One of the most maddening things about AIDS is that every time medical science throws a punch, the disease counterpunches. The most hopeful development in the long battle against HIV is the cocktail of antiretroviral medications that for the past 10 years has helped many people in the developed world (and a few in the developing world) fight the virus to a draw, allowing them to resume a more normal life.
That ought to be very good news, but in a disturbing echo of the earliest days of the epidemic, many hospitals and other institutions are clearly unprepared for a sudden influx of a new population of HIV patients: middle-aged and even elderly people surviving with the disease into their later decades. Nearly 27% of people living with AIDS in the U.S. are 50 or older--a proportion that is expected to increase. This vanguard group must confront the ordinary ailments of age complicated by the extraordinary ferocity of the AIDS virus.
There are practically no studies on how medications for high blood pressure, osteoporosis or other age-related maladies interact with AIDS drugs, says Stephen Karpiak, one of the authors of a landmark report on older folks and HIV that was released last week by the AIDS Community Research Initiative of America (ACRIA). In addition, nerve pain, visual problems and other ills associated with HIV mimic those of aging, leading many doctors to confuse symptoms of AIDS with hallmarks of age.
When researchers and activists gather in Toronto next week for the XVI International AIDS Conference, those problems may at last get some attention. One major concern of AIDS experts is the design of clinical drug trials, which typically exclude older folks because of their age and other health problems. And try to find a prevention poster or ad campaign geared to sexually active seniors. In many cases, those people may need the information as much as the young do. "People who no longer have to worry about pregnancy don't see the need for a condom," says Jeanine Reilly, executive director of Broadway House, an AIDS service group in Newark, N.J. Indeed, the ACRIA survey showed that 33% of older folks who were sexually active in the previous three months did not engage in safer sex.
More moving than the health messages and the science, however, are the portraits and stories of these seven Americans, ages 51 to 73, who have been living with AIDS, in some cases for 20 years. They know, perhaps better than most, that AIDS still cuts too many lives far too short--even in the U.S. They have encountered the same ostracism by family and friends that younger AIDS patients face, made worse by the fact that their later years are when they rely on those support systems most. But something--faith, fortitude--led them to take their pills and not give up. Simply by doing so, they help relieve perhaps the greatest problem faced by older Americans with AIDS: invisibility.
To view a multimedia essay about the graying of AIDS, visit time.com