It's an easy assumption to make. One of the few illnesses people over 50 don't have to worry about is AIDS. Like acne or tonsillitis, it rarely affects people later in life. From an older person's perspective, AIDS is the exclusive property of another generation.
It's someone else's problem.
And then some disturbing numbers started showing up in the data banks at the U.S. Centers for Disease Control and Prevention in Atlanta.
In 1994, there were almost 6,000 new AIDS cases nationally among people 50 and older, an 11 percent increase over the previous year. During the same period, all other age groups showed only slight gains.
According to the CDC, preliminary indications show the trend is continuing.
What couldn't happen . . . is happening.
Quietly but steadily, the over-50 age group has become the fastest-growing segment of the AIDS population.
Health experts cite two reasons for the trend: many older people don't consider AIDS a threat and therefore don't practice safe sex, and the incubation period of AIDS can be 10 years or longer, so that people who were infected in their 40s and 50s (and weren't tested for HIV, the virus that causes AIDS) are now turning up sick in their 50s and 60s.
While AIDS has invaded the over-50 population, the outbreak appears to be relatively contained. Nationwide, the number of people over age 50 who have AIDS is small. Even in Florida, the over-50 group represents a fraction of the total cases: about 12 percent _ or 6,918 people as of Aug. 1. (In the majority of the Florida cases, the mode of transmission was homosexual contact.)
Last year, public health clinics in Citrus and Hernando counties reported no new cases. Pasco reported one; Pinellas, seven; Hillsborough, 15.
But here's the rub.
Only 2,055 people over 50 were tested in that five-county area _ an area that includes more than 2-million people.
(It should be noted that only people with AIDS are counted _ not those infected with HIV. Because Florida and many other states don't currently require doctors to report cases of HIV infection, there is no accurate way to know how many people have the virus. After Jan. 1, however, doctors in Florida will be required to report cases of infection. It is estimated that about 1-million Americans are HIV positive.)
There are compelling reasons why people over age 50 should consider a test, or at least learn more about HIV and AIDS.
The AIDS virus attacks older people more quickly than younger people, so the earlier an HIV positive person can be treated, the better. The life expectancy for people over 50 with HIV can be as much as two years less than younger people because the older someone gets, the harder it is to fight off the infections associated with AIDS.
Many older men don't use condoms, or if they do, they use them incorrectly, which places everyone at higher risk.
Many people over 50 don't discuss sex _ even with their doctors. To most, it's a highly personal subject. They don't tell their doctor they had an affair or sex with a prostitute. As a result, AIDS has been misdiagnosed as everything from Alzheimer's disease to complications of menopause.
The chief means of transmission for people in the over-50 age group is sexual contact between gay and bisexual men. However, heterosexual transmission is the second-leading identifiable cause of infection.
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Dr. Robert Wallace, a St. Petersburg physician who treats AIDS patients and conducts physician education seminars about the disease, says both older patients and their doctors have a responsibility. Patients should not be afraid to ask to be tested, and doctors should not be afraid to ask their patients to consider a test.
"A lot of doctors don't think about HIV in either men or women, particularly older physicians," Wallace said. "They just don't believe older patients get HIV.
"But we have to make everyone more aware, in all aspects of the community. We don't know who has the virus unless we test for it."
At the beginning of the AIDS epidemic, in the early 1980s, the disease was a hot topic among the group it hit the hardest _ gay and bisexual men. As the disease spread to drug users and heterosexuals, awareness also spread.
But among the last groups to address the issue of AIDS prevention has been older adults.
"There is very little fear in the elderly community concerning AIDS," said Marge Kennedy, a 70-year-old registered nurse and member of the Florida HIV/AIDS And Aging Task Force. She has made it her mission to find older people with HIV or AIDS and try to get them help. "Older people think they can't get it. Or the only way they can get it is by giving blood.
"They're wrong on both accounts. There is sex after 60."
Even organizations such as the American Association of Retired Persons are beginning to get involved. Judy Fink, a senior program specialist with the AARP in Washington, D.C., said organizations like hers do not want to create a panic, but they do want to raise awareness.
"I still don't see AIDS awareness posters with older adults on them," Fink said. "It's hard to think about mom and dad being sexually active, let alone grandma and grandpa.
"But I read just recently about a woman in her 70s who got sick. She was tested for everything. Even a bad reaction to exotic food. Finally, the doctor said, "I give up. Let's do an AIDS test.' She was HIV positive, and she died of AIDS shortly afterward.
"The point is that the more information we get out, the more likely everyone will think about this."
To that end, AARP has sent about 200 copies of an educational video aimed at seniors titled HIV/AIDS: It Can Happen To Me to senior centers, AIDS educators _ anyone who is interested.
