Most AIDS research and prevention programs targeted to women focus on “women
of child bearing age” (defined as 15-44 years) and most health care providers
are not adequately prepared to diagnose and treat midlife and older women with
HIV/AIDS. Indeed, older women’s invisibility ensures that essential services
will not be available.
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.
Margaret Uriegas
Multi-Cultural Educator
This article appears in December 15 • 1995 and December 15 • 1995 (Cover).