Saunders' positive result came as a shock to the nurse, but it shouldn't have. Seniors are one of the fastest-growing HIV-infected populations in the U.S. Sunny south Florida, a magnet for retirees, has the largest concentration of people 50 or older with HIV. Seniors account for 14% of AIDS cases in Dade, Broward and Palm Beach counties, compared with 10% nationally. "You've got people contracting it later in life," says Drace Langford, a member of the Florida HIV/AIDS and Aging Task Force. But there are also seniors who have been living with HIV for years, thanks to the effectiveness of the new AIDS "cocktails."
Before blood screening became mandatory, most older people got HIV from transfusions. But since such transmissions have been all but eliminated, medical workers are being forced to confront the fact that seniors are getting infected primarily during sex. Promiscuity is common in senior centers, where the ratio of women to men averages 7 to 1. Since fear of pregnancy is no longer a concern, many seniors don't use condoms. And Viagra has added more fuel to an already volatile mix. Physically fit single men, dubbed "condominium Casanovas," often flit from one woman to the next, sometimes passing along AIDS. Widowers often hire prostitutes. The manager of a Miami apartment complex once asked former Miami Beach geriatric counselor Vincent Delgado to speak to an 82-year-old woman who brought young men to her apartment for sex whenever she got her Social Security checks. "She said she was going to die anyway," Delgado said, "and to leave her alone and let her enjoy life."
Public health officials blithely assumed that seniors weren't at risk because, of course, they didn't have sex. But the increasing numbers are challenging that assumption. The American Association of Retired Persons has produced an AIDS-prevention video called It Could Happen to Me, which is distributed to senior citizens nationwide. Meanwhile, public health officials are handing out condoms at senior complexes, offering free HIV tests and training a cadre of the elderly as counselors to help educate their peers about the dangers of unsafe sex.
Even so, this demographic group is often difficult to reach. Many elderly people are reluctant to discuss their intimate life with strangers. "A lot of people were taught that you don't air your dirty laundry," says John Gargotta, supervisor for the Senior HIV Intervention Project, an AIDS advocacy group. Most troubling, though, is that doctors often fail to consider HIV as a possible illness among their senior patients. As a result, the elderly are often misdiagnosed. Also, AIDS symptoms like dementia and weight loss can mimic the ravages of old age. "So there is a higher prevalence of people being diagnosed in the month of death," says Dr. Karl Goodkin, an associate professor at the University of Miami School of Medicine. Goodkin, who is conducting a national study on the rate of cognitive impairment in HIV-infected elderly, says the virus proceeds to full-blown AIDS twice as fast in seniors, making early detection all the more crucial.
Early intervention saved Sue Saunders. Her HIV was diagnosed eight years ago, but she is alive today, thanks in part to protease inhibitors. Meanwhile, she has made it her mission to warn others about the dangers of high-risk sex in the golden years. "I'd just like to save one life," she says.