Like their younger counterparts, when older people are diagnosed as having HIV or AIDS, they often find themselves feeling isolated and alone. They are in desperate need of support, and few of the groups they may belong to _ civic organizations and service clubs _ offer it.
So Kennedy is stepping in to try to fill the void. With the help of Dr. David Speer of the Department of Aging and Mental Health at the University of South Florida's Florida Mental Health Institute and a coalition of public and private health care agencies, she is leading the Pinellas County HIV/AIDS and Aging Project.
Because so little is known about older adults with HIV or AIDS, project members are trying to locate and interview at least 100 HIV-positive people over age 50 in Pinellas, and then repeat the study with a similar group in Hillsborough. The goal is to find out how older adults are coping with the disease, and pass that information on to health care organizations.
How do you know if you're at risk? That's easy, according to Dr. Wallace.
"If you've had unprotected sex with someone in the last 15 years, and you can't contact that person, you should get tested," he said. "I know of couples who were married for six or seven years, and then one of them becomes ill. And neither was tested. That's a real nightmare."
Officials hope a recent breach in security _ a confidential AIDS list from the Pinellas County Health Unit was leaked last month to several organizations, including the St. Petersburg Times _ won't deter people from getting tested.
In fact, an HRS spokesman said the security breach will likely lead to tighter controls.
"To the best of our knowledge, no names have been published anywhere," said HRS spokesman Tony Welch, "and when this is all over and we finish our review, we expect our security to be as tight as any in the nation. Already things are different.
"We've been really aggressive in the way this has been handled," he added. "It's so important that this information is protected."
Early diagnosis is important because the sooner AIDS medications are taken, the better the results. While there is still no cure, and nearly every person who gets the disease dies, a new class of drugs called protease inhibitors offers hope the disease can be managed, somewhat like diabetes.
In basic terms, protease inhibitors _ Crixivan, Norvir and Invirase _ block the action of protease, an enzyme that the AIDS virus needs to reproduce. Deprived of protease, the virus begins to die off. Only time will tell whether HIV is resilient enough to defeat protease inhibitors and whether the new drugs prove to have long-term toxic effects.
In the meantime, the best thing older people can do is talk to their doctor, openly and honestly, and get tested if they feel it is necessary.
"I make it clear to my patients that they can talk to me about anything _ including sex," Wallace said. "That's a relationship every person should have with their physician.
"We're not here to pass judgment. We're here to provide care."
"But we still have such a stigma and a phobia about HIV and AIDS. It's overwhelming sometimes.
"What people don't understand, is that AIDS is going to continue to spread as long as people think, "It can't happen to me.'
If you would like to participate in the Pinellas or Hillsborough HIV/AIDS and Aging Project, either as a participant or a volunteer, call 974-1975 or 974-1977.
Recommended reading: HIV/AIDS And The Older Adult by Kathleen Nokes. (Taylor & Francis, $24.95. Call (800) 821-8312.
In Florida, anonymous testing is available through most county health departments. The cost is usually about $20, but no one is turned away.
Signs and Symptoms
Many of the following symptoms are common to several illnesses, but the presence of these conditions for several weeks in the absence of other causes may be a warning sign of HIV infection.
oral sores or patches
Some people with HIV or AIDS are without symptoms until they abruptly develop an opportunistic infection or purple skin nodules (Karposi's sarcoma). Pneumocystis carinii pneumonia (PCP) is the most common and one of the most deadly infections acquired by people with HIV.
Where to call:
National AIDS Hotline, English: (800) 342-2437 (342-AIDS)
National AIDS Hotline, Spanish: (800) 344-7432
Florida AIDS Hotline, English: (800) 352-2437 (FLA-AIDS)
Florida AIDS Hotline, Spanish: (800) 545-7432 (545-SIDA)
By the numbers
Reported AIDS cases+, persons age 50 and older, through Sept. 30, 1996, by county.
Mode of transmission Citrus Hernando Hillsborough Pasco
Homosexual or bisexual 4 6 141 18
IV drug user 0 0 33 5
Homosexual or bisexual 0 0 3 3
IV drug user
Adult hemophiliac 0 0 3 3
Heterosexual contact 3 3 85 3
Transfusion 0 3 24 9
Risk not specified 4 3 21 5
TOTAL 11 15 310 46
Mode of transmission Pinellas Total
Homosexual or bisexual 155 324
IV drug user 18 56
Homosexual or bisexual 5 11
IV drug user
Adult hemophiliac 4 10
Heterosexual contact 28 122
Transfusion 20 56
Risk not specified 7 40
TOTAL 237 619
+ Excludes Department of Correction. Source: HRS Office of Disease Prevention.