The Graying of the Aids Epidemic

When LaVon Watkins was 49 years old, he went to the doctor’s office for a routine physical and blood test. He expected the next conversation with his doctor to be just like the rest: healthy results and friendly farewells. But when Watkins received a phone call from his doctor requesting an immediate visit, he knew this discussion would be quite different. During this meeting, Watkins learned he was living with AIDS.

Watkins already lived a chaotic life. He was struggling with chronic depression that left him unable to work. Yet the diagnosis actually motivated Watkins to get his life together — he quickly focused on AIDS rather than his depression.

“I wasn’t devastated,” he explains. “I accepted there are things I have to do. I have to find a support group, I have to find the medicine I have to take. It was a mission for me.”

Watkins contracted AIDS from unprotected sex with another man. Even though he had worked at the Cleveland Clinic as a phlebotomist — drawing blood — he says public-health warnings about HIV never reached him.

“Condoms, for me, were for birth control, not to prevent STDs,” explains Watkins. “That’s the way baby boomers are thinking.”
Since AIDS was discovered in the 1980s, a generation of young adults has learned how HIV is transmitted and how to prevent it. But the message never got to many of their parents, grandparents or great-grandparents.

Today, HIV and AIDS are growing among people over 50. Between 2003 and 2004 alone, new AIDS diagnoses more than doubled among city of Cleveland residents more than 45 years old. In 2006, 29 percent of the people living with HIV in Greater Cleveland were 50 and older, compared to the national average of 19 percent.

HIV-prevention campaigns aimed at older adults are almost nonexistent. Also, many mature adults have outdated assumptions about birth control and do not talk much about sexual behavior with their doctors — even divorcées and widows who are part of an active elderly dating scene.

Jim Campbell, an AIDS activist living with HIV, was distressed about the lack of prevention efforts for older adults. He was running a housing-advocacy program for homeless, living with HIV when he met Paul Quinn, vice president of the Boston-based National Association on HIV Over 50, the only national organization that specifically educates older adults about HIV.

In 1996, Campbell became president of the organization. “There were no risks or prevention information for older people,” explains Campbell. “No one was talking about older people infected with HIV.”

Rosemary Geisbuhler, 56, of Cleveland, didn’t see or hear the warnings. She was diagnosed with HIV last fall. “I literally cried all day,” she says. Her husband of two years had died years earlier, and she learned afterward that he had suffered from AIDS and tuberculosis.
Geisbuhler says she wishes more information about HIV was directed at people her age. She wants to learn more about the virus. “It’s really mind-blowing,” she says.

Earl Pike, director of the AIDS Taskforce of Greater Cleveland, says HIV educators are not paying enough attention to how mature adults are living their lives.

There isn’t a lot of education that reflects the experiences of people over 50, Pike says. “Dating may be a new experience after 20 years of being in a relationship.”

And social stigma gets in the way. Younger people don’t want to know the details of intimate elderly relationships. But even Grandpa needs to know about safe sex.

“People don’t stop being sexually active once they get their AARP card,” Pike says. “But popular culture sort of assumes they stop.”
In fact, one in three adults 70 and older engages in sex at least once a week, according to a 2004 AARP study.

Viagra and other erectile dysfunction drugs have contributed to HIV’s spread among seniors by allowing many older couples to remain sexually active, Campbell believes. “With the sale of 2 million prescriptions of Viagra last year, it makes a big difference.”

Prescribing Viagra, Cialis or Levitra offers doctors a perfect opportunity to talk with patients about their sexual history and behavior. But most doctors avoid this discussion, Campbell says. “Even taking good sexual histories of patients is not done well in most places.”

This uncomfortable silence puts patients at risk. Pike mentions a man in his late 70s who recently came to the Taskforce.

“He acquired HIV sexually, in a way that a 20-year-old would,” Pike says. Yet the man didn’t think he could be at risk.

Even older adults can buy into the stereotype that their peers aren’t sexually active — leaving them in denial about the risks they take.
“It’s easier for older adults to say, ‘HIV? STDs? That’s not something that can happen to me — that’s something that happens to kids,’ ” says Pike.

So many adults aren’t careful when they rejoin the dating scene after widowhood or divorce. Bingo halls, living-complex socials, movie nights at the senior center and Internet-dating services provide many opportunities for older adults to meet and mingle.

Elderly dating dynamics also create risks. “In elderly-housing complexes, lots of times, the ratio of women to men is very lopsided,” says Campbell. Some older men, who find their company in demand after their peers pass away, become promiscuous, he explains. “There are men that go to three different houses during the week,” he says. But if a man doesn’t think he’s at risk of contracting HIV, he could unknowingly put himself and others in danger.

Some older adults associate condoms with birth control, not protection against disease. “After women have menopause, there are many who think, ‘Well, I’m through menopause, so there’s no way I can get HIV,’ ” explains Marc Blair, a social worker with the Cuyahoga County Department of Adult and Senior Services.

