Women over 50 years old living with HIV are a demographic group that is particularly neglected in research.
The specific criteria for diagnosing women with HIV were not even established until nearly 15 years after the epidemic began..1 What do epidemiological data and academic research tell us about HIV and aging, specifically for women?
Many women over 50 years old have been diagnosed
Given that nearly 25% of newly diagnosed seniors (50 and older) are women, are there specific factors that put them at greater risk?
A recent analysis found that menopause is a factor, as postmenopausal women may have more cases of vaginal dryness, which can cause tearing during sexual activity and increase the risk of HIV transmission.
This edition of the Research Roundup of POZ summarizes additional contemporary peer-reviewed research on aging women with HIV/AIDS.
Women in this study were between 50 and 95 years old.
This study looked at the HIV testing habits of elderly women attending a Georgia medical clinic. The researchers interviewed 514 women, aged between 50 and 95 years old, and found that only a third had ever been tested for HIV.
They also paid special attention to whether high-risk older women participated in the trials. Women in the study were considered at high risk if they had sex with high-risk male partners, such as men who use intravenous drugs, sex work, or who have already been incarcerated.
Only 45% of older, high-risk women were interested in being tested for HIV, citing a lack of need, perceived lack of risk, or having been tested previously as justification.
High-risk women who were not interested in getting tested were more likely to be older than the other participants and more likely to be African American women.
Brennan and associates analyzed data from the Ontario HIV Treatment Network Cohort Study of people aged 50 and older living with HIV/AIDS. About 11% of participants were women aged 50 and over. More than two-thirds of participants had been living with HIV for more than a decade and nearly 90% had an undetectable viral load. Aging women with HIV/AIDS who participated in the study experienced higher levels of stigma, low self-image and maladaptive coping skills than other participants. However, these women also reported high levels of social support, good health and were less likely to engage in cigarette and alcohol use.
This study included 290 individuals over the age of 50 living with HIV/AIDS and evaluated condom use. The researchers found that only 20% of heterosexual women in the study were sexually active.
PrEP and the I = I are factors that aggravate the neglect of condom use
They were more likely to be wealthy, report good health and maintain a relationship. However, only 12% used condoms regularly.
Four percent of these women reported having a seroconcordant relationship, in which both partners were living with HIV, and practiced irregular use of condoms. (Note: PrEP and I = I are factors that aggravate neglect of condom use, and syphilis or gonorrhea, for example, are serious STDs that PrEP and I = I cannot prevent).
Three percent of the women in the study were in a serodiscordant relationship where the woman is positive and her partner is not, and practiced the irregular use of condoms. Irregular condom use was associated with being in the first relationship and knowing less about HIV/AIDS.
Boredom and Women Over 50 Living with HIV
Golub and associates studied factors that increased the likelihood of condom use among HIV-positive women over 50 years of age. They found that to have "purpose in life", “environmental domain” and “autonomy” significantly increased the probability of condom use.
“Purpose in life” was defined as the process of seeing deeper meaning for life's challenges.
The authors suggest that this may reflect individuals' spirituality and having spiritual practice may increase the desire to participate in preventive behaviors.
“Environmental dominance” and “autonomy” can increase condom use because they indicate that a woman in a relationship is more comfortable discussing contraception and advocating for her sexual needs.
Joseph Bianco and his fellow researchers looked for factors that would increase adherence to antiretroviral therapy for women living with HIV over 50 years of age.
Negligence in Treatment
Just over half of the women in the study they took their antiretroviral drugs properly.
Those who engaged in coping with avoidance (ignoring a stressor to protect themselves) and had less social support were considered more likely to become depressed.
However, the study did not find a significant correlation between lack of social support, avoidance strategies, depression and adherence. In fact, the researchers found no psychological or sociological factors that predicted a woman's medication adherence.
In this qualitative study, 19 women living with HIV over the age of 50 were interviewed about their sexual choices.
For these women, the main barriers to sexual and romantic relationships were fear of stigma, negative body image and discomfort in relation to disclosure.
