Middle-aged and older women are frequently ignored in discussions of HIV prevention and care. In fact, they may be the most overlooked portions of the entire population. For these reasons, it is necessary that everyone – the women themselves, their health care and social services providers, and their families – understand how the virus can and does impact this senior age group.

• Statistics say that about 18 percent of AIDS cases in the U.S. female population are in women older than 50, with women of color representing the largest portion. The number of AIDS cases in aging women has increased nearly five times the rate in 1995, and heterosexual HIV transmission rates among women older than 50 may have increased as much as 100 percent.
• Despite the myth that older people don’t have sex, many senior women are sexually active, and some are injecting-drug users. So, they can be at the same risk for HIV infection as younger women, depending on their behaviors.
• The number of 55-to-64-year-old single persons in the U.S. increased about 1.5 million in the late 1990s, the majority being women. If you are in this group and are thinking about dating, you need to be aware of what’s out there now. There is HIV, and there are other sexually-transmitted diseases (STDs).
• Elder women with HIV usually are invisible and isolated, keeping their disease secret from friends and even family. They are afraid to admit they have HIV because of the stigma. Common thinking in our society is that older women, especially grandmothers, should not be having sex or doing drugs.
• Due to the lack of awareness of HIV in the older population (women in particular), this age group has been omitted from educational prevention programs and other intervention efforts, research, and clinical trials.
• Aging individuals are not routinely tested for HIV. This means that older women are often misdiagnosed and/or not diagnosed with the virus until a late stage. Therefore, they can become ill with AIDS-related complications and die sooner than younger women.

It’s not often that you see the face of a senior woman on an HIV prevention poster – older women are often a forgotten audience for informational programs. Thus, they must be given information to understand the basics of HIV transmission. Elder females are frequently in denial about the disease. They believe that they are not at risk because of their age. They need to understand that they should not have unprotected sex: unless they are in a mutually monogamous relationship in which neither partner is infected with an STD. They also should never share needles, even for injections such as insulin.

• Women who have gone through menopause often don’t think about condoms because they do not need them for birth control. However, condoms can prevent STD transmission at any age. A couple needs to discuss “safe sex” in advance of intimacy, before passions affect good judgment. If a partner refuses to use protection, a woman might want to think about how much he truly cares for her.
• Remember that no one really knows the sexual or drug history of anyone else. A woman could be unaware that her new or old partner (a lover, a husband) might be having experiences with other women, including prostitutes. Her partner could also be having sexual encounters with men who are gay or bi-sexual, or be secretly injecting drugs and sharing needles.
• For aging women, there is another consideration. Vaginal walls become thinner and can tear more easily, and there is a decrease in the fluids that lubricate. This can put an older woman at higher risk during unprotected sexual intercourse.
• Health care and social service providers need to recognize and accept that their aging female patients and clients can be at the same risk for HIV as the young. It’s said that providers don’t like asking patients who look like their parents or grandparents about their sex lives or drug use. But providers must overcome any reluctance or embarrassment and take sexual and drug histories. Providers also can offer information on transmission and prevention and suggest HIV testing.

With senior women, the question frequently is, “Is it HIV or is it aging?” This is because many symptoms of the virus are similar to those associated with growing older such as fatigue, weakened immune system, skin rashes, gastro-intestinal problems, depression, forgetfulness, bone loss, diabetes, cancer, and cardio-vascular ailments.

The aging process itself lowers energy levels, restricts social encounters, and causes decreased physical and mental capabilities. This means that older women with HIV may suffer more emotional problems and physical stresses than do others.

Stigma can also make things very difficult. There is the stigma of living with HIV disease, which can be considered “dirty” or disgraceful. There also is the stigma of ageism. This is because in U.S. society in general older people are subject to discrimination.

For these reasons, it is important for providers to keep in mind the concerns and sensitivities of their older female patients and clients. These women deserve special care and attention. They have the right to be treated with dignity.

Many seniors are already taking medications for age-related ailments. It is important to know if HIV drugs can interact with these medications, such as those used for high blood pressure or high cholesterol. Seniors should speak to their doctors about possible drug interactions. They should also be aware of the increased risk of heart disease and diabetes caused by HIV and HIV drugs.

Senior women are less likely to find support among family and friends for a couple of reasons. First, they are ashamed and hesitate to tell anyone that they have HIV. Second, they are seldom comfortable in support groups and therefore aren’t inclined to join them. However, it is important for seniors to seek out professional support so depression does not set in. A mental health counselor, health educator, or peer counselor can help. These people have a great deal of knowledge to share. Some peer counselors may have had similar experiences and can help develop good coping

Age offers no “vaccine” in regard to transmission of HIV. The virus infects because of what you do, not who you are or how old you are. It is important to find out your HIV status to get the care and treatment you need. But since many geriatric doctors are not looking for HIV among their patients, the diagnosis often comes at a later stage of disease progression.

If you may have been exposed to HIV, no matter what your age, look into HIV testing. You have a better chance of staying well if you are diagnosed sooner rather than later and if you get good medical care. If infected, you do not have to give in to the virus, or give up. If you have a good attitude and take care of yourself, you may be able to live with HIV as a chronic disease, well into old age. And if you are negative, you can learn what precautions you need to take to stay that way.

1		Levy, J., et. al., Guest Editors. (2003). The graying of the AIDS epidemic: HIV/AIDS and people age 50 and older. JAIDS (Journal of Acquired Immune Deficiency Syndromes), 33(Supplement 2).
2		AIDS Community Research Initiative of America. (2004). Over 50 with HIV. ACRIA Update, 13(3). 1-18.
3		Winningham, A., et. al. (2004). The changing age of HIV: sexual risk among older African-American women living in rural communities. Preventive Medicine, 39(4). 809-814.