December was AIDS Awareness Month, a time to remind the country that, despite advancements in treatment, the threat of developing HIV/AIDS is still very real. One area where the experts say there needs to be more awareness is among heterosexual women age 50 and older.
California mother and grandmother Nell Davis, 64, doesn't fit any of the past profiles of those at high risk. But she has become one of the new faces of the disease and was recently featured in the PBS Frontline documentary Endgame. Davis was a divorcee who met and married a "nice man from the church." While on their honeymoon, Davis says, she started to feel ill with symptoms she could not shake. Later, "I found his HIV test results hidden in his Bible," she says, adding that the date of the test "told me that he knew he was HIV positive well before we got married, but he never said anything."
(MORE: HIV/AIDS and People Over 50)
Women over 50 make up 10 percent of all women living with HIV. Across the country, African-American women, like Davis, make up 60 percent of all new HIV/AIDS cases among women and most were infected through heterosexual contact, according to the Centers for Disease Control and Prevention.
As education and awareness campaigns remain focused on people age 18 to 34, women in their 40s and beyond are not always getting the messages they need to hear about safer sex and regular testing. Between 1988 and 2001, the rate of HIV infection in women age 50 to 59 rose 56 percent. For women 60 to 65 years old, the rate of infection rose 53 percent. Among women over 65, the rates tripled.
A Population Unaware?
According to the CDC, 20 percent of the 1.1 million American men and women living with HIV/AIDS do not know they have the disease. Experts believe the percentage is higher among those over 50, due to a lack of education and testing in that population. There are many reasons why infection rates among older women continue to rise:
- Many women (and men) over 40 do not see themselves as being at risk, so they don't take the precautions of using condoms and practicing safe sex. Even if they want to limit their risk, negotiating condom use with a new partner is often difficult. For divorced people who may not have been on the dating scene recently, if ever, such discussions may represent new territory.
- Older women's physiology can also put them at increased risk. Menopausal and post-menopausal women often experience vaginal wall thinning and dryness, which could cause small tears, creating more opportunity for HIV to permeate the vagina and enter the bloodstream.
- Older adults with no suspicions that their partners could be infected also fail to get tested for HIV when they have checkups. But testing is vital to stopping the spread of the disease, and treatment has proved to be both lifesaving and helpful in preventing the transmission of the virus to others.
"Women over 40 are definitely at risk, and few understand that risk," says Kaye McDuffie of the Lansing (Mich.) Area AIDS Network, which primarily supports black and Hispanic people living with AIDS. "Being married or in a committed relationship is no guarantee that you are not at risk."
McDuffie often talks to older women about the importance of protection and finds that they usually have no idea that their partners are engaged in other relationships.
HIV/AIDS prevention experts say that more effective education and awareness for older women is essential, as is a bolstered safety net to support women who have to figure out what to do after their cases are diagnosed. But as much as better information is needed for women in middle age and beyond, there has been even less outreach to older heterosexual men. CDC officials concede that they have focused their limited outreach resources on the populations with the greatest need, which continues primarily to be men who have sex with men.
Those campaigns have shown signs of progress. In the meantime, stories like Davis' are repeating themselves nationwide, in women like Daphne Robinson. She had to navigate the waters of dating after she and her husband of 20 years divorced. Several years later, she moved in with a man she had fallen in love with. Then, she says, "one day when I was cleaning up the house I found some loose pills on the floor. And as far as I knew he wasn't on any medication."
After taking the pill to her pharmacist to find out what it was, she got shocking news. "The pill was for AIDS," she says. "My pharmacist told me that I should get tested right away — and I did. But I just knew the answer."
Robinson says it wasn't until two years after her diagnosis that she enrolled in services and started taking medication herself. "I was ashamed, and the stigma was overwhelming," she says. But she adds that she has gained support and guidance from other women who get care at the same clinic. Hearing their stories helped her decide to step out and help other women through support groups. "I didn't do anything wrong," she says. "I just loved someone."
(MORE: How to Talk to Your Doctor About Sensitive Issues)
How to Protect Yourself
You can take these steps now to protect yourself and those you love from HIV infection:
- If you are sexually active, don't underestimate your risk for HIV/AIDS. Practice safe sex. Have an open and honest conversation with your partner about both of your HIV test results and the continued importance of protecting yourselves.
- Make routine testing a part of your annual medical examination. If your health care provider doesn't offer the test as part of his or her standard regimen, ask for it. Don't let embarrassment or a perceived stigma keep you from getting tested. It could save your life. And if you're tested, get the results. Information is power, but many people never go back to find out their status.
- Work with your social, community and religious groups to make sure they are providing information and outreach about HIV prevention to other people over 50. Bring in speakers who can address the risks and the importance of testing and treatment.
Andrea King Collier is a multimedia journalist and lead author of The Black Woman’s Guide to Black Men’s Health.