Originally Published in Serving Our Seniors Magazine July-September 2013 Issue
In March 2013 I attended the University of Toledo’s 17th Annual Geriatric Medicine Symposium, where I heard Robert Brandt, Jr., MD, Clinical Professor of Family Medicine and practicing physician speak on the topic of Aging & HIV. His expertise is HIV/AIDS, Family Medicine, Addiction Medicine, Sexually Transmitted Infection Medicine, Gay and Lesbian Health Issues, Transgender Medicine. In April, I interviewed Dr. Brandt to educate our readers about how HIV is changing who it affects and how its symptoms are different in later life. It is with some trepidation that I publish this article in such clear and frank terms. I do so recognizing that this problem is very serious. I cannot pretend that softer/more ambiguous language is what will serve the public best. For those who might find blunt, yet true information about sexual behavior offensive, it is recommended that you do not read the second from the last paragraph. The purpose of the information contained in that paragraph is to prevent the spread of HIV/AIDS in Erie County.
– Robert Brandt, Jr., MD
In 2010/2011 The Erie County Health Department conducted a study on the health behavior of adults age 65+, with regard to their sexuality. That is when we learned that 20% of Erie County’s older adults, surveyed, reported that they have had sex with more than one person in the past year.
HIV (Human Immunodeficiency Virus) is primarily a sexually transmitted infection. When HIV has progressed to severe impairment, based on T-cell count of 200 or less, the patient is referred to as having Acquired Immune Deficiency Syndrome (AIDS).
More older adults are living with HIV. This is due to acquiring HIV as a middle aged adult and not being diagnosed until later life. Other contributing causes are divorce, having more than one sexual partner; and engaging in male to male sex in later life. Also, as Dr. Brandt explains, “People who are HIV positive are being effectively treated, so that they are able to grow old with the disease”.
Erie County’s 20% statistic does not surprise Dr. Brandt. He says, “This statistic would surprise the majority of family physicians.” “Older adults need to be open with their physician about their sexuality”. “Sexually transmitted infections are out there! If you continue to be sexually active, knowing that more people are living longer with HIV and being sexually active, too, the risk of infection over time is likely to be greater”. “40,000 new cases are diagnosed every year.” “On a yearly basis about 15% of new HIV infections are people age 50 and older”.
Dr. Brandt implores sexually active older adults, who are not in a long-term, monogamous relationship, to use a condom and discuss their sexual habits with their doctor. Why? Because HIV does not always present symptoms in an older patient the way symptoms are seen in a young or middle-aged adult. “Nine years ago, I had a patient who is 79, today”. “He went from doctor to doctor for his continuous weight loss”. “He’d been widowed 10 -15 years and was sexually active”. “I can’t tell you how many colonoscopies and other tests this man went through before he stumbled into our office”. “I was able to diagnose by asking, Are you sexually active”? “It turned out he was sexually active with men, a risk factor for HIV infection. No one had ever asked him before”.
“Another example of how symptoms are different in later life is this… For younger adults, someone with HIV may have a severe sore throat, rash and fever, just like a case of Mononucleosis”. “Older adults are less likely to respond with these same symptoms. Older patients are more likely to have unexplained fatigue and weight loss”. “In other cases, some older patients could look/act as if they have dementia”. “Treat the HIV and the dementia goes away.”
I asked Dr. Brandt what he hopes the readers will take away from this article and he replied, “Take your own sexual inventory to determine if you have been at risk”. “HIV/AIDS is not contracted through kissing”. He was clear in pointing out that if you are not in a monogamous relationship, heterosexual intercourse, male to male sex and oral sex is the sexual behavior that causes the spread of HIV/AIDS. “…and if you have had multiple sexual partners and never had an HIV test — you are at risk!”
“You can test for HIV by going to your doctor, going to the local health department – or you can buy a testing kit at the drug store for about $40.00 – $50.00”. “It’s called Ora-Sure”. “There is such a thing as Anonymous Testing”. “This is when you don’t have to give your name or you can make up a fake name”. “The local health department should be able to refer you”. “Some private physician practices may also do Anonymous Testing”.