HIV Does Not Discriminate

Let's face it, sex never gets old. Turning 50 does not mean sex life automatically stops. For a long time stigma around age and sex has shaped how many people feel; discussions about aging and sex have been behind closed doors. This stigma contributes to how persons in the US and Europe see the increase of newly HIV infected older adults and seniors. Studies show that many people over age 50 do not use condoms. They seem to ignore or be unconcerned about HIV and AIDS. At the moment, the 50 years and older population is the fastest growing population in Europe and the US. In the year 2000, approximately 605 million people were 60 years or older. By 2050 that number is expected to be close to 2 billion. This is very large group of people. Why should this group be ignorant and excluded from the fight against HIV/AIDS.

What can we do to make older adults realize they are at risk? How do we get older adults to get tested for HIV? How can we change the general view on aging and sex?

To solve this problem we need to attack the problem from different angles. I believe popular culture is encouraging a slow change in the image of older adults and seniors. More TV shows and films portray mature women and men living a happy life including sex. Pop culture has started to show more dimensions of people over 50. This development will help change the view younger people have about aging and sex. It may also serve as a form of identification for older adults, helping them to be more open and comfortable about sex and their sexuality.

However, health care systems must take more responsibility when it comes to older adults and their sex lives. This is a good place to start dealing with the taboo around sex and age. Older adults and seniors may not feel comfortable talking about their sex lives with their doctors, a holdover from their earlier experiences when talking about sex was something one did not didn't do. Sexual activity was a very private matter rather than the sex education that is taught in schools today.

Today, doctors should ask their patients about their sexual life and if they are protecting themselves against infection. Since signs of HIV/AIDS can be the same aches of normal co-morbidities of aging, it is important that doctors talk to all their patients about risky sexual behaviors and encourage them to get tested for HIV.

Another important part in making older adults and seniors aware of the risk of HIV and other sexually transmitted diseases is to create HIV/AIDS campaigns that specifically target older people. Most campaigns target young people. By not including the older population in these campaigns, organizers are reinforcing existing stereotypes around aging and sex. These campaigns can serve several purposes, not only prevention and awareness, but also encouraging people to know their HIV status by getting tested.

These are not impossible goals. It is about time we stop thinking that HIV/AIDS is a “young person’s disease.” HIV does not discriminate. No one who has sex is safe, no matter what gender you have or what year you were born.

Sanna Klemetti s.klemetti@globalaging.org

Awarded Exemplary Manager Fired Due to HIV Status

A couple of weeks ago I wrote about how HIV/AIDS related stigma still exists in the USA. This week I will introduce you to a man who was fired due to his HIV status.

Antonio Munoz is a 47 year old man currently living in New York City. He was diagnosed with HIV during the winter in 2008. When Antonio learned this news, everything stopped for him. He wondered how this could have happened. In his earlier life living in Montreal, Canada, Antonio, he had engaged in alcohol and substance abuse. After moving back to New York City, after eight years as “sober and clean,” and with a new job and health insurance, he went for his first medical physical exam. That's when he found out about his status. He felt that the consequences of his past had caught up with him. It took time to understand the effects of all the medicine he had to start taking. Sharing his status with his close friends was hard, and he was worried about how everyone would react. Antonio was especially worried about how his new job colleagues would take the news. Would he be shunned and treated as an outsider? Would he be the “leper” who deserved what he got, because he is gay? He was surprised to see how well his family and friends took it. However, the news did not go as well with his employer. After sharing his HIV status, he was fired shortly thereafter. Antonio could not believe that after 30 years since the HIV epidemic began, he had to still face stigma and discrimination associated with HIV.

The Case

Tony was working as an Assistant Front Officer Manager for the Manhattan Club Timeshare Association (a hotel) from October 2007 to February 2011. During these four years Tony received an “Exemplary Manager Award” and got two raises after that, one of which was a reward for excellent performance. He was also given a satisfactory written review in 2008. No incidents occurred during 2009. At the end of 2009, Antonio’s doctor told him that his HIV medications were not performing as expected; to improve his health he had to start taking “Sustiva.” This medication must be taken at night since it causes drowsiness; patients much rest after taking it. During this time Antonio was working very long hours during the night shift. His doctor suggested that he change his shift to improve his health. Up to this point Antonio had not revealed his HIV status to his employer; he had made it clear that he had a serious, chronic health condition. The employer never asked him to tell them about the exact nature of his disability. Rather, the employer told him not to tell them what his condition it was when Antonio offered to share the information. After the diagnostic news from his doctor he decided to speak to his employer. He made a verbal request to change his shift and explained to his manager that his chronic condition required him to medicate himself at night requiring which bed rest in order for the medication to take effect. The reply he got was, “The only people entitled to a quality of life are me,” and she also mentioned two other names, who were all managers above Antonio’s rank. Later she also told him that he and all the other managers at his level were to be at the timeshare 24 hours and 7 days a week as required. She also said that she needed him there because he knew the job and she could sleep better knowing that he was there.

