Safer Sex in Later Life: Qualitative Interviews With Older Australians on Their Understandings and Practices of Safer Sex

PrEP-eligible behaviours and condom use among sexually active older adults in China: Findings from the sexual well-being (SWELL) study

OBJECTIVES

Older adults remain sexually active and at risk of sexually transmitted infections (STIs). This study aimed to explore consistent condom use and pre-exposure prophylaxis (PrEP)-eligible behaviours and their correlates among sexually active older adults in China.

STUDY DESIGN

Cross-sectional study.

METHODS

Data were collected from a multicentre cross-sectional survey in China between June 2020 and December 2022. Eligibility criteria were community-dwelling older adults aged ≥50 years who were sexually active (i.e. had oral, vaginal or anal sex in the past year). In-person questionnaire interviews included demographic characteristics, general health and sexual health information.

RESULTS

In total, 1332 sexually active older adults were recruited in the study. Overall, 33.7 % (449/1332) of participants consistently used a condom in the past year and 7.9 % (105/1332) reported PrEP-eligible behaviours. Consistent condom use was significantly associated with the following characteristics: age (only for women aged 50-59 years [adjusted odds ratio (aOR) 0.60, 95 % confidence interval (CI): 0.36-0.98]; women aged 60-69 years [aOR 0.27, 95 % CI: 0.10-0.71]), living alone (men [aOR 0.40, 95 % CI: 0.20-0.79]; women [aOR 0.27, 95 % CI: 0.10-0.72]), body mass index (men [aOR 1.59, 95 % CI: 1.18-2.14]; women [aOR 1.76, 95 % CI: 1.13-2.73]), general health status (men reporting 'fair' health [aOR 0.62, 95 % CI: 0.39-0.97]; women reporting 'very good' health [aOR 0.39, 95 % CI: 0.16-0.96]), talking about sex (men [aOR 1.67, 95 % CI: 1.23-2.26]) and knowledge of condom use to prevent sexually transmitted infections (men [aOR 1.52, 95 % CI: 1.06-2.18]). PrEP-eligible behaviours were more likely in men (aOR 1.76, 95 % CI: 1.08-2.90) and in individuals who were not in a stable relationship (aOR 4.80, 95 % CI: 2.41-9.54) and who lived alone (aOR 2.02, 95 % CI: 1.07-3.82).

CONCLUSION

Consistent condom use was moderate among sexually active older adults in China. More than one-quarter of older adults who lived alone reported PrEP-eligible behaviours. Comprehensive intervention measures should consider the characteristics and health needs of community-dwelling older adults.

Academicians' Metaphorical Perceptions of Older Adult Sexuality: An Example of Metaphor Analysis

Sexuality is one of the most natural aspects of life that continues throughout life and is within the scope of basic human needs. Sexual life can be affected by many factors such as individual characteristics, diseases, society's values, attitudes, and cultural and religious characteristics. The objective of this research is to identify the metaphorical perceptions of older adults' sexuality held by academics, employing a phenomenological methodology. This study was conducted with the participation of 164 academicians. The research data were collected between March-April 2022. The evaluation of the metaphors created about the concept of older adults' sexuality employed content analysis techniques. The metaphors pertaining to the perceptions of academics regarding the sexuality of older adults were classified into four categories and 11 sub-themes: "Perceptions that sexuality as natural," "Diminishing sexuality," "Sexuality as love, affection and friendship," and "Sexuality as hidden and stigmatized." The majority of the metaphors created by the academic researchers were found to contain negative themes related to the sexuality of older adults. It can be suggested to organize seminars to increase the awareness of academicians on sexuality, older adults' sexuality, and sexual health.

Adaptation and validation of a condom-related stigma scale for older adults in China

BACKGROUND

Condom use has long been recommended as an effective method for preventing HIV/AIDS. However, a large proportion of older adults in China reported not using condoms, leading to an alarming increase in HIV prevalence among this population. Negative attitudes, especially condom-related stigma, have been identified as the main barrier. However, no condom-related stigma scale has been developed or validated for older adults in the Chinese cultural context. This study aimed to adapt and validate a condom-related stigma scale for older adults (CRSS-OA) in China, based on a scale previously developed for men who have sex with men (CRSS).

