You might think that we’re long past the HIV/AIDS epidemic, but a new, especially virulent form of HIV has hit Cuba. Should you be concerned? With newly opened borders, this new illness could infiltrate our population—and many people who think they could never be infected by HIV are seriously mistaken.
THE NEW THREAT
We’ve lived with HIV long enough now to think of it as a back-burner threat—always affecting someone, sure, but no one who doesn’t engage in really risky activity. Right? And if the worst happens—if you do get infected with HIV—then today’s drug treatments can keep the virus under control so that it becomes a chronic bother, but not life-threatening AIDs.
Here’s the problem: While HIV has traditionally taken many years and even decades to cause serious illness and AIDS in those affected, a new form of HIV that causes progression to AIDS within just three years has turned up in Cuba.
The new recombinant HIV strain, dubbed CRF19, reproduces much faster than other variants, which is why those infected have a much higher viral load, leading to rapid progression to AIDS. The higher viral load makes it more likely to spread to sexual partners easily, too.
WHY WORRY ABOUT HIV?
You might be wondering whether a dangerous strain of HIV found in Cuba could affect you at all. But as we’ve recently seen with Ebola outbreaks in some parts of the world and measles, chikungunya and antibiotic-resistant bacteria such as E. coli even in the US, tourism and other travel allow dangerous pathogens to easily cross borders and infect entirely new, previously untouched populations. Now that travel restrictions to Cuba have been eased, we can expect more American interaction with Cubans—all kinds of interaction—and those people will come back to the US clueless about what they have picked up.
And make no mistake—the new rapid-progression strain of HIV is not concentrated in the homosexual community. The study that examined the new strain found that nearly 50% of the patients who had AIDS due to the new strain were heterosexual. Alarmingly, 80% of these patients admitted to not being diligent about using condoms when having sex even after learning that they had HIV/AIDS. And whereas the median time for HIV infection to become AIDS was 10 years in patients who did not carry the new strain, it was only 1.4 years in the patients who did have it.
You’re never too old to be at risk for STDs. Americans 55 and older account for 5% of all new diagnoses of HIV infection, and those older than 50 account for 27% of all new diagnoses of AIDS. As for other STDs, rates of chlamydia and syphilis among those 65 and older are increasing across America—by 31% and 52%, respectively, over the last five years, and in some areas of the United States, double that of the national average.
“We have a larger, older population now—and they’re healthier and more active than past generations of mature adults. We also have drugs that help men perform in the bedroom, and it’s socially acceptable to use them,” said William Schaffner, MD, a professor of preventive medicine at Vanderbilt University School of Medicine in Nashville. Retirement communities and assisted-living facilities have become sexual playgrounds akin to college campuses, according to one recent news report.
“Older adults should follow the same advice we give to younger people about safe sex—use condoms,” he said. And this warning is not just about the new strain of HIV that we can expect from Cuba—not by a long shot. “People of any age ought to know about the health status of their partners, particularly whether they’ve been tested not only for HIV, but also for the hepatitis C virus.” Hepatitis C, a virus that affects the liver, is most commonly transmitted through sexual activity, can take decades to do its damage and is most common in people age 50 and older, particularly those who engaged in unsafe sex and experimented with drugs during the 1960s and early 1970s. You’re at risk if you have sex with someone who is infected with the virus—and most people who are infected do not know that they are until symptoms of liver disease emerge when they are in their 60s and 70s. “We know that new hepatitis infections occur well beyond 60 years of age,” added Dr. Schaffner.
HOW TO BE PREPARED
When we were younger, many of us thought that older folks generally didn’t have sex. But now that we are older, we know that “it’s not over ’til it’s over”—which is a good thing.
Doctors are increasingly keeping an eye out for STDs in older patients, but they aren’t as diligent as they should be, said Dr. Schaffner. “Doctors who routinely question their younger patients about sexual activity may be less apt to ask older patients the same questions, leaving themselves—and you—at a loss for practicing preventive medicine,” he said. Even if your health-care provider doesn’t outright ask about it, be sure to let him or her know whether you are sexually active and get his or her advice about safe sex and whether you or your partner (or, let’s be realistic—partners) should be tested for diseases such as hepatitis, human papillomavirus (HPV), herpes or another STD—including HIV.