Tuesday, August 2, 2005
By JESSICA ADLER, HERALD NEWS
In the early 1980s, when Jane Fowler's husband of 23 years left her for another woman, she asked herself a common question.
How could this happen to me?
"Pick up the pieces," friends told Fowler, who lives in Missouri and was working as a journalist for the Kansas City Star at the time. "Get on with your life."
So Fowler did what so many newly single men and women do. She hit the dating scene. By early 1986, at the age of 50, Fowler had been seeing a man on and off for three years. The two had plenty in common: He, too, had recently been through a divorce. Plus, they were old friends: He was in her wedding party back in 1959.
When the two had sex, Fowler didn't even consider asking him to use a condom.
"There was no need to - I wasn't going to get pregnant," Fowler said in a phone interview. "To my generation, condoms were only used for birth control. So if you weren't going to get pregnant, why would you use one?"
According to experts, that's a widely held perspective among Fowler's contemporaries, who came of age well before "safe sex" education campaigns. And it's just one factor contributing to a troubling trend: Those 50 and older account for an increasing percentage of newly diagnosed cases of HIV/AIDS.
"People have a mistaken idea that age is some sort of vaccine, that they don't need to be concerned with HIV, that it's a disease of younger people and not us," says Fowler, who is now 70. "I'm here to tell you that's not true."
In 1991, Fowler took a blood test required to qualify for a new insurance plan. That's when she found out she had HIV, which, she says, she contracted from the man she was dating in 1986.
According to the Centers for Disease Control HIV/AIDS Surveillance Report for 2002, those age 45 and older made up 21 percent of new HIV/AIDS diagnoses in 1999. By 2002, that figure had grown to 25 percent.
Although state statistics are measured with slightly different parameters, they reflect a similar trend. A 2004 report from the Division of HIV/AIDS Services at the New Jersey Department of Health and Senior Services shows that people age 50 and older make up 25 percent of all 32,401 HIV/AIDS cases in New Jersey. People 50 and older accounted for 12 percent of new HIV/AIDS cases diagnosed in New Jersey in 1997, the report says. By 2002 — the last year for which comparative data are available — they accounted for 16 percent of new cases.
"There are so many factors that could cause this phenomenon," says Larry Ganges, assistant commissioner with the Division of HIV/AIDS Services.
Ganges points out that age at diagnosis may not be an indicator of the age at which the disease was contracted. For example, he says, someone might live with HIV for 20 years before being diagnosed at age 50.
Still, there's no doubt that people over 50 are more at risk than they might think. Those diagnosed at younger ages are receiving better treatments and living longer, so there is an increased risk of exposure to HIV or AIDS among older peers.
According to the 2004 report from the Division of HIV/AIDS Services, people age 50 and older are less likely to be tested for HIV/AIDS than their younger counterparts. And experts say those who don't know they have the virus are more likely to spread it.
With the aid of sexual stimulant drugs like Viagra, older men are able to have sex more often and with more partners. And the women they're with — women like Jane Fowler - may never have thought of HIV or AIDS as a personal threat, or to use a condom. Then, there are married men and women who contract HIV or AIDS from a spouse who has been unfaithful.
"If things are not done to educate this part of the population in such a way that individuals 50 and over understand that they need to adjust their behavior, you will continue to see this trend become more disturbing," says Larry Ganges with the Division of HIV/AIDS Services.
The first step in providing that sort of education is to recognize societal preconceptions of aging, says Robert Skeist, founder of the New Jersey Association on HIV Over 50.
"You have these stereotypes of what it means to be older and those stereotypes are inconsistent with thinking about these kinds of issues," says Skeist, a registered nurse specializing in geriatric nursing at the Family Treatment Center at Newark Beth Israel Medical Center. "People think of older people as law-abiding well-behaved people that don't do things they shouldn't do — like shoot up drugs or have sex outside of marriage. Nobody wants to think of their parents having sex or their grandparents having sex."
That includes health care providers, who may not ask 50-plus patients about their sexual and drug use history, or address the topic of sexually transmitted diseases. That means older patients are more likely to remain under-educated about diseases like HIV/AIDS.
"Most people think it's happening to somebody else but it's not going to happen to me," Skeist says.
There are efforts afoot to change that mindset.
The New Jersey Association on HIV Over 50 organizes educational programs at community and senior centers throughout the state aimed at raising awareness.
And in 1995, Jane Fowler founded a nonprofit, HIV Wisdom for Older Women, which delivers prevention and outreach programs nationwide to health, aging and social service providers; church congregations; students; senior groups; and fraternal, social and corporate organizations.
Earlier this year, Assemblywoman Nellie Pou, D-Paterson, sponsored Assembly Resolution No. 247, which designated May 27, 2005, as "HIV Infection in Persons 50 Years of Age and Older Awareness Day."
"We need to provide greater awareness to the population out there," Pou says, "that this is a growing problem."
The New Jersey Association on HIV Over 50 is currently developing support groups in English and Spanish. For more information, call Robert Skeist at (973) 926-6826, or write to The New Jersey Association on HIV Over 50, c/o Robert Skeist, Family Treatment Center of Newark Beth Israel, 201 Lyons Ave., G-3, Newark, NJ 07112. E-mail rskeist@sbhcs.com.
To contact Jane Fowler at her nonprofit, HIV Wisdom for Older Women, call (913) 722-3100 or visit www.hivwisdom.org.
Rapid HIV testing is available throughout New Jersey. For information about counseling and testing sites, call the Department of Health and Senior Services at (800) 624-2377.
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