Friday, 9 November 2012

Aged Women: At Risk for HIV Infection

In the US, HIV began mostly as a disease of young men. Today, however, the epidemic affects both women and men of all ages, including older women (age 50 and over). While 50 may not seem ‘old,’ it is often the age currently used by organizations that keep track of health-related statistics (e.g., the Centers for Disease Control and Prevention, or CDC).

While most new HIV infections are still in younger people, women over 50 are getting HIV at an increasing rate. In addition, many people living with HIV (HIV+) are living longer, healthier lives because of the success of newer HIV drugs. As a result, it is estimated that by 2015, almost half of all people in the US living with HIV (HIV+) will be over 50.

Older Women: An Overlooked Group
Women over 50 are frequently ignored in discussions about HIV prevention and care. It is important that this change, and that older women, their health care providers, and their families understand how the virus can and does impact this group.
  • The population of women over 45 living with HIV and AIDS in the US has been steadily growing in recent years. According to the CDC, the number of women over 45 living with HIV increased 22 percent from 2006 to 2008. Moreover, the number of women over 45 living with AIDS more than tripled between 2000 and 2009. It is important to consider that these reported numbers are likely smaller than the real number of women over 45 living with HIV/AIDS, since many people do not get tested for or diagnosed with HIV even though they may have been HIV+ for several years.
  • Despite the myth that older people do not have sex, many older women are sexually active. One study showed that close to three out of four people aged 57 to 64 had had sex in the last year, as had over half of those aged 65-74. Older women can actually be at greater risk for HIV infection during sex than younger women because of thinner vaginal walls and dryness that can cause tears in the vaginal area.
  • Many women over 50 are thinking about dating and becoming sexually active after the end of a long-term relationship or the death of a partner. Women who have been in monogamous relationships for many years and are now becoming sexually active with new partners may not see themselves as at risk for HIV. They may feel uncomfortable discussing sexually transmitted diseases (STDs) or safer sex with their partners or health care provider, and may not know how to protect themselves.
  • Many older women have gone through menopause and therefore do not think about using condoms because they do not need them for birth control. However, condoms can prevent the spread of STDs at any age. For more, see our info sheet on Negotiating for Condom Use.
  • Older HIV+ women are more likely to be invisible and isolated, keeping their disease hidden from friends and family. They are afraid to admit they have HIV because of the stigma.
  • Due to the lack of awareness of HIV in the older population (women in particular), this age group has been left out of educational prevention programs, research, and clinical trials
  • Many older women inject drugs, and are therefore at risk of getting HIV from sharing needles and other drug equipment. The CDC reports that injection drug use is the cause of about 16 percent of new HIV diagnoses in people over 50.
  • Older individuals are not routinely tested for HIV. This occurs in part because health care providers often feel uncomfortable asking older patients about their sexual behaviors. It also occurs because health care providers, like the general public, are often under the misconception that older women are not sexually active. Therefore, when faced with an older patient with flu-like symptoms, many health care providers do not think to test for HIV. This means that older women are often misdiagnosed and/or not diagnosed with the virus until they have reached a more advanced stage of HIV disease.

What To Do?
There are many things older women and the community at large can do to prevent the spread of HIV in this population and help older women live healthfully in their second half of life.

Understand HIV: Knowledge is Power
First, it is important for older women to have correct information about what HIV is and how it is spread (transmitted) from person to person. To learn more, see TWP’s What is HIV? and HIV Transmission info sheets. If you have heard rumors or stories about HIV, check out our Myths and HIV info sheet to separate fact from fiction.

Age does not protect you from getting or spreading HIV. Practicing safer sex can reduce your risk of getting HIV. So can using clean needles when injecting drugs. For more information, see our Safer Sex and Cleaning Works info sheets.

Getting Tested
It is important to prevent new HIV infections in older people by making sure that they understand the need for routine HIV testing and early diagnosis. The CDC now recommends that screening for HIV infection be performed routinely for all patients aged 13--64 years in all health-care settings. Additionally, it recommends that all health-care providers encourage patients and their prospective sex partners to be tested for HIV before initiating a new sexual relationship.

If you may have been exposed to HIV, no matter what your age, it is important that you get tested for HIV. You have a better chance of staying well if you are diagnosed sooner and get good medical care. If you do test positive for HIV, there is no need to give in or give up (please see our Did You Just Test Positive? info sheet). With a good attitude and a good HIV drug regimen, you may be able to live with HIV well into old age. If you are negative, you can learn what you can do to stay that way. Lastly, knowing your HIV status is an important way to prevent the spread of HIV to others you care about.

Unfortunately, older people are often a forgotten audience for HIV informational programs. We do not usually see the face of an older person or senior citizen on HIV prevention posters. It is important for health care and social service providers to recognize and accept that their aging patients and clients are at risk for HIV. It is also important for providers to ask older patients about their sexual and drug histories.

It is just as important for older women to tell their health care providers about any injection drug use or unsafe sexual experiences, as well as any physical or sexual violence in their lives. Also mention any other events or situations that you think may have put you at risk for HIV, such as getting a tattoo without being sure that the tattoo artist was using sterile disposable needles. Giving your health care provider accurate information is the best way to protect your health and ensure that you get good medical care, even if it feels awkward or uncomfortable to do so.

Older Women Living with HIV
There are several ways in which living and aging with HIV are different compared to aging while HIV-negative. Many of the health problems of older people appear to happen earlier and progress faster in HIV+ people. If you are an older HIV+ woman, you may be interested in our Menopause and HIV and our HIV and Aging info sheets.

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