, he observes. Meanwhile, men over 50 may not seek diagnosis or treatment because of the secrecy, shame, denial and the stigma associated with HIV – which may be even more acute for that age group. According to Arbess, they are about one-sixth as likely to use condoms as younger men, perhaps partly because of difficulties keeping their erections.
The proportion of those over 50 with HIV is also increasing simply because PWAs are living longer. But little is known about the effects of antiretroviral drugs, since older people are generally excluded from clinical drug trials. As well, they may already have a compromised immune system and may suffer from pre-existing conditions like hypertension and coronary artery disease, and be taking medication which could interact badly with antiretrovirals. What is known is that AIDS, like some (but not all) other illnesses, progresses more rapidly in older people.
Meanwhile, people continue to be newly diagnosed at an older age. A recent University Of Toronto study estimates that about 7.2 percent of first-time HIV diagnoses among gay and bisexual men were among men over 50. The study, which looked at the period 1985 to 2000, estimated that men between 40 and 50 accounted for another 20 percent of first-time diagnosis.
Jim Truax, 65, is making it a bit of a personal crusade to draw attention to the issue of HIV and aging. “I joke that I want to start up a group called IFOF: Infected Fags Over Fifty.”
Truax himself was infected 10 years ago, at age 55, in the wake of his lover’s death from cancer. “What can I say? I was grief stricken, I was self-destructive.”
Not that he considered himself at risk at the time. He was in hospital for an unrelated illness and had self-declared as gay when he agreed to be tested just because, “It was time. I had tested negative the August before and was unconcerned.”
What did take Truax aback was the extent to which he was stigmatized for becoming infected. “I was amazed. [People said,] ‘How could you be so stupid at your age, you fucking fool.'”
There are lots of reasons people can be “so stupid,” he suggests. “If you don’t have sex all that often, you may just be thrilled to have it.” The result might be not insisting on safer sex. “If you have sex with older men, you may think they’re not a risk. Or you may just think, what the hell, it doesn’t matter.”
At a National Institutes Of Health conference this fall on HIV and aging, Truax says he was struck by one participant’s remark: “In the aging community, nobody cares about HIV. In the HIV community, nobody cares about aging.”
But educating older people about HIV could have a big payoff, he argues. “We have to figure out how to get to people most at risk – after a partner has died, say, or after divorce. And if we educate people over 50, they can have such a positive effect on others. I don’t know how many times I’ve heard young gay men say that they could tell their grandmother all kinds of things they couldn’t tell their parents.”
James Murray, as the AIDS Committee Of Toronto’s men’s community development coordinator, is working on a study on HIV and aging. He’s been interviewing HIV-positive and HIV-negative men over 40. Although he’s still compiling results, Murray notes there’s a wide range of attitudes.
Men who didn’t come out until their 40s, for example, haven’t had the experience of losing dozens of friends to AIDS.
“They’ve had no real experience of AIDS and what they feel mostly is, ‘Finally I get to lead the life I want and I want to have lots of experiences.’ For them, quality of life is paramount.”
For many, there’s no talk before sex. Instead, “people assume consent is implied and assume based on their own status – if they’re negative, they assume the other person is. If they’re positive, they assume the other man is too,” Murray says.
The US site www.hivoverfifty.org is a good source of further information.
Why you can trust Xtra