Antonio moved on by requesting that his doctor to write a note explaining the importance of how his chronic medical condition required a strict dosing schedule. He also said that if this regime were not followed it could cause substantial health risks. Antonio’s employer did not respond to this explanation. Antonio took the matter to Human Resources office with no luck. These officials told him that the person in charge of the department had authority to do “whatever” he or she decided. However, the Human Resources staff person promised to talk to the head of his department.

On February 1, 2010, Antonio was in a meeting with the people involved and they asked him for how long he had to be on this proposed scheduled change. He explained that he had to medicate himself for the rest of his life. Both of them stated that Antonio knew what the job required from him; if he could not do the job, he could quit. Antonio was denied the change of schedule, even though there were two other employees who said they were willing to take his shift. At this point Antonio asked for the denial in writing but this request was ignored. He requested a week off to think about what he should do and to seek his doctor’s advice. The MD told him that this specific medicine was the best way to ensure that his health improved.

After a week off, Antonio went back to work and was surprised to see that he was put on the day shift. He felt glad that the issue had solved itself. Everything went on as normal for two months. However, the following April 15th the same year he was put back on the night shift. Antonio invoked FMLA and requested intermittent leave; he also filed a complaint of disability discrimination as a result of not being accommodated. After the complaint he was told he could go back to the day shift but at this moment, his employer began retaliating against him. Before the request for an accommodation, the manager praised Antonio; shortly thereafter she wrote up his 2009 evaluation which was misdated to 2008. The evaluation was negative and full of falsehoods. After this, his manager never discussed anything of substance with Antonio. She did not respond to emails. After a while, the employer put Antonio back on the night shift whenever a night worker was sick.

Later he returned to a daytime shift. On February 11, 2011, Antonio was fired. He was told he lost his job because of a customer complaint dating from December 2010. Antonio had never heard about this complaint until the day he lost his job. Antonio believes there never was any complaint; if there were a complaint, the hotel had never mentioned (???) it. Customer complaints were a constant at his job but had never been a cause for termination without explanation. Still today Antonio knows nothing about this customer complaint. He thinks it is pretty clear why he got fired so he decided to pursue his legal options against his former employer. He invoked his rights under the ADA (Employment Rights as an Individual With a Disability) and FMLA (Family and Medical Leave Act).

I asked Antonio what effect losing his job had on him. He told me he felt he had lost his self- worth. Dealing with the HIV illness and the self-imposed stigma was too much to handle at the time. After losing his job Antonio started suffering from depression. He went on unemployment benefits in the absence of a job. When he started to feel better he decided to be pro-active, be his own advocate. Today Antonio is enrolled at Fordham University getting his CASAC (credentialed alcohol and substance abuse counselor) training. He is looking forward to working again.

We at Global Action on Aging wish Antonio much good luck as he moves forward. And we will try to give you updates to let you know how things are going for him!

Sanna Klemetti

HIV/AIDS and Stigma

What is Stigma?

If you look up the word in the dictionary it says:

1. “A mark of disgrace associated with a particular circumstance, quality, or person,” or “a mark of disgrace or infamy;” a stain or reproach, as someone’s reputation.”

You could say it is a social disapproval of a person on the grounds of their unique characteristics distinguishing them from others in society. Almost all stigma is based on a person differing from the current social or cultural norms. Stigma often creates obstacles for those targeted persons.

HIV-related stigma exists in every country in the world, although it shows up differently across countries, communities, religious groups and individuals. Up to this day there are a lot of misconceptions about HIV/AIDS. Many people are prejudiced or have fear of a number of socially sensitive issues including sexuality, aging, disease and death and drug use. This type of stigma can lead to discrimination and other types of human rights abuses. HIV/AIDS stigma often occurs alongside other forms of stigma and discrimination, such as racism, poverty, homophobia, and age. It is important to understand that HIV related stigma is not static. It has changed over time, just as the knowledge of the disease and the availability of treatment.

Stigma can lead to discrimination and other violations of human rights. This affects the well being and health of people living with the virus. Throughout the world we find well-documented cases of people living with HIV who are denied the right to health care, work, education and freedom of movement. Not only does stigma harm people living with the disease, it also discourages HIV testing as well as prevention methods such as condom-use, and it may create confusion about how HIV is and is not transmitted.

Stigma may look different depending on where you live. In the US stigma often occurs in the workplace and in the health care system. It is not unusual for people with HIV to be refused the care they needed, being blamed for their health status, and also having health care professionals refuse to touch them. In the workplace, people living with HIV may suffer stigma from their co-workers and employers, such as ridicule and isolation, or experience discriminatory practices, such as termination or refusal of employment. Often persons living with HIV fear their employer's reaction should they reveal their status. Next week I tell you about a man who was fired from his job due to his HIV status. This example will clearly show how stigma and discrimination still takes place in New York City in 2011.

