Risky Business

By Jessica Weisberg, August 31, 2007

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Are "risk-groups" an aging concept in the fight against HIV/AIDS?

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At the end of May, the Texas State Legislature passed over 15 pieces of health-related legislation, including SB 453, which requires prisons to conduct HIV testing for all incoming prisoners. Rep. Garnet F. Coleman (D-Houston), one of the bills sponsors, told the Committee on Corrections that impetus for the bill stems not just out of a concern for the health of inmates, but also, out of concern for Texas' African-American and Latino populations, due to the disproportionate incarceration of minorities. In Texas, some 12 percent of the population is African American. Yet 38 percent of Texans living with HIV are African American. African American and Hispanic women combined represent 78 percent of women living with HIV in Texas.

For Coleman, SB453 is a hard-nose attack at reducing HIV-transmission among two of Texas' major risk groups -- inmates and minorities. The bill received little media attention -- mandatory HIV/AIDS testing in prisons is already required in 20 states. But for the folks at Human Rights Watch, the bill represented a gross human rights violation. Human Rights Watch employees Joe Amon and Megan McLemore published an editorial in the Austin American-Statesman in which they wrote "Informed consent is a cornerstone of legal and ethical medical testing requirements, and inmates, while losing certain rights to liberty, do not leave all of their rights at the jailhouse door." The authors continued to write that the bill "perpetuates stigma, isolation and discrimination, undermining efforts to address the epidemic both in prison and out."

The editorial not only decries the bill for basic human rights violations, but for perpetuating the concept of "risk groups." The editorial implies that the notion of "risk groups" has led the general public to underestimate the pervasiveness of the HIV/AIDS epidemic. The tendency to only offer sex education and preventative care for "at-risk" groups has led many communities, who are not traditionally conceived to be at-risk, to fall off the radar.

An example of such a community is older adults. Between 11 percent and 15 percent of U.S. AIDS cases occur in people over the age of 50. Between 1991 and 1996, AIDS cases in the over-50 population rose more than twice as fast as those among younger adults. Despite these statistics, the over-fifty population is not traditionally conceived as being at risk of HIV/AIDS infection. "There is a tremendous misconception that older people are asexual," said Michael Adams, executive director of SAGE (Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders). "But, older people are sexually active and make mistakes just like everybody else." SAGE offers discussion groups, educational programs and social activities for over 2,000 seniors in addition to individual and group counseling and comprehensive case management. SAGE is also working to make sure that condoms are more readily available in senior citizen centers. The majority of SAGE's clientele are older adults who were infected while they were younger; however, there are a growing number of individuals who first become infected as an older adult.

Adams listed a number of reasons why older adults might be more susceptible to HIV/AIDS than younger adults. Many older adults aren't versed in sexual protection. One study found that only 20% of sexually active older adults regularly use condoms. Older adult women are at greater risk of HIV-infection than younger women due to certain biological factors, such as reduced vaginal lubrication and thinner vaginal walls. According to Adams, "as people age they can face isolation, decreased social interaction, and even depression, all of which can lead people to engage in risky behaviors." Along those lines, in an article titled "The Crystal Conundrum," Tony Valenzuela analyzes why crystal meth has become the drug of the moment for "gay men who thought they'd die young." Valenzuela writes "If you believe, as I do, that drug use is an escape, for better or worse, then you understand that the grim state of affairs that queer communities find themselves in can only elevate crystal's popularity."

Adams also believes that the concept of "risk groups" has made older adults more vulnerable to infection. "The message that identifies young people as an 'at-risk' group has told older people, 'oh you don't have to worry about this.'"

This isn't to say that preventive education efforts should be all encompassing and general, to the contrary Adams argues that over-50 adults are far too wide and diverse a demographic for one preventive message to appeal to everyone. "What people in their 50s respond to is different than what people in their 60s or 70s respond to," explained Adams. The group also spans the socioeconomic spectrum. "From the very poorest to people with quite a lot of money, there's no group among older adults that is not at-risk of HIV/AIDS infection." The trick is to make prevention campaigns direct, without leaving anyone behind.

Adults over 50 aren't the only demographic unreachable by traditional notions of "risk groups." Research indicates that marriage actually increases the chance of HIV infection. In fact, the most dramatic increase in prevalence rates in recent years has occurred among monogamous married women. One study found that in rural Uganda, 88% of HIV-infected women age 15 to 19 are married.

"Risk groups," in addition to perpetuating stigma, classifies the HIV/AIDS epidemic as a "gay" or "minority" or a "young person's" disease, when in fact, it's a global epidemic transmitted through a variety of activites and your sexual/racial/economic/generational identity won't protect you from infection.

Jessica Weisberg is a writer and filmmaker who lives in Brooklyn, NY. Her articles have appeared in many publications, including The Nation, Grist, Gastronomica, and Dollars & Sense Magazine.