This article first appeared in the St. Louis Beacon, Dec. 1, 2010 - Shortly after his HIV infection became full-blown AIDS, St. Louisan John Watts faced another life-threatening health crisis: a heart attack.
In 1997, the then-41-year-old department store designer began taking a new AIDS cocktail of antiretroviral drugs. Soon, his once-normal cholesterol level shot up to an alarmingly high 400 mg/dL. On the day of his 1998 heart attack, Watts clutched his chest in pain as he drove himself to the hospital where a cardiologist discovered major blockages requiring five bypass grafts, uncommon for a man of his age.
Today, with his AIDS under control with the help of newer medications, Watts' 270 cholesterol level is still 70 mg/dL over the high end of normal. He's grateful for the life-saving drugs that have allowed him to live 25 years and counting after his HIV+ diagnosis. But the medications' side effects --- which include not only elevated cholesterol but also lipodystrophy, a redistribution of body fat --- make them a mixed blessing.
"There's a price to pay," Watts said.
Separating Out Aids, Aging And Meds
Like Watts and numerous others affected by HIV/AIDs, 52-year-old Kendrick Davis of St. Louis has seen some negative health changes since being diagnosed with HIV in 2008 and beginning medications earlier this year. Six months into a drug trial, Davis' blood pressure is on the rise. But due to a kaleidoscope of risk factors, his doctors can't pinpoint the reason.
"They don't know if it's caused by the disease, the medications or just my age," Davis said.
Davis' dilemma is becoming all too common, as the HIV/AIDS population gets older. In 1987, over half of those diagnosed died within 10 years. Today, 90 percent can expect to live another decade. And by 2015, half of those living in the U.S. with HIV will be over 50 years old, according to Dr. Turner Overton, assistant professor and infectious disease specialist at Washington University School of Medicine.
"Facing 50 is kind of a magic number when we begin worrying about aging," Overton (left) said. "And people who have HIV may be between 10 to 15 years older than their biological age."
Medications can contribute to some of the accelerated aging process. But Overton's research is focused on the virus itself. HIV is implicated in the development of heart and liver disease, cancer, osteoporosis and dementia -- all of which also have increased odds as we grow older. Working to ward off AIDS-related dementia, Overton and other Washington University researchers are comparing the brains of Alzheimer's patients with those of people with HIV/AIDS.
"Our patients are aging, living into their later years, so the question is: How do we help them face the challenges of aging which may be exacerbated by HIV?" Overton said.
Heterosexual Sex Now Chief Route For HIV
While scientists are investigating interventions for the future, local health service providers are learning about the risk of infection in older people and how to care for their older HIV+ clients --- currently numbering more than 2,500 out of 5,388 total infected people in the St. Louis metro area --- right now.
In St. Louis, a city with the fifth highest HIV rate in the nation, 52 percent of those affected are over the age of 45, giving St. Louis another distinction as one of the oldest HIV+ populations in the country. At a recent HIV and aging workshop in south St. Louis, caregivers learned that specific myths about HIV are major obstacles to diagnosis and treatment.
Among those myths: Postmenopausal women aren't at risk. In fact, a woman's chances for infection actually increase after menopause because her thinner vaginal tissues are more prone to tearing --- creating entry points for the virus.
It's imperative for health-care and other senior service providers to bring HIV into the conversation with their clients, according to workshop presenter Hanna Tessema of AIDS Community Research Initiative of America.
"It's really us, who are working in the field who are uncomfortable with the topic," Tessema said. "That's the biggest barrier to getting the word out."
Getting the attention of older people who don't believe they're at risk is another big challenge. A belief still persists that AIDS is a disease primarily affecting drug users and young, gay, white males. But today's reality is shockingly different.
"The main mode of transmission now is actually through heterosexual sex," Tessema said.
According to a 2006 ACRIA study of 1,000 HIV+ New York residents over the age of 50, 38 percent reported they contracted HIV through vaginal intercourse, compared to 36 percent who cited intravenous drug use and only 28 percent who cited anal sex as the point of transmission.
Of those who contracted the virus in the last five years, 61 percent reported vaginal sex as the mode of infection.
'Anyone Who is Alive is at Risk'
Vaginal transmission of HIV is higher among African Americans and Latinos than whites because the diagnosed population in those groups includes more women and heterosexuals. Among blacks, prejudice about HIV/AIDS runs particularly deep, with its own version of "don't ask, don't tell" establishing a deadly silence about the disease.
Workshop attendee Tammy Brown, a case worker with Williams and Associates, a group dedicated to improving minority health disparities, said people in the African-American community, and all other communities, who assume older people aren't sexually active -- and therefore not at risk for HIV -- are seriously misinformed.
"I want to create more HIV- and aging-specific outreach programs that are pertinent to folks in senior communities -- because sex still happens in those communities," Brown said.
One of the chief messages Brown wants to deliver: Know your HIV status. Both Brown and Overton are proponents of HIV testing becoming a standard component of all medical checkups -- just another blood test -- for older and younger patients.
"Anyone who is alive is at risk for HIV," Overton said. "We should all receive routine testing."
Nancy Fowler Larson is a freelance writer in St. Louis.
