That’s Men: HIV does not discriminate against old age

Grace was dating again. George, a close family friend she had known for a long time, was starting to stay overnight more often. Because she was past childbearing age, Grace didn’t think about using condoms. And because she had known George for so long, she didn’t ask him about his sexual history. So, Grace was shocked when she tested positive for HIV.

That example is from the website of the National Institute on Aging in the US and it illustrates the need for sexually active older people not to drop their guard just because there is no longer any risk of an unplanned pregnancy.

In 2011 persons aged 50 or over accounted for 10 per cent of new HIV diagnoses in Ireland, according to the HSE’s Health Protection Surveillance Centre report for that year. Of the 33 people concerned, 16 had engaged in sex between males and nine in heterosexual sex. The route of transmission was unknown or not reported for the other eight.

I was struck by the age ranges involved in new HIV cases generally. Among heterosexuals, of whom just over half were women, the age range in men was 22-63 years and in women 16-61 years. The idea of a 16 year old becoming infected with HIV is shocking but it happens.

Among men having sex with men, the age of diagnosis ranged from 18-77 years. At both ends of the age spectrum, the diagnosis must have been devastating.

Injecting drug users accounted for only 5 per cent of new diagnoses. It may be that this population is frequently in touch with medical services which are on the alert for HIV infection and, therefore, diagnosis is likely to come at a much earlier stage.

Infected for years
A major problem with HIV in older people is that they can be infected for years without realising it and this puts partners at increased risk. Late diagnosis increases the chances of death from the illness.

Diagnoses are missed because doctors don’t always test older people for HIV and Aids and older people are less likely than younger people to be asked about their sexual activities. Older people themselves may assume that the signs of HIV are part of the normal process of ageing.

Because the risk of an unplanned pregnancy is no longer a worry, older heterosexuals having casual sex may be less likely than younger people to use a condom. Also, says the National Institute on Aging, "vaginal dryness and thinning often occur as women age. When that happens, sexual activity can lead to small cuts and tears that raise the risk for HIV/
Aids."

It is hardly a surprise that older people diagnosed with HIV/Aids can become very depressed. They may not have the same family support network as younger people and they may already have other diseases of ageing to cope with. If they are caregivers, living with HIV and Aids, especially if it has gone undiagnosed for a long time, can make that task even harder.

The situation is summed up by Dr Ofer Zur, a fellow of the American Psychological Association, as follows: "Older people have sexual relations. Married men have sex with other men. Older people are becoming infected at an increasingly alarming rate.

“Many find out only after they have developed symptoms of full-blown Aids and are seriously ill. Since they do not consult with their physician about their intimate relations, or they mistakenly think they cannot become infected, they do not get tested for HIV.”

The take-home message is that older people need to be just as alert as younger people to the risk of sexually transmitted disease. I wish it wasn’t like that but it is. In itself, it has nothing to do with good or bad, right or wrong: it’s just the way viruses and our bodies work.

The National Institute on Aging report is at iti.ms/16DtbdF and the report on Irish statistics in 2011 is at iti.ms/1cnUBsO

Padraig O'Morain (pomorain@yahoo.
com) is a counsellor accredited by the Irish Association for Counselling and Psychotherapy. His book, Light Mind - Mindfulness for Daily Living, is published by Veritas. His mindfulness newsletter is free by email.