Marcela Valente*
BUENOS AIRES, Dec 29 2008 (IPS) – AIDS prevention campaigns tend to target the young, who make up a large percentage of those infected with the disease. But experts in Latin America say that people in older age ranges with an increasingly active sex life are being neglected, and are at risk because of lack of information.
Sexuality in older people is discounted, so no research is being done on the risk of sexually transmitted diseases spreading among the elderly, Liliana Gastrón, an expert on gender and ageing and head of the doctoral programme in social and human sciences at the University of Luján in the Argentine province of Buenos Aires, told IPS.
The 2008 report on the global AIDS epidemic by the Joint United Nations Programme on HIV and AIDS (UNAIDS), released in July, indicates that there are 1.9 million persons infected with HIV in Latin America and the Caribbean, 160,000 of whom were diagnosed within the previous year. These statistics include children under 15 and adults aged between 15 and 49. People over 50 are excluded.
However, the Brazilian Health Ministry found that the number of HIV-positive women aged 50 to 59 doubled between 2000 and 2007. For women aged 60 to 69, the number grew by 88 percent, and among those over 70, by 190 percent. Among men the trend is less marked, but numbers are also increasing.
We still don t know whether these are new cases, or have only just been diagnosed, the head of the non-governmental Brazilian Interdisciplinary AIDS Association (ABIA), Veriano Terto, told IPS. Maria Luiza Pereira of Maria Mulher, an Afro-Brazilian women s organisation, however, said the incidence of AIDS among older women has increased sharply.
In stable couples, women find it difficult to negotiate the use of a condom. They believe the stability of the union makes for safe sex, but infidelity may still occur, said Pereira. Another factor that makes older women vulnerable is the lack of pregnancy risk, which reduces concerns over not using condoms.
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In Mexico, 11.7 percent of HIV-positive people are over 45, according to the National Centre for the Prevention and Control of HIV/AIDS (CENSIDA).
Mexican geriatrician Agustín Polanco told IPS he is finding cases of HIV infection in people over 60. At that age, he said, condom use is rare, and older people are not being targeted by prevention campaigns.
Polanco said that Viagra, the medicine used to treat erectile dysfunction, allows older people to have a more active sex life, and he predicted that in a few years time there will be a significant number of (HIV-positive) cases among older adults, many of which will be new infections.
In Colombia, the head of Corporación Semillas de Esperanza (Seeds of Hope), Rafael Planeta, told IPS that non-governmental organisations in his country run HIV/AIDS programmes for young people, but there is no ongoing work aimed specifically at over-50s, a sector of the population where risk does exist.
Because this issue goes unrecognised, particularly for women, Gastrón, a pivotal figure in Argentina of the international organisation Development Connections, performed a study on the risk of HIV infection in older people and the silence to which they are consigned if they contract HIV/AIDS.
After menopause, women are more vulnerable because the vaginal tissues are more fragile. If lesions occur, there is a greater risk that the virus will enter the body, said Gastrón. Later on, if they develop AIDS symptoms, the problem remains hidden under other pathologies that are common in the ageing process.
At two recent congresses of health professionals held in Argentina by the National Institute of Social Services for Retirees and Pensioners (INSSJP), Gastrón presented her study and spoke on the infection risks faced by older women.
The immediate reaction of the audience was surprise, she told IPS. But gradually the health professionals described different experiences they had of contact with older people exposed to the infection. They are seeing cases, but they still do not have a clear perception of the phenomenon, Gastrón concluded.
International bodies themselves are beginning to see that their HIV/AIDS epidemiological statistics were focused on people of reproductive age, because there is an underlying assumption that older people are neutral in gender, as if sexuality somehow disappears at a certain age, she said.
Gastrón called these prejudices that stereotype older adults in negative ways ageism, consisting, for example, in the assumption that they must all be ill, or deaf, or senile. These prejudices are also common among healthcare personnel, she said.
Because of the prejudices, they don t realise that older people continue to have sexual relations beyond the age of fertility, and that they are at risk. Sexually transmitted diseases are no respecters of age, said Gastrón.
She said that with the advent of Viagra, sexual activity among senior citizens had increased, both within stable couples and outside of them. Some women have occasional unprotected sexual contacts, and some men have sex with prostitutes as well as an active sex life with stable partners.
I am not advocating abstinence, but I do think that when Viagra is prescribed, prevention counselling should also be given, the expert said.
In fact, at the INSSJP congresses, the centres for retired people participating at the meetings where Gastrón presented her work confirmed that older adults were at risk, and said their associations could distribute condoms among their members.
Similarly, the National Front of People Affected by HIV/AIDS (FRENPAVIH) in Mexico is calling for special campaigns for older adults. Although cases of infection are known, there are few official statistics, they say.
Vicente López, a FRENPAVIH activist, mentioned that among HIV-positive people who attend their meetings there are older people who became infected when their sex lives were reactivated by Viagra. But he hastened to add that it s not this medication that is responsible for the infection, but the lack of information.
Finally, the Bulletin of the Faculty of Medicine at the University of Chile published an article titled El abuelo tiene VIH (Grandpa has HIV), which said that 10 percent of HIV-positive people in Chile are older adults who live in fear of being stigmatised. It s not a very high figure, but it is gradually increasing, said Juan Molina, a geriatrician.
*With additional reporting by Mario Osava in Brazil, Helda Martínez in Colombia and Diego Cevallos in Mexico.
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