Ever since former U.S. senator and presidential candidate Bob Dole came into American homes talking about erectile dysfunction and Viagra via a TV commercial, the use of such medications has skyrocketed. Unfortunately, increased sexual activity'especially with multiple sexual partners'brings greater risks of contracting HIV and other sexually transmitted diseases, topics seldom, if ever, discussed with America's seniors.
Paul Lapierre, executive director of the Canadian AIDS Society, notes that nearly 12% of all new HIV infections in Canada in the first half of 2003 were in the 50-plus age group. This is up from 6.6% for the period of 1985'1997, and he believes that use of Viagra, introduced in 1998, is partly to blame. 'Older people, especially heterosexuals, are simply not being targeted for prevention messages,' Lapierre says. 'Older gay men know about HIV, but heterosexuals remain in the dark for the most part.'
To illustrate how HIV-prevention strategies are failing to register in many seniors' minds, Lapierre points to a 1996 study revealing that 14.7% of people age 50 to 64 did not know that condoms are effective in preventing HIV infection'compared to 6.3% of those age 18 to 49.
This lack of knowledge becomes more dangerous, Lapierre believes, with the use of drugs to treat erectile dysfunction. Older men who were unable to get and sustain an erection can now choose from two new medications'Cialis and Levitra'in addition to Viagra.
It is not just the ability to be sexually active at a certain age that is resulting in new HIV infections in older people, however; there is also a reluctance in health care circles'as well as society in general'to talk with seniors about sex. People do not want to think about their older family members or friends having sex, according to E. Bentley Lipscomb, the Florida director of the American Association of Retired Persons. 'It is time for society to wake up,' he says. 'Old people have sex.'
New Lessons to Teach
In Florida'with its large population of older and retired people'the overall percentage of new HIV infections has been steady, but the proportion of people over 50 with AIDS in the general population continues to climb, according to data from the state public-health department. This may indicate that seniors are not getting the same message other groups are. In 2003, 25% of all AIDS cases in Miami-Dade were in the over-50 population, as were 14% in Broward County and 11% in Palm Beach County.
Lipscomb wants the issue of using erectile-dysfunction drugs and the lack of targeted outreach to be addressed: 'People over 50 should not be discriminated against. They should get the education they need.' He also notes that the U.S. Centers for Disease Control and Prevention and the surgeon general have failed to address HIV-prevention messages to the over-50 set.
Kathy Nokes, the chair of the New York Association on HIV Over Fifty and an authority on HIV infection in the elderly, agrees with Lipscomb's assessment: 'It is very frustrating that the CDC still refuses to recognize that the 50-plus group needs special attention. When providers are prescribing Viagra [and other erectile-dysfunction medications] they should be talking about safer sex: 'When you use this drug you should use a condom.' '
Jane Fowler, who remembers hearing about AIDS in the early 1980s but did not think it applied to her, now has a special interest in the topic. 'It meant very little to me,' she says. 'I knew virtually nothing about symptoms or whom it affected. I thought of it as primarily a gay disease. It just had not been a part of my life at all.'
Fowler went through a divorce at 47 and found herself back on the dating scene, so she talked with her physician about having an HIV test. She says, 'My physician looked at me like I was crazy. 'Oh, no, Jane, not you,' she said. This reinforced my idea that HIV was not really a concern for me. I did not know who could become infected.'
In order to get new health insurance in 1991 she had to take an HIV test, and it came back positive. She was stunned. Fowler says it had never occurred to her to use condoms, and no one had ever suggested that she should. After all, she was postmenopausal, she says, so pregnancy would not be an issue. 'My generation was not aware of sexually transmitted diseases when we came of age,' she points out.
So at 55, Fowler found herself HIV-positive. She soon discovered she was not the only one; many other seniors were testing HIV-positive as well. A retired journalist, she helped to create one of the few outreach programs for HIV prevention for the elderly. She was a founding member of the National Association on HIV Over Fifty and is the founder and director of HIV Wisdom for Older Women. She knows from her work in the area that this group of people can be difficult to reach, but she emphasizes that they are indeed reachable.
Easy to Come By
Obtaining medications for treating erectile dysfunction is not difficult. People do not even have to go to a doctor's office anymore; there are online pharmacies that will fill prescriptions without any direct physician-patient contact if the customer has a credit card and answers a simple questionnaire. This practice is more than troubling to the American Medical Association.
According to guidelines adopted in 2003 by the AMA, physicians should obtain a medical history and perform a physical exam prior to prescribing any medications via the Internet. However, most online pharmacies supply medications with few questions asked. And many are located in other countries and therefore not regulated by the AMA.
Without an in-person assessment by a physician, many critical factors regarding a person's health can be missed. Many seniors are on medications for cardiac disease that contain nitrates. The combination of nitrates and erectile-dysfunction drugs can dangerously lower blood pressure and even induce a fatal heart attack.
Paul Ewing, a spokesman for Pfizer, the manufacturer of Viagra, says company officials are aware of the 'inappropriate use of Viagra.' He says the company has materials in development about STD and HIV transmission and prevention that will be available within the next year. 'We recognize our need to have a proactive role on this topic,' he says. 'Foremost, we feel strongly about making people aware that Viagra is intended for medical treatment, and physicians should be counseling their patients about safer-sex practices when the prescription is written.'
As the spread of HIV increases among seniors it is clear that education and outreach are needed. The U.S. Department of Health and Human Services and the AARP have produced a pamphlet, 'The Pocket Guide to Staying Healthy at 50-Plus,' which includes a section on sexually transmitted diseases and how to avoid them but does not talk directly about erectile-dysfunction treatment and HIV infection.
Fowler is one person who knows that more has to be done to protect seniors. 'We need safer-sex education when people get a prescription for erectile-dysfunction drugs,' she says. 'Even now old Bob Dole could do us all a favor. He could talk about HIV prevention by telling his cronies, 'Now, if you can get it up, cover it up.' '