11 February 2004

Older people hit by STIs too

Apparently contrary to what many people think - including some physicians - men and women in their 60s, 70s and beyond do have active sex lives.

Jane Fowler had just finished telling high school students her story about living with HIV when a girl raised her hand.

"She was very smug," Fowler recalls, "and she said, 'Well, look, we all know we're going to die someday and you're old, so what's the big deal?' "

"I told her the big deal was that I intended to live a couple more decades and, contrary to what she thought, I had a life!" Fowler says.

Apparently contrary to what many people think - including some physicians - men and women in their 60s, 70s and beyond do have active sex lives. Healthier lifestyles and medical advances are helping Americans live longer, and the advent of Viagra and other treatments for erectile dysfunction have put a spotlight on love in the later years.

What's been left out of that conversation, however, is that senior citizens now face the same kinds of risks as young adults for sexually transmitted diseases, including HIV and Aids.

In fact, the incidence of Aids in people 50 and older is growing at a rate twice as fast as for people younger than 50, according to statistics released by the Centres for Disease Control and Prevention (CDC).

"There are a lot of men who are over 70, have a lot of money [and] are out dating a lot of younger women and not using condoms," says Anita Finley, a gerontologist and radio talk-show host in South Florida, where she also publishes the magazine Boomer Times. "They don't get it. They were married and didn't have to use protection for so long. It's so obvious, but they're playing Russian roulette."

"It's not that they're not educated," Finley says. "They're making a conscious choice."

'Condo Casanovas'
Such behaviour, conscious or not, puts senior citizens at risk, say health educators who participate in the state-wide Senior HIV Intervention Project in Florida. They cite a widespread use of prostitutes by senior citizens and the presence in retirement communities of so-called "Condo Casanovas," or men who take advantage of an environment in which women outnumber men by 7 to 1. With that level of competition for a man's affection, typically after decades of marriage and a healthy sex life, many women are reluctant to demand that their partner use a condom, experts say.

Senior citizens simply don't think of themselves as being at risk for sexually transmitted diseases including Aids any more than they're at risk for unwanted pregnancies, says Marcia Ory, the chief social scientist at the National Institute on Aging.

"We have a situation where people who engage in risky practices don't see that the messages about risky behaviour pertain to them," Ory says. "They don't look at them because the messages come with pictures of young people. An older person will look at that message and not see anything related to them."

Fowler says she's even had to give some women friends the definition of "STD" because, when they were dating years ago, the term for sexually transmitted diseases didn't exist.

The problem is exacerbated, experts say, because senior citizens and their doctors think the other party will start any needed discussion about sex. As co-chairman of the National Association on HIV Over Fifty, Fowler says she constantly hears that doctors don't take sexual histories on their older patients or ask them about drug use because they don't want to offend their patients. And senior citizens assume that if it's important, their doctor will bring it up.

Another complication is that symptoms of HIV and Aids - including weight loss, fatigue and confusion - often mimic those of Alzheimer's disease and general ageing. As a result, many older people with early stage HIV, whose immune systems already are weakened by aging, don't receive the benefits of new drug treatments that could help them stay healthy.

Although 12 percent of Aids patients between the ages of 13 and 49 die within a month of diagnosis, the number of deaths rises to 22 percent for people between 60 and 69 years of age, according to a study done in the early 1990s. And for people 80 and older, nearly 40 percent die within a month of their Aids diagnosis, the study says.

"Older people do have significant sexual activity and, in fact, may be using substances and may not be taking proper precautions," says Dr Karl Goodkin, a researcher at the University of Miami School of Medicine.

"The idea that doctors shouldn't approach this question because it might be offensive is really passé," Goodkin says. "If we don't change this predilection in physicians, we're essentially condemning older people with HIV to an early death. That's true more today than ever with the disease management tools we have. We're denying them that opportunity if we don't change the medical standard."

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