May 12, 2016
If you think that women in their 20s and 30s have an uphill battle with sexual health and mental health, believe that it doesn't get easier as time goes by. According to the Centers for Disease Control and Prevention, the HIV rate among black women took a sharp dive from 8,020 to 4,623 over the 2005-2014 period. That's nearly 42%. But among older generations (the 50+ crowd), the infection rate continues to rise. In 2013, people aged 50 and older accounted for 27% of the AIDS diagnoses in the U.S. What's more, the rate of HIV diagnoses per 100,000 among those 50-54 was 59.3 for African Americans followed by Hispanics with 23.3. The numbers look similarly poor in the mental health arena. Among African Americans older than 55, depression, anxiety and dementia are the most common mental health problems. These problems are exacerbated by late diagnosis, mistrust of the medical community and denial.
TheBody.com interviewed Tonya Taylor, Ph.D., an assistant professor in the College of Medicine at the State University of New York (SUNY)'s downstate Medical Center in Brooklyn, NY. She specializes in the sexual health of older people. Dr. Taylor explains that educating older people about HIV and mental health can be challenging, but not impossible if you approach the subject right.
How does stigma play a role in HIV for older women of color?
Stigma is the perennial problem. We've done a lot to educate the older generations about the risk of getting infected -- and the treatment. We've also explained how people living with HIV are wonderful people and that no one deserves this disease. Yet, 30 years later, we still have an environment in which people don't feel safe enough to disclose their status. For older adults, there is a double stigma. There's the thought that they're old and couldn't possibly be living with HIV. And they're also dealing with ageism, where society isn't really thinking about them and the very specific needs of older women. Stigma for the long-term survivor is different. A lot of these women are struggling to have these conversations as a 50- or 60-year-old woman just joining the dating scene again. Some of them have disclosed to their families but they struggle to disclose to a new partner or friend.
What are some obstacles that health educators face when discussing sexual health with older women?
We have a hard time even starting that conversation with older women. We think about them being caretakers but not much else. Health care providers may think: "I couldn't possibly talk to her about this subject. She's my mother's age. She's a grandmother." Well guess what? Grandma has two boyfriends. And grandma may have been drinking and drugging and not using condoms. So folks need to get over that so they can talk to older women of color about HIV and sexual health. For women who are going through the menopausal stage, sex takes on a whole new meaning. Health care providers have to make them aware of their risk for getting or infecting someone with HIV in the first place. The older generations may not be thinking that there's a higher risk for HIV in their community. Some of the women I speak to say they won't use condoms with their partners because their partners are having trouble with sexual dysfunction. Others avoid it because they feel that they are virally suppressed and have less to worry about it. They also struggle with vaginal dryness and other menopause symptoms, so they don't want to add the burden of condoms into the mix.
Let's switch gears to mental health. What would you say are some of the mental health needs of older, positive women of color that should be met?
Depression is an issue with many older adults. For older people with HIV, the risk of depression doubles and triples. They face isolation and loneliness. Older women with HIV need to continue to have support beyond the virus. They're losing friends; their families are moving away; housing is becoming expensive. Their social support system is getting smaller. I was working with two older women who were positive. They were virally suppressed, attended their doctors' appointments and took their meds. They were on it. Both of them lost their sexual partners. One woman lost her partner but her family jumped right in. They took care of her and helped her with her health issues. The other woman has children, but because of underlying issues with mental health, she went a different route. She isolated [herself]. She began using drugs again. She picked up a couple of guys, and I'm not sure what kind of protection she was using. These are two women we thought were on the beat, but because of underlying mental health issues, the one woman wasn't able to cope with her loss.
What can care providers do to ensure that they are providing culturally sensitive care for women who have mental health struggles and are HIV positive?
They will have to work around some misunderstandings that people have around mental health. There is a mindset that only certain people have mental health problems: "No, I don't have depression. Only those people have depression." So therefore they won't seek help and treatment. We have a lot of people who need to see a mental health provider but they won't do it. They will rely on the church, but they won't talk to a counselor. So providers will have to deal with that upfront. If folks are getting their HIV care from a place that isn't providing their mental health care, I hope they are disclosing everything to the mental health provider. Mental health providers need to understand that things are different for people living with HIV. It would help if they were trained in both HIV care and mental health care. It may even help for them to get some understanding about addiction. If you're going to be dealing with patients who have a history of drug abuse, then you need to understand that. And they have to consider that generations have different sexual cultural norms. The baby boomers of the 70s were a generation of free love and not thinking much about contraception. They weren't thinking about HIV. They weren't thinking about the risk. So be mindful of that when you're talking to older black women who are either positive or at risk for becoming positive.
This transcript has been slightly edited for grammar and clarity.
Candace Y.A. Montague is an award-winning freelance health writer and health reporter for Capital Community News in Washington, D.C.
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