practitioner if I should take an HIV test

During my annual physical examination in 1989, I asked my family practitioner if I should take an HIV test. I had begun to hear that the disease was moving into the heterosexual population and, after all, I had enjoyed some intimacies after my divorce. This was the physician who would, two years later, pass on the insurance company test results, but at that earlier time she said simply, "Oh, no, Jane, not you. You don't need that test."

I would like to think that in the intervening 11 years things have changed. But physicians, for the most part, omit the topic of sexuality when dealing with seniors. When I have asked my peers if their clinicians take sexual histories during consultations, they say no.

If physicians would take a more proactive role in discussing sexuality and sexual histories with their patients, there might be fewer misdiagnoses of older people who are, in fact, HIV infected. Misdiagnoses occur because HIV symptoms can be similar to those associated with aging -- weakened immune system, weight loss, fatigue, swollen lymph nodes, skin rashes, respiratory problems, depression, decreased cognitive or physical abilities. Too often older people are not diagnosed until an AIDS-defining opportunistic infection has already developed, and as a result the elderly often die sooner from AIDS complications than younger people do. There even have been cases in which HIV was not confirmed until after the patient had died.

I am reminded of a story passed on by a colleague about a 65-year-old man living in the Chicago area who encountered a "you've lived long enough" attitude from the physician who delivered the man's HIV+ diagnosis. Discouraged, the man next went to an AIDS service organization for assistance. When he inquired about a doctor, he was told he'd have to select his own clinician from a list the ASO would give him. According to the man, the ASO counselor could see he was depressed, suggested he "cheer up," asked his age, and when told, said, "What do you want? You die of something after sixty." Later, this man found a physician he was seeing to be more caring and warmer to his younger patients. "I saw a difference in the treatment I was getting," he said.

How discouraging for him and all of us "over 50" who live with HIV disease, who are conscious of a cultural attitude that assumes, "Elderly people have lived their lives -- so what if they die from AIDS?" Admittedly, I'm one of the fortunate ones, in that my current physician is attuned to aging with the virus. Sometimes a symptom that may be evidence of HIV progression is in fact just a sign of aging. Recently, a head cold evolved into a sinus infection, and when I requested an explanation as to why I am having more sinus infections, my doctor answered that the HIV-infected are more subject to such problems and, "so are old people." Zap! Unknowingly, she had reminded me of my years, and I cringed.

Try as one might to age with good humor and grace, it's not always easy to accept the limitations of decreased physical and mental capabilities -- the loss of muscle strength, the lack of energy, the loss of physical attractiveness and, most discouraging, the forgetfulness. Couple these frustrations with the variety of feelings experienced by any HIV positive individual, and it is simple to conclude that seniors, especially those with self-image issues, may endure more emotional and physical stresses than do others living with the disease.

A beneficial solution could be support groups, often a mainstay of younger adults, but they are not a tradition with seniors, who, we are told, tend to be shy and uncomfortable in such settings. Concerns of older HIV-infected persons are not the same as those of younger people, and it becomes difficult to relate. Yet there are support groups for women and men that have achieved success.

I am nearly 65 years old, well past the childbearing years and I look as I did 36 years ago before the birth of my son. I appear robustly pregnant. This is one of the side effects of the antiviral drugs which can be more distressing to aging individuals. We oldsters who live with HIV have legitimate concerns about the fact that we have not been included in research and clinical drug trials. There are no published studies about the effects of antiviral drug therapy on older people, nor do we have information about possible interactions between antivirals and drugs that are routinely prescribed for a variety of older ailments. Personally, I wonder about my combination of two therapies: triple antiviral and hormone replacement.