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The graying of HIV: Hurdles, hope for older adults

Treatments and healthier lifestyles extending lives, but prevention education presents a challenge

By Karen Ann Cullotta, Special to the Tribune

January 2, 2013

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Chicago artist Curtis Bewley is the increasingly common face of HIV. At 58, he's lived with the virus for 15 years.

Despite being on his fifth treatment regimen, he enjoys an active and healthy lifestyle, working as an advocate for other folks with HIV, completing a master's degree in psychology and freelancing as a mural artist.

It's a life far removed from the one he had around the time he contracted the virus.

"I was very depressed after a breakup with my partner, so I hooked up with someone one night and had unprotected sex," Bewley said. "When I was leaving his apartment, I noticed that his kitchen counter looked like a pharmacy. … There were so many prescription bottles. I just knew he must have HIV."

A growing number of older adults like Bewley are living vibrant and healthy lives due to medical advances that, in many cases, make HIV treatable. Still, officials at public health and social service agencies say they must continue getting the word out about HIV to people over the age of 50, who now account for 11 percent of new HIV diagnoses, according to health experts.

Recent studies estimate that, among people with HIV today, 1 in 4 are age 50 or older. Some studies estimate that within a decade, half of those living with HIV will be 50 or older.

For Dorie Barron, an educator with the Cook County Department of Public Health, it was not a surprise when only one person — a 75-year-old man who declined to give his name — attended a recent presentation in Mount Prospect about HIV prevention among seniors.

When approached by a reporter, the soft-spoken attendee would only say that he attended the HIV prevention seminar "out of curiosity."

According to Barron, many older adults find it awkward to discuss HIV prevention because of the misconception that promoting "safe sex" is a public health message best delivered to teenagers and young adults, not grandparents in their 60s, 70s and 80s. People in that demographic are sometimes assumed to have relinquished their sex lives, she said.

But Barron said those assumptions are wrong, and she's joining forces with public health educators nationwide who are facing formidable challenges educating older adults about the dangers of engaging in unprotected sex with new partners, especially women who are post-menopausal and at no risk of pregnancy.

"When HIV became a public health issue in the 1980s, a lot of our senior citizens today were already in longtime marriages, and they were monogamous," says Barron. "They just assumed AIDS was a gay man's disease, and they didn't need to know anything about it.

"But now they are widowed, and with new partners, and they are thinking like teenagers again," said Barron, who has brought her HIV prevention message, "Love, Sex and HIV," on the road to Chicago-area senior citizens.

"When it comes to HIV prevention, this was a generation that was skipped, because they came of age decades before we ever even heard about AIDS," she said.

Public health officials call Barron's message a timely one. They warn that an array of societal trends could create a perfect storm among baby boomers who are living longer and healthier lives. Meanwhile, with the help of drugs such as Viagra, they're staying sexually active much longer.

To be sure, advances in drug treatments and special diets also are extending by decades the lives of people who are HIV-positive. Earvin "Magic" Johnson, 53, the former NBA All-Star, recently marked 21 years since his disclosure that he was HIV-positive.

"It's not unusual now to find patients who have been living with this disease for 30 years," said Stephen J. Brown, vice president and medical director of the AIDS Research Alliance in Los Angeles.

"It's also not unusual for people to not know they were infected until they are over 50," Brown added. "And some of them may have been quite sexually active in the meantime."

Complicating matters, Brown said, people over 50 are apt to shrug off or ignore early HIV symptoms such as body aches, fatigue and night sweats, assuming they are merely signs of growing older, or for women, attributable to menopause.

"Everyone should know their status, not just for HIV, but if they have high blood pressure, or if their cholesterol is high," said Brown, who supports a national effort to include HIV testing as part of the standard of care for older adults receiving regular health screenings.

"No one wants to think about their parents having sex, but when you look at the sales numbers for Viagra, clearly there are a lot of people who are older having sex," Brown added. "They are not concerned about HIV, and it's probably not something they think about at all."

"People are living longer with HIV, but they are also getting HIV in their 70s and 80s," added Norma Rolfsen, a nurse practitioner and program director of the HIV Care Program of the Michael Reese Research & Education Foundation at Mercy Hospital & Medical Center in Chicago.

Rolfsen is among the public health advocates promoting HIV testing for older adults visiting their doctors for checkups and routine tests such as blood pressure and cholesterol screenings. Primary care providers also should be discussing HIV prevention with older patients who are sexually active, Rolfsen said.

In addition, for HIV-positive adults who are living longer, Rolfsen said, health care providers must also remain vigilant about not ignoring other health issues. Cancer screenings and bone density tests, or addressing memory loss, remain important regardless of HIV status.

Bewley advises health care providers at the Midwest AIDS Training + Education Center at the University of Illinois College of Medicine in Chicago, so he's well acquainted on different levels with the needs of older adults living with HIV.

That wasn't always so. After the encounter Bewley long ago came to see as a mistake, he soon visited a doctor for an HIV screening. It was negative, but six months later Bewley tested positive.

Though he hasn't developed AIDS, he has suffered debilitating side effects from some of the medications he has been prescribed over the years. For example, in 2011 he was hospitalized after suffering kidney failure his doctors attributed to an HIV medication his body rejected.

Today Bewley remains irrepressibly positive about living each day to its fullest. He begins most days at 5:30 a.m., being careful to eat a healthy breakfast — a high protein cereal with fruit — and taking his first dose of the three medications that are part of his latest, twice-a-day, HIV treatment regimen.

By 8 a.m., Bewley is often en route to a freelance job, relying on public transportation and toting his paints and supplies in a gym bag, along with a nutritious brown-bag lunch. He's a mural artist whose assignments range from creating works of art for nursery walls at private homes to illuminating the confines of pediatric waiting rooms.

This winter he is in his final course toward a master's degree in psychology from Argosy University in Chicago that he hopes will lead to a career as a counselor.

In the meantime, Bewley enjoys volunteering at his church, singing in a community choir and keeping physically fit by walking and biking in his North Side neighborhood. While he sometimes worries about occasional lapses in his memory, he is above all, grateful to be alive, and determined to keep sharing his message, well into a ripe old age.

"There is a need for the public to stop stigmatizing AIDS as a gay man's disease," Bewley said. "Everyone is at risk of HIV, and each of us needs to learn to take responsibility for our own health."