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

Even if condoms don’t seem necessary, every sexually active woman should have an HIV test every year. Make a habit of asking for one at your physical or gynecological exam. (It is covered by most insurance companies; check with yours first to be sure.) Your husband or partner should get checked too. Many states also provide free, anonymous testing through their departments of health (Google "free anonymous AIDS test" and the name of your state). The process is surprisingly easy: The so-called rapid test costs just $10 and provides a result in only 10 minutes (you’ll need to get a confirmatory test if yours comes back positive). Some don’t even require giving blood; doctors can swab the inside of your mouth or use a urine sample.

Removing the stigma of HIV testing will go a long way toward defeating this disease, experts say. Health officials at the Centers for Disease Control and Prevention are urging doctors to integrate testing so seamlessly into healthcare that any time a person between the ages of 13 and 64 enters a clinic, doctor’s office or hospital, they’ll be given one, unless they specifically decline. As Carole puts it, "It’s always better to know. And if you’re diagnosed, don’t give up or hide. Hope and health are the two most important things."

Helping Women Live Longer

The newest generation of anti-HIV drugs — a multi-drug combination called highly active antiretroviral therapy — may in some cases reduce AIDS deaths by 80 percent, if treatment begins before there is major damage to the immune system and if the medications are taken diligently. "Folks who have HIV disease today can anticipate a normal lifespan," says Kevin Cranston, director of the HIV/AIDS Bureau for the Massachusetts Department of Health. "That’s something I could never have dreamed of at the beginning of this epidemic."

Another big plus: The multi-drug regimen appears to be less toxic to women than older drugs were. Tested almost exclusively on men, some of the earliest anti-HIV drugs were later found to hurt women’s livers or cause birth defects. One powerful drug that Carole took for years eventually caused lipodystrophy, a sometimes disfiguring shift of body fat. "I used to be beautiful," Carole says. "But now my face is sucked in. And with my high cheekbones, it’s really pronounced." Oddly, lipodystrophy melts fat away in the face, arms and legs while adding it to the abdomen, breasts and back. "I have skinny little arms, no ass and big boobies," Carole admits. "It’s a real chore to find clothes."

The newest medications don’t seem to have those effects, says UCLA’s Judy Currier. However, not everyone can tolerate them, and the jury is still out on their long-term safety: There’s evidence that the regimen, combined with the underlying HIV, may increase the risk of heart attack, diabetes, high cholesterol, and poor bone density. Nonetheless, Currier is pleased at the progress. "We lost so many people because we didn’t have effective drugs," she says. "It’s difficult to live with HIV, but, ultimately, treatment is what keeps people alive."

Alexis Jetter teaches journalism at Dartmouth. Her last piece for MORE was a profile of Janet Napolitano, in March 2008.

Originally published in MORE magazine, April 2009.

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