STD Quarterly

Senior citizens and HIV: Age is no defense when it comes to infection with AIDS

While senior citizens may be wise in many subjects, when it comes to knowledge of HIV risk, they may be operating in the dark. Results of a survey of women ages 50 and older indicate seniors have limited knowledge when it comes to sexual transmission of HIV.1

Only 13% of the 514 women surveyed knew that condoms provide effective protection against HIV About half of the women believed vasectomies provide some protection against HIV, while half of the women said diaphragms prevent the spread of the deadly disease. None of the women surveyed correctly answered all of the nine survey questions.1

According to the Centers for Disease Control and Prevention, Americans ages 45 and older accounted for 26% of new diagnoses from 2001 to 2004; 18% of those diagnoses occurred in those ages 45-54.2

"Unfortunately, sexually transmitted diseases are a reality, no matter what age you are," says Lisa Bernstein, MD, assistant professor of medicine in the Emory University School of Medicine in Atlanta and lead author of the survey article. "If you are not taking steps to protect yourself with barrier protection, you are going to be at risk," she adds.

The Senate Special Committee on Aging held a hearing last May to explore the rising rate of HIV infection in seniors older than age 50. Among the factors contributing to the rise in HIV among seniors identified during the hearing include:

  • lack of condom use due to the elimination of pregnancy threat after menopause;
  • reluctance of health care providers and seniors to discuss topics of a sexual nature;
  • lack of awareness of HIV/AIDS and prevention due to generational issues;
  • success of antiretroviral therapy helping HIV-positive people live longer.3

Although older Americans account for a relatively small proportion of new HIV infections, it is important that seniors get information and services to help protect them from infection, says Jennifer Ruth, CDC spokeswoman. Many older Americans face unique prevention challenges, such as a discomfort in discussing sexual behaviors with physicians and partners, as well as a discomfort in discussing condom use, she observes.

"While risk behaviors are more common among younger adults, doctors should talk with all patients about sexual and drug-related risks," says Ruth. "Regardless of age, prevention efforts must continue to focus on changing risk behaviors that lead to HIV infection and helping those living with HIV learn their status."

Seniors are active

Findings from a 2004 study by the AARP show that many older adults are engaged in regular sexual activities and count it as one of life’s important pleasures.4 About 1,700 adults ages 45 and older were surveyed on attitudes and other factors affecting their health, sexuality, and quality of life. The study served as a follow-up to an initial 1999 look at senior sexual health.5

When AARP conducted its 1999 study, the erectile dysfunction drug sildenafil (Viagra, Pfizer, New York City) had been on the market less than a year; just 5% of men reported using it. Two more treatments have followed: vardenafil hydrochloride (Levitra, Bayer Pharmaceutical; West Haven, CT) and tadalafil (Cialis, Eli Lilly; Indianapolis). In the 2005 study, about 20% of men said they had used some type of drugs or treatments to address problems with sexual performance. Most men said the treatments had increased their sexual satisfaction. Women in all age groups reported that their own sexual satisfaction was enhanced by their partners’ use of the drugs.3

Be prepared to ask

Responses to the 2005 AARP survey indicate seniors have a greater openness to speaking to health professionals about sex. More seniors reported health professionals as their leading source of sex information (37%; up from 26% in 1999).However, the survey conducted by Bernstein’s group showed that health professionals ranked last when it comes to seniors’ information sources for information about HIV/AIDS; television was the most commonly identified source of information.

Be prepared to broach the topic of sex with your 50-plus patients, says Bernstein. Take a very good sexual history, she advocates.

When speaking with a patient about sexual activity, Bernstein may follow questions about a patient’s lifestyle, such as queries about drinking and smoking, with such questions as, "Are you married?" or "Do you have a significant other?" If they are married, she will ask, "Are you still engaging in sex?" and if they are not married, she will say, "If you have a significant other, are you having sex with that person?"

Bernstein approaches her questions about HIV in a nonjudgmental way, saying that she asks them of everyone due to the reality of the HIV/AIDS epidemic. She asks whether the patients have been tested for HIV and if they know the HIV status of their partner.

"I tell them the only person who is going to protect them is them and that they have to take this responsibility to have this conversation with their partner and to protect themselves from any potential infection," Bernstein notes.

Providers need to be watchful for such symptoms as weight loss, wasting, fatigue, and dementia; health care providers often misdiagnose HIV/AIDS in older people since such symptoms occur naturally in older people or can indicate Alzheimer’s disease.6 Women who present with such symptoms such as hot flashes, night sweats, and depression may be treated for menopausal symptoms rather than tested for HIV infection.6

Stay vigilant

The important thing to realize is that 50-plus patients still are sexually active, Bernstein says. The problem is that they don’t realize that they’re at risk for HIV/AIDS, she notes.

"Many of these women have no knowledge because they think of AIDS as something that affects their children or grandchildren and not themselves," she notes. "Their hypothesis is that since they are postmenopausal, they can’t get pregnant, and they think they can’t get anything."

Explain what steps patients can take to protect themselves, such as barrier protection, states Bernstein.

"Sometimes it is embarrassing and I have had patients turn bright red on me, but they walk out of the office with a list of condoms that they can buy," she notes.

References

  1. Henderson SJ, Bernstein LB, George DM, et al. Older women and HIV: How much do they know and where are they getting their information? J Am Geriatr Soc 2004; 52: 1,549-1,553.
  2. Centers for Disease Control and Prevention. Trends in HIV/AIDS diagnoses — 33 states, 2001-2004. MMWR 2005; 54:1,149-1,153.
  3. U.S. Senate Special Committee on Aging. Chairman Smith calls attention to HIV threat among America’s seniors. Press release. May 12, 2005. Accessed at: aging.senate.gov/public/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=524&Month=5&Year=2005.
  4. American Association of Retired Persons. Sexuality At Midlife and Beyond. 2004 Update of Attitudes and Behaviors. Washington, DC; 2005.
  5. American Association of Retired Persons. AARP Modern Maturity Sexuality Study. Washington, DC; 1999.
  6. The Foundation for AIDS Research. Seniors Hidden HIV Risk Group. Accessed at: www.amfar.org/cgi-bin/iowa/news/record.html?record=105.