HIV, Sexually Transmitted Infections, and Sexuality in Later Life

Sexual health in an aging world: a global call to action for more resilient services for older and disabled adults

Sexual health and well-being are critical for people across all age groups. However, older adults are neglected in sexual health research, programs, and policies. This editorial is a call to action for greater attention to the sexual health of older adults. We welcome all related research on this topic, but are particularly interested in manuscripts related to sexual functioning and co-morbidities, menopause and related topics, sexual health service utilization, research that links sexual activity and health, perspectives from low and middle-income countries, and community-engaged research on sexual health among older adults.

A Qualitative Study of the Impact of HIV on Intimacy and Sexuality Among Older Childhood Sexual Abuse Survivors Living with HIV

Childhood sexual abuse (CSA) is a traumatic event known to influence health outcomes, and the rate of CSA among people living with HIV is more than twice that of the general population. Individuals living with HIV with a history of CSA may find establishing intimacy and sexual relations more challenging due to the dual adverse impact of HIV and CSA. This study aimed to explore the effects of HIV on intimacy and sexuality among older CSA survivors living with HIV. We collected data from 24 older adults living with HIV (OALH) aged 50 and older with a history of CSA in South Carolina via in-depth, semi-structured, one-on-one interviews. We used a thematic analysis approach comprising discussion of initial thoughts and key concepts, identifying and reconciling codes, and naming emergent themes for analysis. Five themes emerged: rejection, avoidance, vulnerability, relationship with a partner living with HIV, and no or low sexual intimacy. Study participants reported that they desired to establish intimate relationships; however, living with HIV impacted their ability to do so, affecting their overall health and quality of life. Our findings suggest that addressing the intimacy and sexuality of older CSA survivors living with HIV is warranted in their continuum of care to improve their health outcomes and overall quality of life.

"I'm in control: I'm not stumbling in the dark anymore": Midlife women's experiences of successfully negotiating safer sex with new partners

The rates of STIs in women over 45 years have been steadily increasing in Australia and other Western countries. Traditionally sexual health and STI prevention and research has positioned young people as the priority population; to date, insufficient attention has been paid to the sexual health of women over 45 years. Using a strengths-based approach, the objective of this study was to explore the factors and mechanisms that enable Australian women aged 45 to 64 years to successfully negotiate safer sex practices in new relationships. Interpretative Phenomenological Analysis (IPA) was employed for an in-depth exploratory study of a sample of eight women. Three broad themes emerged: being informed, being prepared, and being empowered. These findings provide a valuable insight into how we can initiate change and support safer sex practices for this target group.

The intimate lives of older adults living with HIV: a qualitative study of the challenges associated with the intersection of HIV and ageing

Older adults living with human immunodeficiency virus (HIV) are at risk of experiencing difficulties in their intimate lives due to the combined effects of HIV and ageing. To date, little research has focused on the lived experience of sexuality. This article seeks to fill in the gap by documenting the challenges faced by this population with respect to their intimate relationships and sexual lives. Based upon the results of a qualitative study conducted in Montreal (2010–2012) using semi-structured interviews with a diverse sample of 38 people aged 50–73 and living with HIV, this study revealed several difficulties, including those related to their social location, whereby HIV and ageing intersect with other social determinants (including gender, sexual orientation and drug use). Difficulties that were identified include lower sexual desire linked to ageing, erectile changes, difficulty in using condoms, stigma related to HIV and/or ageism, changes in appearance caused by HIV and/or ageing, along with the impact of their lifecourse experiences. Our results shed light on the specific nature of the difficulties experienced by older adults living with HIV with regard to their intimate lives, as well as on the importance of using an analysis that combines the theoretical approaches of intersectionality and lifecourse to enhance our capacity for understanding complex and unique experiences.

Women 50 and Older and HIV: Prevention and Implications for Health Care Providers

The current article discusses the importance of implementing HIV and AIDS education, prevention, and intervention programs that are tailored to women 50 and older and to determine HIV risk factors for this population. A literature search was performed, resulting in 41 relevant articles. The literature underscored the significance of increasing awareness of HIV/AIDS, particularly among older women. HIV risk behaviors and the effect that these behaviors have on HIV transmission and prevention among women 50 and older are described. Prior research findings identified risk categories of older women that may contribute to the transmission of HIV among this particular population, including heterosexual relations, perceived HIV risk, ageism and HIV transmission, biological factors, transfusions, sexual enhancement aids, and health care providers and prevention messages. In addition, previous findings indicate that health care providers have not traditionally targeted women 50 and older for HIV prevention. Health care providers should incorporate discussion of HIV risk and transmission during clinic visits and implement prevention programs that target this population. [Journal of Gerontological Nursing, 43(12), 29-34.].

Factors influencing STI transmission in middle-aged heterosexual individuals

Research has shown that individuals aged 45-64, or the 'middle-aged' population, are at an increasing risk of contracting a sexually transmitted infection (STI). An exploration of the factors that may influence STIs in this age group was carried out to ascertain how to reduce the risk. A critical review identified 14 research papers that considered STIs in middle-aged people. The available evidence base highlighted an under-representation of women, the absence of a consistent definition of 'middle age', and a paucity of specific information on the sexual health needs of this group. Low condom use was found to be a possible contributor to increasing STI rates; men were shown to report particularly low use. Behaviours such as contact with sex workers and sexual encounters abroad were found to be additional risk factors in men, requiring further consideration. The breakdown and formation of relationships during middle age was also identified as a possible area to investigate, as were the behavioural traits of women and associated STI risk. Further research into these areas could facilitate the development of attitudes, knowledge, policy and practice that could help provide better support for individuals affected.