Stigma lowered rates of sexual and romantic couples because they were afraid of being judged as "dirty" or "bad". Negative body image, caused by side effects of anti-HIV drugs and/or menopause, also affected romantic and sexual couples. Also, discomfort with disclosure affected the rate of sex and intimacy.
In the midst of all this I believe that, although I'm a man, I think I can put something interesting in this text, as it contextualizes:
I cut my hair last Friday and the barber knows my HIV status. Although I don't really care what people tend to say, and anyone who knows me knows well how I react to certain nonsense. The barber, at close range, told me:
"Is your hand like this because of AIDS?"
I almost got up from my chair and sent him to #¿$?%! But I replied:
— Due to the action of HIV since 1994 and, also, due to the initial bounce given by AZT…
— Wow, you go out with a lot of women, right?
By the way, he suggested I was promiscuous, but I replied sourly:
-Yes, it was once a night, sometimes twice and, I added, lying. In some cases three or even four. After all, I'm a DJ...
“The mines fall killing right”?
I replied with a yes look and shut up.
See, the conversation went further, since the cut took almost thirty minutes, I had a MANE!
Fact is, I won't cut my hair in that salon again.
The essence of this brief dialogue shows the following: The stigma and prejudice created by the brown media, by the hypocritical religious (dogs) hit and stayed. I'm afraid to say that NEVER, NEVER AND NEVER WILL PASS and, unfortunately, it gets worse in dealing with and with women.
Following the translation...
This discomfort came from past negative experiences, where women experienced rejection, as well as the fear of future rejection.
And there are people who say that social death does not exist and it is nonsense ignoring, for example, that, in Brazil, ⅓ of the economically active population would refuse to work alongside a person living with HIV - a person like that, they they say- and that everything is normal (…) just take a pill. And there are those who, as communicators and opinion makers, who, without a clue, give space for statements like these!
Sara Glasser explains:
In my review of contemporary research on aging among women living with HIV/AIDS, I found that most studies focused predominantly on condom use and included small samples and narrow scopes of study.
Many articles have included women's issues, but they did not separate women and men in their analysis..
As a result, there is a paucity of information about the specific challenges faced by older women with HIV. Future studies would benefit from the analysis beyond sexual activity, with a more holistic approach.
There is also a great need for formative research on trans women aging with HIV, all of which would better inform prevention, treatment and support services for women.
I, Claudio, ask myself and I ask you, women: Is it domestic violence? Is it structural violence? Is it racism or structural racism? Or, still in the countryside, now of extreme structural violence, the low capacity of risk perception, due to a bad education and low levels of education?
I don't know… What I assure you is that I'm paying more attention to it 😉
Akers, A., Bernstein, L., Henderson, S., Doyle, J., & Corbie-Smith, G. (2007). Factors associated with lack of interest in HIV testing in elderly women at risk. Journal of Women's Health, 16 (6), 842–858.
Brennan, DJ, Emlet, CA, Brennenstuhl, S., & Rueda, S. (2013). sociodemographic Profile of elderly people with HIV / AIDS: gender differences and sexual orientation. Canadian Journal on Aging / La Revue Canadienne du Vieillissement, 32 (1), 31-43.
Lovejoy, TI, Heckman, TG, Sikkema, KJ, Hansen, NB, Kochman, A., Suhr, JA, … & Johnson, CJ (2008). Patterns and correlates of sexual activity and condom use behavior in people over 50 years of age living with HIV/AIDS. AIDS and Behavior, 12 (6), 943–956.
Golub, SA, Botsko, M., Gamarel, KE, Parsons, JT, Brennan, M., & Karpiak, SE (2013). Dimensions of psychological well-being predict consistent condom use among older people living with HIV. Aging international, 38 (3), 179–194.
Bianco, JA, Heckman, TG, Sutton, M., Watakakosol, R., & Lovejoy, T. (2011). Prediction of adherence to antiretroviral therapy in HIV-infected elderly: the moderating role of gender. AIDS and Behavior, 15 (7), 1437-1446.
Sarah Glasser is the Community Coordinator and Fellow of AVODAH at GMHC.