Midlife & Older Women
Because of economic or emotional dependence, many older women may be aware of their partner's infidelity with men or women but feel trapped in their relationships or marriages. Midlife and older women who abuse drugs are often silent about their use. As women age, the stigma attached to these behaviors increases dramatically so women do not feel they can share this information with families or others. For many people, particularly the midlife and older women, transfusion may be seen as a more acceptable route of transmission than drug use or sexual behavior.
Other physiological changes related to aging also increase women's vulnerability to HIV infection and make women who are already HIV infected more susceptible to opportunistic infections. After menopause some women experience vaginal changes, which may include a thinning of the vagina walls, decreased elasticity, fewer secretions, and increased acidity. Vaginal thinning and dryness does not occur in all women, however, those who do experience it are at higher risk of HIV infection because dry, thinner vaginal walls are more likely to suffer a micro abrasion which can facilitate a viral entry.
In midlife and older women, HIV is often undiagnosed, misdiagnosed, or diagnosed late. Because these women are not thought to be at risk their symptoms often are first attributed to age-related illnesses. HIV dementia is the diagnosis most often mistaken for Alzheimer's disease in elderly people. Initial differentiation between the two can be difficult, especially if HIV infection is overlooked as a possibility for older women. In addition, because women still take seriously their traditional role as family caregivers, they assume the responsibility of providing for their partners, children and other family members before they will consider their own health needs. For some women, the connection between spirituality, religious faith, and health is significant and the traditional self care makes them more likely than men to seek other forms of care outside the strictly Western medical model. Many older women will seek care from herbalists, chiropractors, traditional healers, cuanderos and/or other alternative treatments. It is also necessary to consider the barriers that religious dogma might create for midlife and older women, particularly if religious leaders and their teachings engender a sense of shame and uncleanliness associated with HIV.