Condom Use, Sexual Risk, and Self-Reported STI in a Sample of Older Male Clients of Heterosexual Prostitution in the United States

While there is evidence of increasing rates of sexually transmitted infections (STIs) among older men in the United States, there has been little research on older male clients of female sex providers. The purpose of the current study was to understand the sexual risk behaviors and psychosocial correlates among older men hiring sex providers through provider review websites and discussion boards. A convenience sample of 208 male clients ages 60 to 84 completed online surveys about their sexual behavior and psychosocial factors. Participants indicated the most common sexual activities with providers in the past 12 months were receiving condomless fellatio (33.7%) and having penile-vaginal intercourse with a condom (31.7%). Although condomless penile-vaginal sex with a provider in the past 12 months was only reported by 2.9%, about half (51%) of the respondents indicated that they had experienced this at least once during their lifetime. This was associated with a preference for providers who do not require condoms, having been previously diagnosed with an STI, and perceiving one's HIV risk to be higher, as well as advancing age and having more emotional relationships with providers. Findings demonstrate the need for general and sexual health care practitioners to openly discuss protective measures and strategies for avoiding STIs among their older-to-elderly male patients.

Obstetrician/Gynecologist Care Considerations: Practice Changes in Disease Management with an Aging Patient Population

Demographic changes across the country are leading to an increased proportion of older Americans. This shift will likely lead to changes in the patient population seen by obstetrician/gynecologists, and practices may need to adapt to the needs of older women. This article looks at mental health, sexual health, bone loss, cardiovascular disease and cancer as areas in which obstetrician/gynecologists may experience changes with the increasing age of patients. While this is by no means a comprehensive list of changing areas of practice, it offers a guide for reflecting on the future of obstetrician/gynecologists training, and the importance of considering the needs of older patients in practice.

Age and cancer risk: a potentially modifiable relationship

This article challenges the idea that cancer cannot be prevented among older adults by examining different aspects of the relationship between age and cancer. Although the sequential patterns of aging cannot be changed, several age-related factors that contribute to disease risk can be. For most adults, age is coincidentally associated with preventable chronic conditions, avoidable exposures, and modifiable risk behaviors that are causally associated with cancer. Midlife is a period of life when the prevalence of multiple cancer risk factors is high and incidence rates begin to increase for many types of cancer. However, current evidence suggests that for most adults, cancer does not have to be an inevitable consequence of growing older. Interventions that support healthy environments, help people manage chronic conditions, and promote healthy behaviors may help people make a healthier transition from midlife to older age and reduce the likelihood of developing cancer. Because the number of adults reaching older ages is increasing rapidly, the number of new cancer cases will also increase if current incidence rates remain unchanged. Thus, the need to translate the available research into practice to promote cancer prevention, especially for adults at midlife, has never been greater.

Sexually transmitted infections in older populations

PURPOSE OF REVIEW

People are living longer and healthier lives. In recent years, there has been a focus on recognition of ongoing sexual activity among older adults and leading from this, the potential for an increase in diagnoses of sexually transmitted infections (STIs). Data on STI rates, sexual behaviour and factors affecting susceptibility to STIs are discussed.

RECENT FINDINGS

There is limited published literature in this field and few recent longitudinal studies of STI acquisition in people older than 50 years. Although there is evidence of an increase in incidence, STIs remain rare in older compared with younger populations. Compared with their heterosexual counterparts, older men who have sex with men are at higher risk of incident HIV and some other STIs. The HIV epidemic is ageing as a result of increasing life span and acquisition of HIV at older ages. Improved longevity, evolving societal norms and physiological changes may place older people at risk of HIV and other STIs.

SUMMARY

Routine STI screening is not warranted in all older people. Education and prevention strategies for all people at greater risk of HIV, regardless of age are required. Age-appropriate interventions designed to impart knowledge and provide the requisite skills needed to reduce STI risk in older age would be beneficial.

Perception of vulnerability to HIV infection among older people in Nairobi, Kenya: a need for intervention

It is evident that sexual activity tends to decrease with age. Nonetheless, it is still prevalent enough to be considered a risk factor for the spread of HIV among older people. This paper uses quantitative data for 2053 individuals to examine HIV risk perception and correlates of perceived risk among older people aged 50 years and older living in Nairobi slums. It emerged that a majority of older people did not consider themselves at risk of infection. Of those who felt at risk, a greater proportion sensed only a small chance of contracting HIV. Women cited 'no sexual activity' while men mentioned 'having only one and/or a faithful sexual partner' as the primary reasons for perceiving minimal risk of HIV infection. There were no differences by sex in the basis for perceiving moderate-to-great risk of infection. Religion is a key factor in risk perception with Muslims perceiving higher levels of risk and, conversely, devotees irrespective of faith perceiving lower levels of risk. Older people willing to be tested for HIV had a decreased likelihood of perceived risk compared with those unwilling to be tested. This paper recommends evaluation of older people's perception of risk in order to better inform interventions aimed at minimizing their vulnerability to HIV infection.

STI epidemiology in the global older population: emerging challenges

This paper reviews the evidence concerning the epidemiology of sexually transmitted infections (STIs) with a particular focus on older people. Evidence from North America, Australia, China and Korea clearly shows increasing rates of many STIs in the population group aged 50 years and older. Similar changes are identified in three studies conducted in sub-Saharan Africa. There is a significant lack of detailed epidemiological data from Asia-Pacific and many African countries. There is also a lack of health education and health programmes directed towards older people. It is likely that sexual ageism is the dynamic that underpins this lack of focus and resources for older people.