Doctors could clear up this misunderstanding during routine visits. A gynecological visit is a good time for doctors to initiate safe-sex discussions, says Dr. Barbara Gripshover, medical director of University Hospitals’ John T. Carey Special Immunology Unit. Doctors could also talk about sexual history, HIV prevention and testing when a patient mentions a divorce or the death of a spouse.

Recently, the Centers for Disease Control recommended that doctors test all patients ages 13 to 64 during their routine yearly exams. “They want us to be able to diagnose people sooner,” Gripshover says. “People that are aware of their status are less likely to put people at risk.”

 

The aging face of HIV

Today, many HIV patients are living long lives after they’re diagnosed. Thanks to advanced HIV treatments, it’s likely that an HIV patient will not die of AIDS.

“The likelihood of dying in an accident or something other than HIV is just as likely,” says Dr. Susan Rehm, vice chairman of the Cleveland Clinic’s infectious diseases department.

AIDS used to mean certain death, until 1995, when more powerful medications proved effective at preventing or slowing HIV replication. Now, medications can make a HIV a chronic but not necessarily fatal disease.

That means doctors and AIDS organizations are caring for a huge number of chronic HIV patients. Living with HIV long term has challenges of its own. HIV/AIDS medications can cause high blood pressure, strokes, liver problems and kidney disorders.

Complications are especially common among older adults who have been living with HIV for more than 20 years. Additional medical costs can put a burden on patients who may already be spending thousands of dollars a month on medicine and treatment.

“Carlos,” 65 (who spoke under an alias because most people he knows are unaware of his status), was diagnosed with HIV more than 10 years ago. He used to be a heavy intravenous drug user. “People would share needles at the drop of a hat,” he explains.

Carlos suffered a stroke five years ago. “The stroke started because of what I was doing to my body,” he says. The stresses the HIV medication put on his body didn’t help. Carlos now finds comfort in his Muslim faith and his membership in a group of long-term HIV survivors.

As adults age, common illnesses and ailments tend to follow. Some of these illnesses are similar to HIV symptoms, so it can take some time for doctors to diagnose an HIV patient.

Sharon Thomas had flulike symptoms when she decided to go to the doctor nearly 20 years ago. She was afraid she had diabetes. HIV didn’t enter her mind.

When the doctors called Thomas, they thought the test was a mistake. She got the call during a busy Friday fish fry at work.
“I picked up the phone, and [my doctor] said, ‘Your test came back, and it tested positive. It must be wrong, so come back on Monday. We want to retest you,’ ” she recalls.

Thomas wasn’t a typical HIV patient. She was a 38-year-old middle-class woman who owned a neighborhood bar. “They didn’t think ‘drunk,’ they didn’t think ‘sexually active’ and they didn’t hear ‘divorced,’ ” she says.

Like many HIV survivors, Thomas has coped by finding a new path: volunteering, educating others about HIV and networking with other survivors.

Thomas is now a certified Red Cross educator, has attended AIDS conferences, volunteers with many HIV programs and speaks at local high schools, colleges and churches.

Vonzella Johnson’s life changed in August 1989 when she took her sick daughter to the hospital for her recurring pneumonia. “She was screaming and hollering because she was tired of needles,” says Johnson. “So the phlebotomist said, ‘I’m going to stick your mother too.’ ” By accident, Johnson’s blood was sent along with her daughter’s. She was called back into the office to be told that she and her daughter had HIV, and that her daughter’s illness had progressed to AIDS.

“I didn’t know [my husband] was also having men on the side,” explains Johnson. “If I would have known I had HIV, I would have never had another child.”

Johnson’s daughter died at age 9. Yet Johnson has managed to keep a positive outlook on life. Now 56, she is working on her master’s degree in urban studies at Cleveland State University, speaks to students about HIV prevention, and even passes out condoms on RTA buses.

She doesn’t let the disease put a damper on her dating life either. In fact, she prefers dating men who don’t have HIV. She says she uses protection and is “up front” about her disease.

Today, LaVon Watkins, 55, has his AIDS under control. He even once told a support group that being diagnosed with AIDS “was a blessing in disguise.” He explains that the diagnosis not only “brought a lot of people in my life I wouldn’t have met,” but also it gave him a mission.
Watkins serves on the Ryan White Planning Council, a local agency that allocates federal funds for HIV health services in Cuyahoga County. He helps at the AIDS Taskforce and attends national HIV conferences, gaining as much knowledge as possible.

He emphasizes the importance of using condoms — even when he’s dating another HIV-positive person. “You can be reinfected or resistant to a different strain,” he explains. “I can become immune to the meds they are taking because of the different strains. So you have to practice safe sex.”

Even though doctors told Watkins he has 20 years to live, he doesn’t get caught up in counting days.

“AIDS lives with me. I don’t live with AIDS,” Watkins says. “I have bigger fish to fry.”