Pat Shelton has
been infected with HIV for at least 15 years and
also struggles with hepatitis C and high blood pressure. But
what is bothering her most on this sultry summer day
are hot flashes.
"I've gone through hell with my menopause," said Shelton, an
elegant woman who recently swapped her dreadlocks for a
close-cropped look while trying to stay cool. "It's
kicking me. But HIV, I've been very blessed. I don't
The 53-year-old Shelton, whose drug regimen has kept her HIV
from developing into AIDS, in many ways represents the
changing face of the HIV population in New York and
around the country: They are getting older and
presenting new challenges to health care providers.
In New York City, the epicenter of AIDS in the United
States, 30% of the 100,000 people with HIV are over
50, and 70% are over 40, according to the city health
department. Nationwide, 27% of people with AIDS are now
over 50, the Centers for Disease Control reported.
"Here is a group of people who, yes, they have HIV, but
they're going to get other illnesses," said Stephen
Karpiak, the associate director of research for the
AIDS Community Research Initiative of America. "And we
don't know the interaction of all the drugs. There are God
knows how many hundreds of drugs used by folks for cardiac
issues, osteoporosis, arthritis--we don't know
those interactions at all.
"No one's ever looked at them," he continues. "Someone
needs to do trials."
Karpiak's agency conducted a study, released this week, that
examined the many challenges faced by HIV-positive
The AIDS service organizations that arose after the epidemic
hit in the 1980s were designed to provide care and
counseling to people facing shortened life spans.
While there's still no cure for HIV, antiretroviral
drugs have made it a manageable illness for many patients
and prolonged their lives beyond what once seemed
As this group ages, they fall prey to a host of conditions
that require medicines that may interfere with the
effectiveness of anti-HIV drugs.
And that's if the condition gets diagnosed at all. HIV
patients typically see infectious disease specialists
who may not have their antennae out for unrelated
diseases, Karpiak said. They don't look for age-related
problems, he said, adding, "That is not their
Conversely, doctors unfamiliar with HIV may not suspect that
older patients have the disease.
Because HIV arose in the United States among gay men, a
stigmatized group, it remains more ostracized than
other diseases. Fearing rejection, HIV-positive people
often isolate themselves. Isolation becomes more of a
problem with age, said Karpiak, who noted that 70% of the
people in the study live alone.
"This is an isolated, stigmatized group of people who have
been largely neglected by their churches, by their
communities," he said. "Half have not told their
families. And as you age, you need those people for
emotional and everyday support."
Without friends and family, Karpiak said, older people with
HIV turn to home health aides. That creates the
potential of overburdening the system as the number of
HIV-positive people over 50 continues to rise.
Marjorie Hill of Gay Men's Health Crisis, one of the
nation's largest AIDS service organizations, said 33%
of the agency's 15,000 clients are over 50--up
from 25% two or three years ago.
Among the organization's tailored services are meals and
exercise classes better suited for older clients.
In addition, Hill said, a public service campaign featuring
older people--unlike the subway and magazine ads
that typically show images of handsome young
men--is in the works.
"We are actively fund-raising to develop a campaign
targeting persons over 50 with prevention and
education," she said.
Shelton, a former drug user who tested positive for HIV in
1991, has been an AIDS peer educator since 1998. She
is trained to give support but gets support herself at
Copacetic Women, a group for women with HIV over 50.
"I really don't feel too comfortable sitting in a group with
people my children's age," she said. "They're not
really going to open up or listen to what I really
have to say. We have concerns and health problems that
the doctors are not taking care of. We needed a safe