Miami Herald - October 13, 2002
Sara Olkon, solkon@herald.com

"I don't want to destroy sex," the 73-year-old health educator tells the crowd in Boca Raton. "Just make it safer."

The topic is HIV and AIDs. And one of her biggest obstacles: combatting the prevailing myth among seniors that HIV and AIDS affects only gay or young people.

Even as the overall number of AIDS cases has declined both nationally and in Florida, the percentage of people aged 50 or older being diagnosed with AIDS or HIV is rising. The issue is concerning government officials so much that they are beginning to collect data to assess the situation.

"It is an area we want to be concerned about," Robert Janssen, director of the Division of HIV/AIDS Prevention at the federal Centers for Disease Control and Prevention, said earlier this year.

Monica Dea, a coordinator with the Center for AIDS Prevention and Studies at the University of California, San Francisco, adds: "Women after menopause are not going to use condoms because they're not afraid of getting pregnant anymore. Viagra is spreading like chewing gum. . . These people are continually getting infected."

In Florida, the number of seniors diagnosed with AIDS is growing at an even higher rate than in the rest of the nation.

People 50 and older represented 13.4 percent of AIDS cases in the United States in 1999, up 25 percent from 1995, according to the most recent statistics from the Atlanta-based CDC. Today, 15 percent of all AIDS cases in Miami-Dade and Palm Beach counties and 14 percent in Broward are among persons 50 and older, said Jolene M. Mullins, an early-intervention consultant with the Florida Department of Health.

Cases of HIV, the virus that causes AIDS, also have skyrocketed among South Florida residents over 50 in recent years: In Broward, Miami-Dade and Palm Beach counties, HIV cases among people 50 and older rose 14 percent from 1999 to 2001, according to data from the state health department.

"Society hasn't woken up," said E. Bentley Lipscomb, Florida director of the American Association of Retired Persons. "Old people engage in sex."

SAFE-SEX MESSAGE

The issue is of particular concern to health activists working in parts of the country popular with retirees. Across the country, retirement communities in turn are preaching safe sex.

Experts fear the number of older Americans with AIDS could increase far more for a variety of reasons. Among them: Seniors who feel uncomfortable discussing sexual behavior and doctors who may not think to ask their senior patients about their sex lives, as well as a lack of awareness about the virus and safe sex.

"[Doctors] think when you are 50, you die from the neck down," said Sue Saunders, a divorced 69-year-old Fort Lauderdale grandmother who was diagnosed with HIV in 1991, but hasn't developed AIDS.

The diagnosis, she says, destroyed a part of her self.

"I knew that AIDS was going around, but it was kids, kids who did drugs," Saunders said.

When Saunders found out she was HIV-positive, she told her four children immediately. Their reaction: complete shock -- and unconditional support.

Saunders says having the virus has made her distrustful of men. And that distrust is shared by her adult children, especially her second son, whose fear of contracting the virus has paralyzed his dating life.

"He wants to get married and have kids, but doesn't want to take any chances at all," she said.

'TOO NAIVE' Jane Fowler, a self-described "original '50s good-girl," contracted HIV in the aftermath of a painful divorce.

The man who infected her was someone she had known her entire life.

"I was too naive to ask that protection be used," said Fowler, 67, director of Kansas City-based HIV Wisdom for Older Women, an organization focusing on HIV prevention and care among older women. "I missed affection."

Fowler began speaking out in 1995, saying she "decided to put another face to the epidemic -- an old, wrinkled face -- to show people that HIV doesn't discriminate." She said healthcare providers seldom ask about the sexual histories of their older patients.

The consequence: Seniors frequently aren't diagnosed until the AIDS has progressed, if they are diagnosed at all, said Dr. Amy Justice, a professor of medicine at the University of Pittsburgh currently studying HIV infection among veterans.

"When an older person comes in complaining of fatigue and anemia, people don't get excited about it -- there are lots of different explanations," she said.

The CDC says that seniors make up less than 5 percent of those tested at government-funded sites for HIV.

Early diagnosis is key because older people tend to become sicker faster than younger people. And once the infection has progressed to AIDS, highly active antiretroviral drug "cocktails" do not mix well with medications often prescribed for age-related illnesses, such as high blood pressure and high cholesterol.

The problem doesn't exist just in Florida. In California, cases of AIDS among heterosexual men have been rising since 1999. AID Atlanta, which gives financial help to people with HIV, receives about six requests a year to speak at senior centers these days. Five years ago, it received none.

Dr. John C. Nelson, a Salt Lake City gynecologist who is the American Medical Association's secretary-treasurer, said doctors need to be more open with seniors.

"We need to make sure we go a little more deeply in the evaluation," Nelson said.

A 1999 AARP survey found that more than half of men and women between 45 and 59 had sex at least once a week. From ages 60 to 74, 30 percent of men and 24 percent of women reported having sex at least that often.

Sexual activity among older people also has increased because of Viagra, experts say. Twelve million Americans have used the pill since its introduction in 1998, said Geoff Cook, a spokesman for Pfizer, Viagra's manufacturer. While Cook said the company does not track the ages of the users, older men are clearly the target.

Former spokesman Bob Dole was 74 when he started touting Viagra.

'CONDO CASANOVAS'

Of special concern to Florida health activists are so-called "Condo Casanovas," older men invigorated by Viagra and enjoying the seven-to-one female-to-male ratio common in many retirement communities.

"They have all the women in the world now," said Saunders.

Alarmed by the growing numbers of seniors contracting the virus in South Florida, the Broward County Health Department started the Senior HIV Intervention Program in 1997 for the tri-county area. The $170,000 program, funded by a Florida Department of Elder Affairs grant, has offices in Miami-Dade, Palm Beach, Belle Glade and Broward.

Brand, who works out of the Palm Beach office, said she spends much of her time talking to older women about self-esteem.

"They can't tell their partner either to get tested or use protection," she said. "They don't feel secure."

At-risk seniors often don't use condoms or get tested for HIV because of their lack of awareness -- and that exacerbates the spread of the virus, said Mullins.

COST OF IGNORANCE

Such ignorance hurt 61-year-old Gerry Orr.

Ten years ago, the Miami seamstress and her husband divorced after 16 years of marriage. She began to date.

In 1997, she found out that her night sweats were not post-menopausal and that her persistent sore throat was not a cold.

She had full-blown AIDS.

"I really didn't think I was at risk," Orr said.

In fact, many seniors are more susceptible to the virus.

Immune systems and tissues often weaken with age, and post-menopausal women are more susceptible to tears that can leave entry points for the virus, Justice said.

Fowler, whose AIDS has been kept at bay for more than 15 years with the help of drugs, said many older women she meets still don't know what a sexually transmitted disease is. But that is slowly beginning to change, activists say.

"The traditional wisdom is that people that age aren't sleeping around, but that's not necessarily true," Dr. Nelson said.

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