The Condom Grandma
The room has that air of little expectancy and resignation familiar to any retirement home. On a screen, the tail-end of a documentary about marine life is still showing. Through the windows, there are perfect green lawns; a golf cart; a US flag. Inside, the elderly audience – ladies and gentlemen, their hair white and their clothes dapper – are waiting quietly for what is to follow the whales.
Not that quietly, actually, once Miriam Schuler gets out her accessories. Schuler, an 86-year-old great-grandmother, begins the afternoon's next presentation by handing out little gifts — a manicure set, a battery-powered fan — but they're unwanted. “I don't need a manicure set,” says one elderly gentleman. “Didn't you bring the condoms?”
Of course she did. The residents of this affluent Fort Lauderdale retirement home may not know it, but they're in the presence of a celebrity, because Miriam Schuler is better known as the Condom Grandma. She's been on national TV and in newspapers for her habit of handing out condoms at retirement homes, at doctor's surgeries, wherever she's legally allowed to do so and where she sees fit. Neither the fame nor the condoms bother her one bit. “At least they don't call me the Condom Great-grandma,” she says with a grin, before she remembers herself. “This mustn't be about me. You must mention Ship. I only do this for Ship.”
Ship, then, is the unique Senior HIV Intervention Program, based in Florida's Broward County, where Miriam the Condom Grandma works as a volunteer, and where 13 per cent of people with Aids are senior citizens. Florida's pensioners are having sex, unsafely, and the Condom Grandma and her Ship colleague Paul Spearing are here today to persuade them not to.
It's an uphill battle. Nationwide, HIV in senior citizens in the US has soared since 1991. New Aids cases have risen faster in the over-fifties than in people under 40. Miriam didn't know any of this when she started volunteering for the Health Department to occupy her time. Volunteers were needed for something called Ship, and Miriam signed up. Not without some embarrassment, at first, when she realised that her tasks included talking about sex and handing out condoms. Like most of her fellow senior citizens, the last time Miriam had seen a condom, it was called a “rubber” and it was only used as contraception. Like them, she'd spent most of the 20th century, and all the years of Aids and safe sex messages, sheltered in a marriage where she thought neither could affect her. Like most women of her generation, she'd gone through the menopause so thought she didn't need contraceptive devices. As for Aids, “I didn't even know what a T-cell was.”
Now she knows everything there is to know, though she won't do the public speaking “in case I have a senior moment”. One on one, though, she's unshakeable. “I don't hand out condoms to everyone, but I'll take them to my doctor's surgery, for example.” When her doctor joked that her condoms weren't big enough for him, she rolled one up her to her elbow and said, “If you're bigger than that, give me your phone number!”
Like Paul Spearing, Miriam uses humour to figure out how to persuade old people to take the condoms even when they're acutely embarrassed. Like Spearing, who's 67, her age helps too, though they've both had condoms thrown back in their face. “I said to one old lady who did that, 'Would you throw back a lifebelt? That's what you've just done.' She took the condoms.”
It was a wise decision. In Aids' early years, infection rates among senior citizens accounted for just 10 per cent of the total, but through blood transmission. Since 1991, though, heterosexual transmission has soared 91 per cent in men and 107 per cent in women, because of ignorance, arrogance and naïvety. In the early years of Ship, says Sue Saunders, a delightful 72-year-old with Aids who was Ship's first speaker, “I'd ask who had heard of HIV and no one would raise their hand. We told them senior citizens were getting Aids and they'd say, 'I can't, I'm too old.' Women think they've gone through the menopause. Men think they're going to die anyway. They think they're safe, but they're not.
“These are people with values from another time,” Spearing adds. “They say, 'I got a dose of the clap so bad they called it applause, and all they gave me was penicillin.' I tell them, 'Penicillin won't cure Aids.'“
There is both bravado and embarrassment at the Willow Wood presentation, which makes it typical. Asked by Spearing what the best kind of sex is, one man answers “Missionary!” (the answer is “safe”). But there's discomfort, too, from the women, who look away when Spearing makes jokes about condoms. But he's prepared for that with his fail-safe technique. “I'll single out the greyest, littlest old lady in the room, sit down next to her, and get her to say the word 'rubbers'. Then everything's fine.”
Other times, he and Miriam suggest women send them to their grandchildren: “At least they take them.”
In the beginning, it was even harder. The people who ran retirement communities couldn't stand to think that their residents were sexually active. When Sue Saunders started, Ship applied to give a presentation at Century Village, a huge condo complex near Fort Lauderdale that's popular with pensioners. They weren't given permission for six months. “But after we did the first presentation, they asked us back.”
“If you think senior citizens are in the woods about this,” says Spearing, “you should see the healthcare providers. Some of them wear heavy green rubber gloves to treat HIV-positive people!” Others just don't want to know, despite a 1994 survey from the University of Chicago that found that over 60 per of men and 37 per cent of women aged between 50 and 59 were having sex several times a month.
