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Condoms for seniors: Gearing up for the graying of AIDS

Mary, 73, and Carl, 76, have been dating for over a year. Mary finds out that Carl is having an affair and sharing his insulin needles with another woman. She is distraught. If she has unprotected sex with Carl, can she contract HIV?

The hypothetical question was put to three social workers in January at a training session at the Rochdale Village Senior Center in Queens, N.Y.

“HIV isn’t present, because Carl is negative,” said the first trainee.

“But we don’t know!” countered the second. “He’s sharing needles with that other woman.”

“He has a high risk, and Mary has a high risk, too, because Carl’s going outside their relationship,” added the third, providing the correct answer.

Sex education brings to mind high school classrooms, not senior centers. But older Americans are now the fastest-growing segment of the HIV-positive population, accounting for nearly 27 percent of all U.S. cases. As a result, experts from Broward County, Fla., to Bowling Green, Ohio, are grappling with the challenge of getting the message of safe sex across to people who were sexually active long before AIDS was a threat.

“Older adults are not getting prevention messages,” said Daniel Tietz, executive director of the AIDS Community Research Initiative of America, a New York-based non-profit organization that recently started training programs about HIV and AIDS for those who work with seniors.

Cases of HIV among people 50 and over soared by 77 percent between 2001 and 2005, according to the Centers for Disease Control and Prevention. In New York City, the epicenter of the AIDS virus in North America, 32 percent of the 100,000 or so people living with HIV are over 50, and nearly three quarters are older than 40, according to the city's Department of Health.

One reason for the trend is that people who contracted AIDS at a young age are living longer, thanks to a variety of potent new drugs that have raised survival rates. But the number of people who are contracting the disease over the age of 50 is also on the rise, which is what has experts worried. In New York City, between 13 and 15 percent of all new HIV cases last year were among people over 50.

Preventing the spread of HIV among older adults presents a unique set of challenges because this age group was raised thinking “safe sex” meant protecting against pregnancy, not sexually transmitted infections. The popularity of sexual enhancement drugs like Viagra has also played a role by increasing sexual activity among seniors. Yet few prevention campaigns target older adults due to the false belief that they are no longer sexually active.

In addition, few older adults get tested for HIV, leading to late-stage diagnoses that raise the potential to spread the virus unknowingly. Since common symptoms of HIV, such as fatigue, weight loss, and sleeplessness, also increase with age, the virus is often misdiagnosed among older adults, allowing it to spread. Common misconceptions--such as, women do not need to require condoms after menopause, or that sharing prescription drug needles is OK--also help spread the disease among older adults.

In New York, the City Council approved a $1 million grant in 2007 to teach people who work with seniors about HIV prevention and treatment. The effort is by far the largest such undertaking in the country.

In January, half-day training workshops were rolled out at senior centers and other agencies that assist seniors. At each workshop, educators presented the facts about the virus, from transmission to treatment, and then engaged participants in discussions about how to talk about AIDS and integrate HIV education into their daily routines. The goal is to bring the issue into the open, said Tietz, the executive director of the organization running the program.

He hopes the training sessions will overcome one of the biggest hurdles in reaching older adults: the stigma associated with sexually transmitted diseases. For example, at a recent workshop geared towards seniors in Morningside Heights in Manhattan, not a single senior showed up.

“It’s been kind of a struggle getting into senior centers,” said Chrissy Cacace, program coordinator for Preventing HIV in the Next Generation, the group that sponsored the event. “They say people won’t come, or people here are not interested.”

In Bowling Green, Ohio, a town of 30,000, Dr. Nancy Orel and several colleagues at Bowling Green State University are creating an AIDS education program for older adults on a much smaller budget--$3,000.

Orel and her team have already offered free HIV testing and run several workshops for local seniors, focusing on risks like the sharing of insulin needles among diabetics. The group also teamed up with the university’s theater department to create a collection of “video vignettes” featuring seniors discussing safe sex that will be distributed to local senior centers.

“Peers teaching peers has always been the most effective way of learning,” Orel said. “Seeing older people actually talking about this is better than some academic spouting facts.”

Broward County, Fla., home to a large number of retirees, is also home to one of the nation’s oldest HIV prevention programs for older adults. The Senior HIV Intervention Project (SHIP), now in its eleventh year, does presentations almost daily at senior centers and health fairs around Broward County.

SHIP’s outreach coordinator, Edid Gonzalez, said the program has made a clear impact in the community. “Believe it or not, I see that people are more knowledgeable about what is going on,” she said, “that this is not just for the young people.”

Gonzalez and SHIP’s five volunteer educators--all in their 70s and 80s, none infected with HIV--show groups an eight-minute video of seniors talking about the virus and have an open discussion.

At health fairs, Gonzalez and the volunteers also hand out free condoms to seniors. “The first thing they say is, ‘Oh, I can’t get pregnant,’” said Gonzalez. “And we say, ‘This is not to prevent pregnancy,’ and they stop, and we say, ‘This is to prevent HIV and STDs,’” she explained. “This is a wake-up call.”

E-mail: jmz2118@columbia.edu