Posted on Mon, Jan. 28, 2008
Special to The Miami Herald
As soon as his Social Security check arrives in the mail, Abraham Hernández goes on the prowl, looking for sex.
The 73-year-old knows exactly what he wants, and after paying a prostitute $10 to $25 at a motel room, he usually gets it.
Hernández, a retired professional wrestler, was diagnosed with HIV in 1987. And he's now among the growing number of Puerto Rican seniors -- 60 and older -- living with the virus that causes AIDS.
For the year ending in September, 238 new HIV cases were reported among people here 60 or older -- about a 25 percent increase from the same period in 2006.
About 4 percent of all HIV cases here are of people 60 and older, said Puerto Rico Health Secretary Rosa Pérez Perdomo.
Nationally, the number of new HIV cases reported among people 65 and older has remained stagnant at about 2 percent per year, according to 2005 figures from the Atlanta-based Center for Disease Control and Prevention.
Puerto Rico has the fifth-highest concentration of AIDS cases in the United States -- behind the District of Columbia, New York, Maryland and Florida -- with about 26 cases per 100,000 population. In comparison, Florida reports about 28 cases per 100,000.
The recent growth in HIV cases has led the San Juan Health Department to create a program it's calling Golden Force: sex education for seniors who feel they are not at risk, don't get tested or refuse to acknowledge they are HIV positive.
SPREADING THE WORD
''We realized a number of our viejitos were starting to get sick,'' said Luis Martínez Suárez, medical director of the main San Juan AIDS clinic, which runs Golden Force. ``We knew we needed to start paying attention to that age group, taking the message of prevention to seniors.''
Martínez Suárez said the reasons behind the increase in HIV among the elderly are many -- drugs like Viagra and Cialis that make it possible for men to have sex well into their 90s -- to the mistaken belief that the virus only affects injection drug users and gay men.
But among seniors on this island of 3.9 million people as well as across the United States HIV cases are mostly attributed to unprotected heterosexual sex.
''Many have never used a condom before,'' said Lexter Rosario Sanjurjo, a Golden Force coordinator. 'They see it as: `I've lived my life, I have grown children, why do I need to worry? If I die, at least I'll die having fun.' ''
Greduvel Duran, executive director of the health department's AIDS office, says the government has several prevention plans in the works, including public service announcements and a radio campaign.
''Abstinence should be the first line of defense in the prevention of HIV,'' Duran said. ``But we realize that adults are sexually active and we have to recognize that abstinence works for some groups and not for others.''
HIV prevention counselor Milagro Meléndez said Golden Force, funded mostly by the city of San Juan, is focusing its efforts on reaching seniors at retirement homes, local fairs and domino parks, where program staffers hand out condoms and talk about safe sex. Future plans include reaching older people at San Juan bars on Saturday nights.
Hernández said he got the disease in the 1980s from his girlfriend at the time, a drug user. He later had another girlfriend for 15 years and still had unprotected sex. They separated two years ago.
''She didn't like condoms,'' he said. ``When we broke up, I asked her to get tested. Her results came back negative.''
Hernández now lives with a false understanding of his HIV status, believing that drugs he takes to prevent full-blown AIDS protects his sex partners from getting the virus.
He has sex with prostitutes three times a month and admits he worries more about shielding himself from gonorrhea or syphilis than protecting his partners from HIV.
''They don't really care that I'm old, once I give them their money,'' Hernández said.
Meléndez said business is especially good for sex workers at the beginning of the month, particularly on the third day, when Social Security checks usually arrive. It is known here as the Third Day Syndrome.
Meléndez says local doctors also face the challenge of dealing with HIV/AIDS patients on an island where the virus largely remains a taboo topic.
Hilda, 68, who asked that her last name not be published, said she has been HIV positive for seven years and has yet to tell her family. She got the disease at 60, after having unprotected sex with her boyfriend, she said.
''I wanted to die,'' she recalled. ``I didn't think that could happen to me.''
EARLY SYMPTOMS
Adding to problems, Meléndez said, when elderly patients complain of health issues to their doctors, the physicians often confuse the early symptoms of HIV -- such as fever and pneumonia -- with old age.
Some HIV-positive seniors, like 76-year-old Carlos Rivera León, use two condoms to protect their partners, despite his strong Catholic beliefs.
Having sex with a condom is ''not the way God intended,'' he said. ``But [the Bible] doesn't say anything about what to do when there's a disease in the middle.''
As for Hilda, she wants seniors to know there's a dangerous downside to sex in their golden years.
''Be careful. Something that looks good on the outside can be damaged in the inside,'' she said ``It doesn't matter if you're married or not. Look at what happened to me. I got it under my own roof.''
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