HIV Tales from my Diary-Tale11

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My Audioseption was at its best concentration when he gave me a call. 73 year old, Manjit’s call ,somehow sent tremors to all other four sensations of mine, as well. I could visualize tears in his saddened eyes, smell his agony, feel the bitterness in his mouth and could sense the pain he was passing through. Manjit was widowed seven years ago and has well settled children abroad. He was living alone in a royal way. Ever since his partner left him alone he started visiting Gymkhana club every day, playing cards, having regular two pegs of scotch in evenings. His mornings on week ends will be well spent joking around with Jockeys and friends in the local Golf club. His life style was envy to many of his age. The only speed breakers in his life were coming through his knees. His son , who , is settled abroad , booked an appointment with the best of KTR surgeon. The operation was fixed in a big corporate hospital. All was set to reset his life , when came a setback. Manjit was found to have suspicion of HIV in his body. Battery of tests increased the panic and confirmed the diagnosis. Knee was not replaced , rather , he was referred to a physician, who proclaimed to know HIV by default because of his degree in internal medicine. But this 80’s pass out forgot that he never tried to sharpen his skills by looking at books again. The sequel was prescription of Duovir- N {Zidovudine ( hardly used now a days)plus Lamivudine plus Nevirapine combination one bid from day 1} in wrong way. This is no more a preferred combination these days in the developed as well as other world. Still whenever used due to economic reasons, it is prescribed it is prescribed as Duovir ( AZT+3TC) one tablet twice a day with Nevirapine 200 mg one tablet a day for first two weeks and then it is advised to switch over to Duovir-N ( combination of AZT+3TC+NVP) twice a day. Manjit’s son consulted his doctor friends in USA. They were not happy and recommended to see another HIV physician. The ball was in my court now. Manjit fixed an appointment with me at the earliest and I obliged sensing his pain and agony. 

His interview with me baffled me. I could not decipher the mode of transmission of HIV in his case. He had two earlier surgeries in good hospitals , no blood transfusion, no nothing to suggest any high risk activity which can lead to HIV transmission. I was confused and finally ordered Western Blot test ( despite viral load being 27K and Cd4, 348 and positive tests by three different kits) to clear the dark clouds surrounding the mystery of his diagnosis. I told him, ” let’s first confirm your diagnosis , uncle”. This ball of mine, was a real googly 

and stumped him leg before. He burst into tears once again. 

His confession put me to a ” think mode “. I was thinking about sex and seniors : the 70 year itch. I was reminded of an article by Loren Stein, I read sometime back. 

Horny old broads, dirty old men. These commonly used terms speak volumes about how society views older people who are interested in sex.

Experts say such derogatory labels reflect a deep level of discomfort in our youth-oriented culture with the idea that seniors are sexually active. Sex is identified with reproduction, youthful attractiveness, and power — and most young and even middle-aged people do not want to confront the inevitability of growing old.

“Use it or lose it,” says geriatrics expert Walter M. Bortz, 70, author of three books on healthy aging as well as several studies on seniors’ sexuality. Dr. Bortz, a professor at Stanford Medical School, is past president of the American Geriatrics Society and former co-chair of the American Medical Association’s Task Force on Aging.

“If you stay interested, stay healthy, stay off medications, and have a good mate, then you can have good sex all the way to the end of life,” he says. 
Sex is different but not diminished

Wellborn’s openness about sex — and the frequency with which she has enjoyed it — may be somewhat unusual, but her perspective is not. One advantage of growing older is that personal relationships can take on increased importance as children and careers take a backseat. Seniors can devote more time and energy to improving their love lives. And while some seniors may be forced to give up strenuous sports, sex is a physical pleasure many older people readily enjoy.

Men may suffer from impotence or have more difficulty achieving and sustaining erections as their blood circulation slows and testosterone levels decrease. Impotence is also more prevalent in men who have a history of heart disease, hypertension, or diabetes. Now there are drugs to help such seniors. Some experts, in fact, worry that these drugs may cause an upsurge in AIDS in people over 50, because they are not likely to take precautions; they urge older people who are dating to practice safe sex. 

Coming back to Manjit and his old age , I had an eye opener. The moment I told him that we may have to confirm his diagnosis. He started looking for an curtain where he could hide but could only find his lowered eyes , no more in contact with me. He stopped looking into my eyes. ” Two years ago , I had sex “, he told. 

” Who was she ?” Was my natural query. 

” Beta , I told you , I stopped having any erections many years ago. I actually, had sex with a man”. 

I made a fool of myself further by asking that was an active partner or passive. A man who is impotent can only be passive , he sort of mocked at me. 

The rubic cube puzzle of his acquiring was now solved. I put him on best of first line ( as desired by his son ) although costly ,combination of Dolutegravir ( Instgra) 50 mg along with a tablet of Tenvir- EM ( Tenofovir plus emtricitabine ) daily. He is showing absolute fantastic virological, immunological and clinical stability for last six months. 

He is a happy man now. His appearances in my clinic , however, leave me grappling with the question of sex and seniors : 70 year itch. 

Rakesh Bharti