Killer Sex: Midlife Women and HIV

1 in 3 women newly infected with HIV is age 40 or over.

By Alexis Jetter
Photograph: Todd Hido

HIV is on the move again — and this time it is climbing the social ladder, reaching into the ranks of middle-aged, well-educated professional women who have long assumed they live comfortably beyond its grip. Unaware of the danger, most over-40 women are, like Silver, making a deadly gamble: They are trusting the men in their lives and doing little to protect themselves from the virus.

* Some names have been changed.

Risky Business

The rate of new HIV infection among women in the United States has stabilized since the early 1990s at about 15,000 a year. Yet because of improved treatment, more American women are living with HIV/AIDS than before, constituting over a quarter of the nation’s estimated 1.1 million-person case load (up from eight percent of the total in 1985). The disease continues to hit low-income African-American and Latina women the hardest; black women of any income level are 21 times more likely than white women to contract AIDS. But there is one new and frightening trend, and it is epitomized by Ann Silver, a 45-year-old heterosexual woman: Today, one in three women newly infected with HIV is over 40 years old; one in four is between ages 40 and 49. "We are the hidden epidemic," she says.

How these women get the disease is no mystery. In 2006, eight in 10 newly infected women were exposed to the virus the old-fashioned way: by having unprotected sex with their husbands, boyfriends, or casual flings. Over-40 women may be particularly at risk because, unconcerned about getting pregnant, they often don’t use condoms, the best available safeguard against HIV transmission. (One recent British study found that only 29 percent of women ages 35 to 44 used a condom with a new partner, compared with 67 percent of women ages 16 to 19.) This blind spot about AIDS is particularly dangerous for midlife women who are dating again after divorce. "You’re relying on the rules from 20 or 30 years ago, but the rules have changed," says Susan Cu-Uvin, MD, director of the Immunology Center at Miriam Hospital, at Brown University, and an expert on midlife women with the virus. "You have to realize that HIV is one of the perils of living in this age and wanting to have sex." And that includes married sex.

"Mature women assume their partners are monogamous, and that gives them a false sense of security," says Kimberly Workowski, MD, professor of medicine in the Division of Infectious Diseases at Emory University. "They’re very shocked when they find out that their partner was having sexual contact with other women or with men."

There are no reliable numbers on how many married men — or women — are unfaithful to their spouses. But recent studies suggest that at least 22 percent of married men and 13 percent of married women engage in extramarital sex at one time or another during their relationship. (Some experts think the numbers, particularly for men, are much higher.) Is a straying husband more likely to use a condom? The story of former New York governor Eliot Spitzer suggests that wives shouldn’t bet on it: He reportedly refused to use condoms with prostitutes, putting his wife at risk for the disease. "Men are willing to take the chance of infecting their wives, because he can’t come home after 25 years of marriage and say, ‘Honey, I think we should start using condoms,’" says Donna Gallagher, a nurse practitioner who directs the New England AIDS Education and Training Center, in Boston. "That’s going to give it away. Married women may actually be at higher risk of getting the disease, because they’re having unprotected sex."

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