Investigation A bitter pill - Christine Toomey

Investigationnew diagnoses each year hasclimbed rapidly.Yet young people particularlyoften see HIV as a curable disease.And many older people also runthe risk of infection throughignorance or indifference. Thenumber of HIV-positive peopleapproaching old age is increasing,not only because newer drugtreatments have improved survivalrates, albeit with medicalcomplications, but also due to newinfections in older people.In 2008 there were 10,208people over the age of 50 seekingtreatment for HIV in Britain — anumber set to double to more than20,000 in the next five years — with816 over-fifties newly diagnosed in2008; this is nearly double thenumber of over-fifties newlydiagnosed five years ago.“A lot of people newly onthe dating scene because of divorceor separation in their middle yearsare putting themselves at riskbecause they don’t use anyprotection when having sex,”explains Mary Jones. “The mencome from a generation that thinksit’s a woman’s responsibility to takeprecautions and the women don’tinsist on their partners wearingcondoms because there’s littlechance of them getting pregnant.”As doctors and older patientsthemselves rarely perceive olderpeople to be at risk of contractingHIV, the latter are less likely toundergo testing. Misdiagnosis iscommon and, if diagnosed at all,the virus is detected much later inthe course of infection, when it hascaused more damage andincreased the risk of dementia.There is also still a lingeringmisconception that HIV only affectsgay men or people from sub-Saharan Africa. But an estimated58% of people newly diagnosedwith HIV in the UK in 2008acquired their infection throughheterosexual contact, and morethan a quarter of these — 1,092 outof 3,717 in total — were not of Black-African or Caribbean origin.Heterosexual people tend to bemore reluctant to be tested, butthe later the diagnosis is made, themore likely it is that complicationswill have set in and respondless well to treatment.Moreover, taboos and stigmaattached to openly discussing HIVstill hamper efforts to eradicate thedisease. As two day-patientsundergoing treatment at theMildmay explain, the threat ofrejection by friends and family is adeterrent to disclosure.Nancy has not heard from hermother in Nigeria since she toldher she was HIV-positive sevenyears ago. The 30-year-oldhairdresser came to this countrywhen she was 20 to work andsend money back to her family.She did not know then she wasinfected, and when she wasdiagnosed and told her mother shewas denounced. “Everyone in myvillage knows I have HIV now. Mymother says I am a prostitute. I cannever go home,” says Nancy, who isnow blind and mentally confused.George is so frightened of howhis family in Jamaica will react ifthey know he carries the virus thathe vows he will never tell them. Hewas diagnosed with HIV six yearsago, shortly after moving to thiscountry. “In Jamaica, if peopleknow you have HIV they don’tcome near you. They leave youto die,” says the 45-year-old,whose cognitive functioning isnow so impaired he has to beaccompanied everywhere by hiswife for his own safety.Worldwide, more than 33mpeople are infected with the virus.In the UK alone, according to theHealth Protection Agency’s latestfigures, there were an estimated83,000 people infected with HIV atthe end of 2008 — a quarter ofwhom are unaware that they arecarrying it. More than 7,000 peopleare newly diagnosed each year.This means the overall numberinfected with HIV in the UK isexpected to rise to around 100,000by the end of this year.“The problem today is that toomany people think if you get HIVyou just take some pills and it willgo away,” says Peter Adams, 62,another Mildmay patient, whosecareer in finance crumbled after hewas diagnosed over 10 years ago.As the stories of the people I metfor this article show with alarmingclarity, this is far from the truth sSome names have been changed toprotect identitiesastm21047.indd 8 10/02/2010 17:39Feb 21, 2010 The Sunday Times Magazine 47