AIDS and aging are not usually thought of as being related. But some experts worry that such a belief may lull older people into thinking that they do not face risks.
In 1990, Nassau and Suffolk Counties had 29 cases of AIDS per 100,000 of their over-50 population, which totaled 729,877, according to the State Health Department. Incomplete figures for last year show that the rate increased to 53 per 100,000. That may seem small compared to the general national rate of 130 cases per 100,000, but health experts say aging people may be the least educated group about the AIDS epidemic.
"When we look at prevention material that's around, we see that it's primarily aimed at college-age kids," said Drs. Ron Stall and Joe Catania of the University of California in San Francisco.
The two epidemiologists said they had conducted the first survey of AIDS and people over 50. The survey, which interviewed 14,000 people in random telephone calls, found that older at-risk Americans were one-sixth as likely as younger people to use condoms and one-fifth as likely to be tested for H.I.V. But, Dr. Stall said, the problem may be that many older people do not consider themselves to be at risk.
"There's a lot of discussion about babies born from H.I.V. mothers," he said, "but that's only 1 percent of the population."
Dr. Stall terms as a typical at-risk group the increasing number of older people who find themselves single after many years of marriage, but most likely do not perceive themselves that way. The survey indicated that 10 percent of people over 50 engaged in forms of risky behavior.
"I don't want to blow this out of proportion," Dr. Stall said. "Younger Americans are still at the greatest risk, and most of the funding should be aimed at this younger group. But just as you promote cardiovascular education for the older population, to completely ignore AIDS seems foolhardy."
Education for older people is also long overdue for people in the medical industry, said the chief of social-science research at the National Institute of Aging in Bethesda, Md., Dr. Marcia Ory. In older people with immune systems that have been weakened, Dr. Ory said, AIDS travels faster and is diagnosed less frequently. "Many doctors don't think to test for AIDS, and attribute symptoms to aging," she said.
Why Older People Are Shy
Fear, embarrassment and shame are some of the factors Dr. Ory cited to explain why older people shy from confronting AIDS. "This is a group that just doesn't talk about sex," she said. "Do you think an older woman will jeopardize her relationship by asking a man about his past or to wear a condom?"
For the women the reticence can be especially perilous. "Older women may be more susceptible to the AIDS virus, because their uterine lining is thinner," Dr. Ory said. "They may be affected sooner."
Although statistics show a steady increase in AIDS cases among older people, having them discuss the illness can be difficult. Those who did said they believed strongly that the message needed to be broadcast, but insisted on anonymity.
One Nassau County couple in their 50's were diagnosed for AIDS last year. Just before retiring to France, the husband, at his wife's urging, went to the doctor to find out why he had lost so much weight, had sores in his mouth and was constantly fatigued. His wife, who had read widely on AIDS, suggested that he might have the disease, even as she dismissed the idea as unrealistic.
When tests showed that they were infected, the couple were stunned. Neither had extramarital affairs or used intravenous drugs. The only other possible mode of transmission, they concluded, was a series of blood transfusions that the man received in 1982 after having been robbed in Manhattan.
They are now bitter, although the woman's religious beliefs have made acceptance somewhat easier. Until the diagnosis, she said, AIDS was the last thing that the couple worried about. Now that it has entered their lives, she worries about other older people, as well. The wife conceded that she had been a bit of a nag with a friend who had been divorced for a few years, but was pleased that she had finally persuaded the friend to take an H.I.V. test.
"If I could get it, anyone who had a husband who was operated on, or who slept with someone who had it and didn't know, could also get it," the wife said.
Husband's Feeling of Shame
The husband is much more reticent. "He hasn't even told his relatives in France or the people he used to work with," his wife said. "He's ashamed, afraid of what they'll think."
A 53-year-old in Suffolk County learned that he had the human immunodeficiency virus in 1987. He reluctantly conceded that he probably caught the virus because of his sexual practices. The man, who speaks publicly about AIDS, said he tried to avoid looking for blame.
"It doesn't make any difference how you contracted it," he said. "The real lesson here is to teach people that it is preventable."
He said many older people who did not know much about AIDS might feel uncomfortable about limits in their relationships. As he put it, "They have to be able to say, 'If you don't wear a condom, we won't have sexual intercourse.' It's not worth dying for."
A spokesman for the Long Island Association for Aids, Jeff Reynolds, said that denial was the biggest enemy of AIDS and that it pertained to most people.
"As we get older," Mr. Reynolds said, "there is a hesitancy to talk about sex. And it's important for them to come to terms with AIDS. But most Long Islanders are in a steady state of denial. They want to believe that AIDS stops at the Midtown Tunnel."