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Older Women: An Overlooked Group
Older women are sometimes ignored in discussions about sexual health, HIV prevention and care. 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. While 50 may not seem 'old,' it is often the age used by organizations to keep track of health-related statistics. In 2018, more than half of all people living with HIV in the US were 50 years or older.
Health care and social service providers need to recognize that their aging patients and clients are at risk for acquiring HIV.
Around the world, 4.2 million people over the age of 50 – 13% of all people living with HIV – are living with the virus, UNAIDS estimates. In 2016, eight of ten older people living with HIV globally were in low- and middle-income countries. In the US, more than half of those living with HIV who know their diagnosis were at least 50 years old in 2018.
It is important that older women, their health care providers, and their families understand how the virus can, and does, affect this group.
- 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 to 74 years. Older women can be at greater risk of acquiring HIV during sex because their vaginal walls are thinner, and their vagina is drier than in younger women. This can cause tears in the vaginal area.
- Many women over 50 are thinking about dating after a long-term relationship ends or their partner dies. Women who have been in monogamous relationships for many years and are now becoming sexually active with new partners may not think that they are at risk for acquiring HIV. They may feel uncomfortable discussing sexually transmitted infections or diseases (STIs or STDs) or safer sex with their partners or health care providers, and may not know how to protect themselves.
- The number of women over 45 living with HIV in the US has been steadily growing in recent years. The reported numbers are likely smaller than the real number of older women living with HIV. Many people do not get tested for HIV, and are therefore not diagnosed, even though they may have been living with the virus for several years.
- Older women may also not be aware of newer options for HIV prevention, such as PrEP. PrEP, or pre-exposure prophylaxis, involves taking HIV drugs before being exposed to HIV to prevent getting the virus. For more information, see our fact sheet on PrEP for Women.
- Many older women have gone through menopause and therefore do not use condoms for birth control. However, condoms can prevent the spread of STIs or STDs at any age. For more information, see our fact sheet, Talking with Your Partner about Condoms.
- Older women living with HIV are more likely to be invisible and isolated, keeping their status hidden from friends and family. They may be afraid to disclose that they are living with HIV because of the stigma surrounding the virus.
- Because many people in the HIV community are not aware of the virus among older people (especially women), this age group has been left out of HIV prevention education, research, and clinical trials.
- Older women who inject drugs are at risk of acquiring HIV from sharing needles and other drug equipment.
- Older people are not routinely tested for HIV. Health care providers may feel uncomfortable asking older patients about their sexual behaviors or believe that older women are not sexually active. When an older patient has flu-like symptoms, many health care providers do not think to test for HIV. This means that older women are often 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 can do to prevent the transmission of HIV and live healthier during 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 our fact sheets on What Are HIV & AIDS? and HIV Transmission. If you have heard rumors or stories about HIV, check out our Myths about HIV fact sheet to separate fact from fiction.
Watch the video "HIV and Aging" from the Administration on Aging at the Department of Health and Human Services (DHHS) by clicking the link below.
If you may have been exposed to HIV, no matter your age, you need to get tested for HIV and talk about post-exposure prophylaxis (PEP) with your provider.
Age does not protect you from acquiring or transmitting HIV. Practicing safer sex can reduce your risk of acquiring HIV. So can using clean needles when injecting drugs. For more information, see our fact sheets on Safer Sex and Cleaning Equipment for Injecting Drugs.
To prevent older people from acquiring HIV, we need to make sure that they understand the need for routine HIV testing and early diagnosis. The US Centers for Disease Control and Prevention (CDC) now recommends that all people aged 13 to 64 years are routinely screened for HIV in all health-care settings. If you are older than 64, you still need to be tested for HIV if you are sexually active. Additionally, CDC recommends that all health care providers encourage patients and their potential sex partners to be tested for HIV before starting a new sexual relationship.
If you may have been exposed to HIV, no matter your age, you need to get tested for HIV and talk about post-exposure prophylaxis (PEP) with your provider. PEP means taking HIV drugs to prevent acquiring HIV after being exposed to the virus. PEP needs to be taken within 72 hours of being exposed to HIV and must be taken for 28 days.
If you do test positive for HIV, there is no need to give up (please see our fact sheet Did You Just Test HIV-Positive?). With a positive attitude and a good HIV drug regimen, you may be able to live with HIV well into old age. HIV is now considered a manageable chronic condition. If you are HIV-negative, you can learn how to stay that way.
Lastly, knowing your HIV status is an important way to prevent transmitting HIV to others you care about. Many years of research have shown that, if they are taking HIV drugs that keep the amount of virus in their body very low (undetectable), a person living with HIV cannot pass on the virus to a sexual partner who is not living with HIV. See our fact sheets, Undetectable Equals Untransmittable: Building Hope and Ending HIV Stigma and Serodifferent Partners: Dating, Relationships, and Mixed HIV Status, for more information about this exciting development.
Unfortunately, HIV information often forgets about older people. We do not usually see the face of an older person or senior citizen on HIV prevention posters. Health care and social service providers need to recognize that their aging patients and clients are at risk for acquiring HIV. Providers also need to ask older patients about their sexual and drug histories.
Older women also need to tell their health care providers about any injection drug use or sexual experiences that put them at risk for acquiring HIV, 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.
Older Women Living with HIV
There are several ways in which living and aging with HIV are different from aging without the virus. If you are an older woman living with HIV, you may be interested in our fact sheets on Menopause and HIV and Aging and HIV. Also be sure to check out our fact sheet on Caring for Your Heart, since heart disease is a leading and often unrecognized cause of illness and death among women worldwide, regardless of their HIV status.