Grandma Has AIDS

By Theo W. Hodge Jr. M.D.

from the May-July 2007 print issue

Rising above the whispers of yesteryear, the topic of HIV/AIDS seems to be on the lips of just about everybody. The worldwide devastating effects of this disease on young men and women, as well as their children, remind us that there is much to be done in the fight against this pandemic. However, the special population glaringly absent in most discussions of HIV/AIDS is that of the adult over the age of 50.

About 11 percent of all new AIDS cases are in people over 50. In the U.S. 28 percent of those living with HIV/AIDS are over 50 and by 2015 that number is expected to increase to 50 percent. Figures from 32 states show that the number of persons over 50 with HIV/AIDS went from 40,000 in 2000 to more than 67,000 in 2003 according to the Centers for Disease Control and Prevention (CDC). Older Blacks are 10-15 times more likely than their White counterparts to be infected.

Typically, older persons are diagnosed with HIV at a later stage of infection, and often become ill with AIDS-related complications and die sooner than their younger counterparts. These deaths may be attributed to original misdiagnoses and immune systems that naturally weaken with age. The reasons for the rise in HIV/AIDS in people over 50 are mired seemingly in multiple myths.

Perhaps one of the biggest myths is that people over 50 don't have sex and therefore are not at risk for HIV. In fact a 1994 study by the University of Chicago proved that sexual desire does not wane after the age of 50. In the study, 60 percent of men and 37 percent of women aged 50-59 reported having sex a few times per month.

Another prevalent myth is that people over 50 do not have the same risk factors as the younger adult population. While blood transfusion was the major transmission route at the beginning of the epidemic for those over 50, heterosexual contact, men who have sex with men, and IV drug use are the main causes of HIV infection today. Debunking the myth that intravenous drug use is a problem of youth, the CDC reports a trend of IV drug use starting much later in life. And since 1991 heterosexual transmission in men over 50 is up 94 percent and 107 percent in women

The above myths are prevalent not only in the over 50 population but in the medical field as well. Many doctors are reluctant to think of their older patients as sexually active though, ironically, they often prescribe Viagra and its cousins Levitra and Cialis to this population. Studies suggest that only 30-40 percent of younger patients are asked by their doctors about their sexual history or practices, a rate that is almost surely lower for patients over 50.

Typically, prevention and education dollars are targeted to the young adult population, and very little toward heterosexual seniors who are unlikely to consistently use condoms during sex because of a generational mindset and fearlessness about possible pregnancy. Additionally, gay men over the age of 50 are a growing population. While gay men have always been a target of prevention education, an aging population necessitates the same prevention efforts for the over 50 gay population.

In summary, it is imperative that people over the age of 50 recognize that the risks of HIV include not only the young but the aged. It is mandatory that healthcare providers also recognize the risk and appropriately educate, assess, and treat this population. Perhaps with these changes one will hear less frequently that Grandma has AIDS.

Theo W. Hodge, Jr., M.D.

Capital Medical Associates

1640 Rhode Island Ave, NW #800

Washington, DC 20036


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