According to Horberg, many of the diseases of aging "are made worse by HIV or its treatment." For example, he said, the AIDS drug tenofovir can impair kidney function, other antiretrovirals cannot be taken with cholesterol-lowering drugs such as Zocor or Mevacor, and it's suspected that HIV infection might even accelerate the onset of Alzheimer's disease.
Issues of HIV prevention and treatment can be especially tough on older women, said Diane Zablotsky, an associate professor of sociology at the University of North Carolina who's worked on the issue.
In terms of prevention, she noted that it may be tougher for a woman past menopause to negotiate condom use with a partner, when pregnancy is no longer an issue. And in terms of diagnosis and treatment, "if you have a woman experiencing night sweats and other kinds of symptoms -- is that menopausal change? A medication issue? Or is it an HIV-infection issue?"
All of the experts stressed that the key to curbing HIV infection in older Americans is the same as it is for the young: prevention. But that will mean having much franker discussions about sex.
"There's this myth that older people aren't sexually active," Fowler said. "Health-care providers could help by taking sexual histories, but they don't because they assume they don't have to. They can ask about smoking and alcohol use, but sex? Oh no, the person is old."
Zablotsky agreed. "The important thing is to reach out to older people in a way which -- if in fact they are engaging in behavior that puts them at risk -- they have a reason to say, 'I need to listen to this, I need to make this change, I need to protect myself.'"
Find out more at ACRIA's Center on HIV & Aging.
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