"That's me," Dr. Karpiak said. "I'm a 57-year-old gay male. My peers are gone. My social network was zapped."

Poverty is another problem. About 60 percent in Dr. Karpiak's survey said they had "just enough money to get by," while another 9 percent said they could not make ends meet.

The city health department said 72 percent of New York's infected over 50 were on Medicaid. While less generous states have waiting lists for people needing help with paying for antiretrovirals, any infected resident of New York City is eligible for a raft of services. The homeless get apartments without having to stay in shelters. Nine centers run by the Momentum Project offer two meals a day, free groceries and subway fare, counseling, job training, and medical and dental care.

For those earning less than $30,000, a diagnosis leads to hospital care under Medicaid and antiretroviral drugs subsidized by the Ryan White Act. Social Security disability payments provide some income. That makes some AIDS patients complain that some of the uninfected are jealous. "People say, 'You've got it made, girl,' " said Helen Hernandez, who lives in the West Farms section of the Bronx. "They say they'd do better if they were infected, and they ask if they can buy your M11Q," she added, naming the city form that confirms the diagnosis.

There are medical challenges in treating this population. Older people take more medications, and drug interactions are magnified by toxic antiretrovirals. Older patients are also more likely to have heart disease or diabetes, and some antiretroviral drugs tend to drive up cholesterol or interfere with the way insulin is metabolized.

Some antiretrovirals strain the liver, and many older people have livers damaged by alcohol and the hepatitis that comes with drug use. And antiretroviral drugs may also exacerbate problems with the peripheral nerves needed for walking or opening jars.

Also, a recent study at the University of California, San Francisco, indicates that aging AIDS patients may have an increased risk of dementia as the virus allows the plaques associated with Alzheimer's disease to accumulate.

Older patients tend to be more forgetful anyway, which is dangerous because each lapse in taking pills on time increases the chances of developing a drug-resistant strain.

Meanwhile, efforts at prevention are complicated. Ms. Shelton said that in the discussions she leads, ignorance about sexual activity was common. Once when she led a group, she said, "People were asking me, 'Do people over 50 have sex?' and I said I gave somebody's dad condoms, and he was 83!"

Public health advertisements promoting condoms are usually aimed at the young, and as Kathleen M. Nokes, a nursing professor at Hunter College and chairwoman of the New York Association on H.I.V. over Fifty has pointed out, a postmenopausal woman cannot use fear of pregnancy to ask a man to use a condom, but "the virus doesn't care how old you are."

To some women, the news that they are infected comes as a shock because they have been faithful to husbands they thought were too.

Also, experts say, older people are less likely to admit to doctors or survey-takers that they engage in homosexual sex or extramarital sex. And doctors are less likely to ask older patients about their sex lives.

Doctors are also more likely to misdiagnose AIDS symptoms in the elderly. Shingles, for example, may be seen as a disease of aging. Night sweats may be written off as a symptom of menopause. AIDS dementia looks like Alzheimer's disease. Pneumocystis pneumonia can be mistaken for congestive heart failure.

Several studies have found that people over 50 are more likely to discover they are infected later than average, when they are severely immuno-compromised. Also, their survival after diagnosis is usually shorter.

A study done in 1992, before antiretroviral drugs were widespread, found that older people typically died within six months of diagnosis, compared with 16 months for younger people. As with flu, deterioration seemed to be faster in the old; specifically, they lose CD-4 immune-system cells faster.

Yet a survey done for the National Institutes of Health in 1997 found that many older patients felt that their arthritis, heart disease and diabetes were greater burdens than their H.I.V. infections. Dr. Karpiak's survey found similar results. Many in it had hepatitis C, nerve damage, arthritis, high blood pressure, diabetes, and vision and hearing problems.

"For a lot of the people we see, AIDS is not the most important thing in their lives," said J. Daniel Stricker, executive director of Acria. "A grandmother in the South Bronx may be taking care of her kids' kids, and be more worried about food and shelter and just getting through the day."

Despite facing serious problems, many older AIDS patients say they are relatively optimistic. In the Acria survey, about two-thirds reported some symptoms of depression, and most had sought treatment for it. Nonetheless, 78 percent said that, over all, they were somewhat or very satisfied with their lives.

Ms. Shelton said she hoped to live as long as one of her aunts. "She was 100-and-something," she said, "and still walking to the store."

New York Times

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