Thirty years ago, at the dawn of the age of AIDS, the miracle of growing old was all but unimaginable for people with that diagnosis.
Today, the number of people 50 and older diagnosed with HIV or living with AIDS is booming.
People 50 and older account for more than 15 percent of the nation's new HIV diagnoses, according to the federal Centers for Disease Control. That percentage is expected to double within the next four years, making older adults America's fastest-growing HIV demographic.
Roughly 533,100 people ages 45 to 64 were living with HIV or AIDS as of 2008, the CDC reported in June. Another 38,400 were 65 and older.
"The 45- to 64-year-old age group is growing so fast because they've survived," said Janet Parker, client services director for Sacramento's Center for AIDS Research Education and Services (CARES). "For the most part, they're not new infections. The population is aging."
These days, longtime survivors as well as the newly infected share not only a diagnosis but also a hopeful prognosis: With good medical care, they can live to a ripe old age.
"Some of our patients have been through it all," said Dr. Jody Gordon, a Sutter Medical Group HIV specialist whose practice includes a handful of patients in their 70s and 80s. "... If you are 50 and contract HIV, the overwhelming probability is that we can get you on a regimen and allow you to continue with your normal work. And you'll live close to a normal life span."
The lion's share of older people with HIV are gay men who have lived with the virus since the epidemic's early days. Besides aging issues, they face the long-term medical toll of taking antiretroviral medications to keep the virus under control.
But they're alive.
"I watched the rise of Harvey Milk in the Castro" district of San Francisco, said Joseph Rosenblatt, 58, a former IT manager who moved to Sacramento in 2004. "... It was a time of glory and celebration, and then we were attacked by this unknown disease. People were dying all over the place."
Rosenblatt was diagnosed with HIV in 1984, although he says a retroactive test of blood he had submitted for another medical study showed he was positive as early as 1980, a year before the CDC identified the AIDS virus.
The disease ravaged San Francisco in the 1980s and early 1990s, but Rosenblatt didn't get ill until 1997, two years after the first cocktail of anti-retroviral medications was introduced. Although newer drugs have fewer side effects, some people suffered significant problems from the early AIDS drugs. Rosenblatt -- who eventually developed bladder cancer and had his bladder and prostate removed -- was one of them.
Medications saved his life, but their complications also led him to go on disability.
"Young people think if you get HIV, no problem, just take the meds. For me, the meds were the problem, not HIV," Rosenblatt said.
Evidence suggests that some HIV drugs may accelerate the aging process, said Gordon, with patients more prone to the early onset of conditions such as high cholesterol, neuropathy, heart disease and osteoporosis.
Michael Jentes, 56, is a CARES manager and longtime survivor who lived in San Francisco at the epidemic's height. By 2001, he was back home in Sacramento, slowly recovering from Stage IV colon cancer and coping with full-blown AIDS.
Many of his older clients have healthy attitudes and lives, he says. They take their meds and regularly get blood tests.
But for other people, he said, "When they're diagnosed, their whole life comes to an end. This is a serious, chronic illness, but it's also a life-changing event."
Just ask Deborah Jane Rafter, now 61. In late 2009, she learned she was infected with HIV. Her boyfriend of almost 13 years died of AIDS within six months.
"He'd been tested, but he didn't adhere to a medical protocol," said Rafter, a Sacramento housing consultant. "He was in HIV denial. He didn't tell me until February 2010, when he was in the heat of dementia from this virus. He cried and told me he was sorry."
She grieves for him still, and wants others to learn from her story.
"This drove me into a state of panic and sorrow unlike anything I've ever experienced," she said. "That doesn't need to happen to other people. We need to be smart and educated. ...
"We can't give ourselves to trust any more. That's shattered. We need to give ourselves to the medical community and get tested."