Legal Framework

Problems abound in tracking down AIDS related stigma and discrimination. The June 2001 Declaration of Commitment adopted by the United Nations General Assembly Special Session on HIV/AIDS addresses this task. It states that confronting stigma and discrimination is crucial for effective prevention and care. And it reaffirms that discrimination related to a person’s HIV status is a violation of one’s human rights.

Convention on the Rights of Persons with Disabilities

The relationship between HIV and disability has not received much attention. People with HIV may develop impairments as the disease progresses, and may be considered to have a disability when social, economical and political, or other barriers hinder their full and effective participation in society on an equal basis with others. The convention does not explicitly refer to HIV or AIDS in the definition of disability. But states are required to recognize that where persons living with HIV have impairments which, in interaction with the environment results in stigma and discrimination, they can fall under the protection of the convention. *

The New York City Human Rights Law

Discrimination is illegal in New Your City. The New York City Human Rights Law is one of the most comprehensive civil rights laws in the nation. The Law prohibits discrimination in employment, housing and public accommodations based on race, color, creed, age, national origin, alienage or citizenship status, gender (including gender identity and sexual harassment), sexual orientation, disability, marital status, and partnership status. In addition, the Law affords protection against discrimination in employment based on arrest or conviction record and status as a victim of domestic violence, stalking and sex offenses. In housing, the Law affords additional protections based on lawful occupation, family status, and any lawful source of income. The City Human Rights Law also prohibits retaliation and bias-related harassment, (including cyberbullying).

Stigmatizing and discriminatory actions violate the fundamental human right to freedom from discrimination. In addition to being a violation of human rights in itself, discrimination directed at people living with HIV or those believed to be HIV-infected, leads to the violation of other human rights, such as the rights to health, dignity, privacy, equality before the law, and freedom from inhuman, degrading treatment or punishment.

Please visit again next week for the article about Antonio Munoz who lost his job because of his HIV status.

If you want to learn more about HIV and stigma. Please click here:

http://data.unaids.org/publications/irc-pub06/jc999-humrightsviol_en.pdf

* Read the full convention here:

http://www.un.org/disabilities/convention/conventionfull.shtml

Sanna Klemetti – s_klemetti@globalaging.org

HIV/AIDS Prevention Campaigns for Seniors and Older Adults on the Streets of NYC

The last couple of weeks I have been looking around New York City for any HIV and AIDS prevention campaigns. I wanted to see who these campaigns are targeting, and if there were any campaigns specifically directed towards older adults and seniors. After a few weeks of intense observing, I found one campaign that is directly focused on older adults. Overall I was a bit surprised over how few HIV/AIDS prevention campaigns are out there.

Age is not a condom

Upper west side, NYC

The text under says:

“And if you can’t use one. Tell your doctor”.

3 posters (by Andy Chen Design).

The text under says: “And still using protection. Each & every time”.

“And neither does keeping yourself protected”.

Why have older persons been bypassed when it comes to HIV/AIDS prevention?

People give many answers to this question. Most think of HIV and AIDS as a young person's disease. Older adults and seniors have often been ignored when it comes to HIV / AIDS prevention. As we approach the fourth decade of the HIV epidemic, it is important to remember that about 17 percent of the newly diagnosed HIV/AIDS cases in the USA are found in people over the age 50, (according to the CDC report in 2009). About one-third of all people living with HIV/AIDS in the USA are 50 years of age or older. This number is expected to grow to one-half by 2015. The 50 years and older population is the fastest growing population in USA. Older adults and seniors need to know why it is important to protect yourself as you are growing older. The immune system naturally becomes less effective as you age, which can increase the risk of sexually transmitted infections. Also, after menopause, women's vaginal tissues thin and natural lubrication decreases. This can increase the risk of micro-tears and of sexual transmission of certain diseases such as HIV/AIDS.

Why so many newly infected older adults and seniors?

There are numerous potential answers to this question. One reason could be that a lot of older adults and seniors feel that it is a taboo to talk about sex. During the time they were growing up sex was not talked about in the same was as it is today. Also, some older persons may not be that knowledgeable about HIV /AIDS and therefore less likely to protect themselves. They may not even perceive themselves as at risk for HIV, so they do not use condoms nor do they get tested for HIV. Another reason can be that the health care professionals may underestimate their older patients’ risk for HIV/AIDS and therefore do not tell them about prevention or offer HIV tests. Symptoms of HIV/AIDS can be misunderstood as symptoms of normal aging, such as fatigue, weight loss and mental confusion.

I don’t think there is one single reason for all the newly HIV infected older adults and seniors. All the above mentioned reasons have created this problem. The good news is that none of it this is unfixable. This is what we need to do: Get more HIV/AIDS prevention campaigns for older adults and seniors. Make HIV testing and prevention conversations an obligation between Health care professionals and their older patients. Start offering Sex Education classes at senior centers, making it less of a taboo.

Let me be clear. I think we should stop thinking people stop having sex after the age of 50, because this is clearly not the case.

Sanna Klemetti. S.klemetti@globalaging.org