Women represent approximately 25% of all older adults living with HIV in the USA. Like other older adults they confront the same challenges of reducing the risks for and management of multimorbidity as they age. Too often HIV research has disregarded women given the real and perceived exclusive association of HIV with MSM. There are too few studies of older women with HIV to comment on frequencies with confidence. While there are few significant gender differences, one should expect women to have a different life experience living with HIV. Clearly women are at increased risk for osteoporosis (see Bone Health Section on this site) and cardiovascular disease. The AIDS-related mortality in women is falling but cardiovascular disease is increasing. There is a study that suggests that indeed women may be at greater risk than men for cardiovascular disease. New reports show increases in obesity in older women with HIV. This may be due to changes in metabolic processes as well as poor nutrition and inadequate exercise.
PSYCHOSOCIAL ISSUES FOR OLDER WOMEN WITH HIV
Women are also at increased risk for domestic violence as well as elder abuse (read additional information section). When comparing clinical, behavioral and psychosocial variables among older women with HIV the literature is not conclusive. Some reports show that women tend to be more adherent to ART with higher rates of suppression, and higher sustained rates of medical visits. Women are less likely to report having depression, but some studies show they have higher rates of bipolar disorders. However, the ROAH (Research on Older Adults with HIV) study does not show a male-female difference for depressive symptoms. Still, there is no question that the frequency of depression is higher than in comparable women without HIV.
Unlike older males living with HIV, women often had/have the responsibility of raising children. Those challenges become further complicated when raising a neonatally infected child. Raising children is a significant stressor as well as a motivator and source of reward. For that reason, women often have family relationships that are typically absent in the older male (MSM and male heterosexual) populations. This is the basis for their social networks which becomes a source of informal caregiving as the HIV positive women ages and their day to day care needs increase. Raising children and sustained family contact with them increases financial demands. And, how often do we hear of women neglecting their health as they give priority to their children’s needs.
The sexual health of women is in part marked by menopause which may occur a few months earlier when compared to the larger uninfected populations. And there is some data showing that menopause in HIV infected women can last longer. Women are at higher risk for having experienced sexual assault during their teens or early twenties. If unaddressed those experiences manifest themselves with increases in PTSD diagnoses. The ratio of women to men in communities of color is disadvantageous to women. There are fewer men due to high rates of incarceration, violent crime and poor access to health care. In order to sustain a long-term relationship woman will tolerate their partner’s lack of serious commitment to them. This is especially true when women internalize AIDS related stigma. Seeking companionship, sexual gratification and intimacy, older women with HIV will often compromise their safety and health and financial health by neglect of medical appointments.
Since it appears that women are at greater risk of cardiovascular disease than men, it is important that women discuss the importance of addressing risk factors, such as smoking cessation, blood pressure control and cholesterol lowering. Finally, if there are any symptoms that might suggest depression, it is imperative that this be discussed with your physician so that help can be provided.
Changes in life style are needed to address issues such as obesity, increased risk for cardiovascular disease as well as bone health. Consult those specific sections on this resource site for guidance. Social engagement is an essential element of aging well. Creating and strengthening such relationships is critical. That includes reaching out to other women so they know they are not alone.