Anecdotal evidence of frisky seniors is even more overwhelming. “In some retirement homes,” says Miriam, “you hear them scurrying around at night.” She knows what it's like, because when she was widowed, she immediately became a catch “because I could drive at night”. When a man becomes a widower, she says, “women are round there immediately, giving him hot meals”. In some retirement communities in the “snowbird” regions of Florida and Arizona — where people retire for sunshine — there are seven women for every man. There is boredom and availability, and, though retirement home staff prefer not to think about it, there are hormones. No wonder someone called retirement life “slow-moving high school”. Yet still society can't countenance the idea of grandparents having sex. After Saunders was diagnosed, a nurse asked her if she'd been infected through drugs. “I said, 'No, it was through sex.' She said, 'Ugh! Disgusting!'"
The most enlightening thing about Ship, she says, “is that seniors could finally admit they were having sex. They love to talk about it because they've never been able to. Condoms just disappear! One time I had a box of female condoms under the table, I moved away to talk to someone; everyone wanted to tell their stories about how they had sex, about their boyfriends and girlfriends, in spite of all the ailments they had. I guess they felt they could talk to me.” When she got back, the box had been stolen. “Another guy took about 50 condoms and said, 'I guess these'll last me the weekend.'“
Once, says Spearing, there was a little Latina lady looking more and more annoyed. “Eventually, she reached into her purse and I was convinced she was going to pull out a gun. She brought out a condom and said, 'Do you have any more chocolate flavour? I've run out.'“ Spearing still laughs loudly at this. “I said, 'I'm sorry, but the Health Department doesn't provide chocolate flavour for free.'“ Only the free oral sex condoms are flavoured, and only strawberry and banana.
Alongside this frankness, though, some seriously unsafe behaviour is going on. It's not helped by the fact that Viagra is available on Medicare, and condoms aren't. “Between men, we talk,” says 67-year-old Enrique Corujo. “Some talk about Viagra. They say, 'I have five or six women on the go, because I can.' Some use condoms and some don't.”
Then there are the drugs. “I tell them,” says Spearing, “you can also catch HIV from sharing needles. They say, 'We're not junkies!' But when I tell them the story of a woman who goes shopping, and chooses to buy a steak over a new syringe for her insulin, because she can share Maisie's down the hall, you see them clicking with recognition.” Other seniors take vitamin B12 shots. Some shoot up because they've been addicts for years, and qualifying for a senior's bus pass doesn't stop them. Some older men get involved with younger women with a habit, and try it out.
“The boredom and the attitude that they are at the last point in their lives makes seniors more willing to take certain risks,” says Dr Isaac Montoya, who's researching IV drug use in seniors in Texas. “The argument that drugs and HIV will harm them and eventually kill them doesn't work because they feel something will kill them in the near future anyway so it might as well be pleasurable. And the probability of their children or grandchildren finding out about their drug use or HIV status is minimal: physicians are frequently willing to list cause of death as something other than drug use or HIV to protect the feelings of the family.”
They're also willing to ignore the sex life of anyone over 50. Testifying before a Senate sub-committee on HIV and ageing in 2004, Shirley Royston, a 58-year-old woman with Aids, spoke for many. “I think my doctor thought I died below the waist when I hit 50.” When Spearing asks the 30-strong Willow Wood audience who has ever been asked by their doctor about their sex life, only one man puts his hand up. “There is definitely ageism among doctors,” says Jim Campbell of the National Association of HIV Over Fifty, the only national organisation dealing with the issue. “Once a woman reaches 50, she's never questioned about her sexual life. There were 12m prescriptions of Viagra handed out last year. I guess they're all wishful thinking.”
This wilful blindness nearly killed Saunders. She was in a long-term relationship with a Bahamian man who became sick. “He couldn't walk, he didn't want to eat.” She guessed that he'd been fooling around (“because my husband did, so I figured he would too. Since I've been doing the HIV program, I figure all men do”). But he was adamant he didn't have Aids, right up to the minute it killed him. Even then, no one suggested that Sue get herself tested. “I went to the doctor with a sore throat and he said my thyroid was going nuts. He said, 'I don't know what it is but it's some kind of horrible virus.' But he never suggested HIV. I was white, a nice, older woman. Women my age didn't have sex.”
Admittedly, it's harder to diagnose an old body, when HIV symptoms — sweats, diarrhoea, mental impairment — can mimic many normal ageing symptoms (hence HIV's nickname of Halfheimers). And there is little research for doctors to refer to. “There's no historical context for this,” says Donna Gallagher, who works with HIV-positive seniors in Boston. “It's not like you can pick up a reference for what it's like to be 75 years old and living with HIV. We're writing the textbook. Providers are flying by the seat of their pants.”
They're also scrabbling for money. Ship used to run in three counties, until funding was cut. At a national level, and despite the Senate investigation, money isn't forthcoming either. “It's tough to get funding for this issue,” says Vincent Delgado, who used to run Ship in the Miami area. “It's got a double face: Aids and ageing. So the Aids people say, let the ageing people fund you, and vice versa. And no one ends up funding it.”
For now, then, the fight against old-age Aids is left to a hardy few. Miriam the Condom Grandma might be indomitable, but even she can be defeated. After the presentation at Wildwood, a couple of elderly gentlemen come over to the table where Miriam is sitting. One takes condoms; the other doesn't. “I don't use them. I know I'm in trouble. I know...” And he shuffles off on his Zimmerframe, unsafe and unrepentant.
Published in the Independent on Sunday Review in 2006