Diagnosis and Treatment

Diagnosis and Treatment

Ageism doesn't stop at the clinic door. Some of the early symptoms of HIV mimic age-related conditions, and many doctors apparently buy into the myth of elderly celibacy and sobriety. When an older patient complains of fatigue, weight loss, or failing memory, a doctor who does not recognize the risk of HIV infection may automatically attribute the symptoms to advancing years.

In a different version of "Don't ask, don't tell," doctors' failure to ask the right questions can be compounded by patients' reticence about divulging intimate details of their sex lives or drug histories to people, including doctors, half their age. This is particularly true of older gay men, according to James Masten, a social worker with Senior Action in a Gay Environment's (SAGE's) AIDS and the Elderly Program. Having come of age in the pre-Stonewall era, today's older gay men remember when they could lose not only their livelihood but even their freedom because of their sexuality. Small wonder that a generation that could once have been institutionalized just for being gay may want to remain closeted even to those charged with providing their health care.

Whatever the reasons, failure to communicate leads to failure to diagnose HIV in its early, and most treatable, stages. According to Spectrum's Joan Zimmerman, the older PWAs in her program typically did not learn of their HIV status until they became sick enough to be hospitalized. Only after they came down with an opportunistic infection that clearly suggested HIV were the lifestyle questions asked and the blood tests ordered. The time for early intervention was past.

Treatment of older PWAs can be complicated, even for the most dedicated and understanding health care professionals, because of difficulties in determining whether particular symptoms stem from HIV or age. Memory loss, for example, may indicate either AIDS-related dementia or Alzheimer's disease. The distinction is important: AIDS-related dementia can be reversed; Alzheimer's cannot.B