By Gary Duff, BBC News Sao Paulo, Brazil
July 29, 2008
Walking down a street or through a shopping centre in Sao Paulo, Lucia looks like any other mother or grandmother going about her normal business.
But this 71-year-old woman carries a burden that few know about. She is HIV-positive and the virus was passed on to her by her husband.
Lucia discovered she was infected in 1999, four years after he died of a heart attack.
"I nearly went crazy. I even tried to commit suicide," she says. "I couldn't believe it."
"Some marks appeared on my skin and I went to a doctor who asked me to do some tests and it was confirmed.
"I got it from my husband. As part of his work he stayed away from home for four months and I think it was then that he got it."
Lucia is one of many older people who are treated for HIV at the Emilio Ribas Hospital, the leading centre for infectious diseases in Latin America.
Research among older patients there has found that among women of more than 60 years of age, 75% were infected by their husbands.
Among the men, 80% contracted the virus through sex outside marriage.
Lucia refuses to blame her husband for what happened in her life, and even goes so far as to shoulder some of the responsibility herself.
"He was very good to me. He was an excellent husband. I didn't feel anger against him.
"We never used condoms because we never thought we would get this disease. I don't think he knew he had this virus."
'Guilt'
At the clinic for elderly people in Emilio Ribas, doctors see 100 patients a month, 10% to 15% of whom are new cases.
Jean Gorinchteyn, a specialist in infectious diseases who was responsible for the research, says he has found it is common for men to feel guilty for infecting the wife, while wives tend to forgive the husband.
"These men symbolise a role within the family, as a father, as a grandfather, as a reassuring figure. Suddenly they discover they have HIV," he says.
"It's a problem because it reveals other things, such as that he has sexual vigour and that he had sex outside the family environment."
Another woman who had to endure this experience was 65-year-old Luciene. She watched as her husband, already ill with diabetes, began to lose weight and his hair, until after repeated tests a doctor indicated he was HIV-positive.
When he was admitted to hospital in 1998, she said he was so shocked and scared by witnessing the illness among Aids patients in that period.
"He was so sad, so sad, that he stopped talking. It was like he was paralysed."
After he died, Luciene had to confront another reality.
"I underwent tests secretly. I was ashamed. My husband was very well known and I never told anyone."
She, too, was diagnosed as HIV-positive, but like Lucia she will not blame her husband.
"I never had the courage to discuss it with him," she says.
"I even asked my daughter not to say anything to anyone that he was carrying the virus and that he died of it. He would be ashamed in front of his friends."
'Education'
Pedro, 73, is among the older male HIV patients at the clinic. He arrived with a walking stick to give him support.
Pedro says he doesn't know how he contracted HIV
"I had a problem with dizziness and went to the doctor. I found out that I was HIV-positive after I had some tests done."
Pedro, whose wife died years ago, says he does not know how he contracted the virus, but he never used condoms.
"I never used to think about using condoms. I was married," he says.
"Nowadays I think that people are well-informed."
For Dr Gorinchteyn, looking after the needs of older people who have HIV and even spotting that they may be carrying the virus represents a major challenge, especially when late diagnosis can add to the problems.
"When you have a young patient with a serious pneumonia being hospitalised, the first thing you ask is whether an HIV (test) has been done. When an older person has serious pneumonia we imagine it could be because his immune system is weakened."
He has found older patients adhere much more closely to their medical treatment than younger ones.
It is as if they suddenly realise that death is closer than they thought, says Dr Gorinchteyn.
Many of those diagnosed with HIV in their 60s were infected a decade earlier, and the doctor says it is important to include older people in sexual health campaigns.
Marginalisation
"Today, someone in their 60s or 70s is still in good physical condition. If they feel physically well they will have sex. If they are going to have sex they run the risk of being exposed," Dr Gorinchteyn says.
The problem is that older patients are overlooked and not targeted by government campaigns, he says.
For Luciene, what matters most now is getting on with her life as best as she can.
Luciene was infected by her husband, but does not blame him
"My life continues well because I have a loving family. I don't want for anything. The doctors here are better than in the private sector," she says.
"The worst thing is the sadness that we have because we feel humiliated."
*The names of the patients have been changed to protect their identity.
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