METHODS

Based on qualitative interviews, we adapted and revised the CRSS to better address the ageism and unique stigma faced by older adults in the Chinese cultural context. The reliability and validity of the adapted CRSS-OA were examined using a random sample of 498 older adults in Hunan Province, south-central China. Reliability was assessed by calculating Cronbach's alpha. Construct validity was assessed through exploratory and confirmatory factor analyses. Concurrent validity was assessed by examining the correlation between each factor of the CRSS-OA and two criterion scales (the HIV/AIDS Stigma Scale and the Aging Sexual Attitudes Scale). Predictive validity was evaluated by analyzing the association between condom-related stigma and engagement in condomless sexual behavior.

RESULTS

The adapted scale included 16 items, loading on three factors, and collectively explaining 70.646% of the variance. These factors were named "labeling condom use," "shaming condom purchase," and "violating traditional sex beliefs," demonstrating strong internal consistency with Cronbach's alpha coefficients of 0.942, 0.850, and 0.852, respectively. Concurrent validity was established by evaluating the correlation between each factor of the CRSS-OA and two criterion scales, with Pearson correlation coefficients ranging from 0.227 to 0.508 (p < 0.05). Predictive validity was assessed by measuring the scale's ability to correctly predict condomless sexual behavior, with an average predictability of 0.77.

CONCLUSIONS

The adapted CRSS-OA has proven to be a valid and cultural-adaptive tool for assessing condom-related stigma among older adults in China. Further studies are needed to explore the external validity of this scale in the future.

Sexual Expression and Subsequent Marital Quality Among Partnered Older Adults

A great deal of research has linked aspects of couples' sex lives to the quality of their relationships. Yet most of this work is with younger couples. Although sexual frequency is associated with positive marital quality, less is known regarding how sexual expression-sexual attitudes, desires, and behaviors-influences later positive and negative marital quality, particularly in older couples. Using latent class analysis and dyadic data on 620 heterosexual couples in long-term marriages from Rounds 2 and 3 of the National Social Life, Health, and Aging Project, we examined how couple-level configurations of sexual expression influence later marital quality. Generally, the latent classes with more agreement on sexual expression and higher overall sexual frequency were associated with later higher positive marital quality for both wives and husbands. Sexual expression configurations were associated with wives' negative marital quality, not husbands' negative marital quality. Across classes, wives' better mental health and husbands' functional limitations were associated with later marital quality. It is essential for practitioners to recognize the relevance of sexual expression to marital quality in older couples.

Sexual behaviour and condom use of older adults living with HIV/AIDS in a treatment centre at Osogbo, south-west Nigeria

Objective

This study assessed the condom use and sexual behaviour of older adults living with HIV/AIDS at Osogbo, Osun State, Nigeria.

Methods

A descriptive cross-sectional study involving all adults receiving care at an HIV treatment centre that completed an interviewer administered questionnaire on their sexual behaviour and condom use. Data were analyzed using descriptive and inferential statistics.

Results

A total of 186 older adults completed the study. Their mean age (SD) was 54.5 (5.6) years. There are 114 (61.3%) females and 72 (38.7%) males. Two fifth 87 (46.8%) were sexually active with over half using condom (45, 51.7%) at last sexual intercourse. The determinants of condom use at last sexual intercourse included age 50-59 years (OR=3.34, 95% CI=1.21-9.25, p=0.020), lower education (OR=3.00, 95%CI=1.04-8.69, p=0.043), being married or have a partner (OR=3.25, 95%CI=1.11-9.52, p=0.031), partner's awareness of respondents' HIV status (OR=13.00, 95%CI=4.25-39.80, p<0.0001) and stigma experience from partner (OR=11.70, 95%CI=4.03-33.99, p=0.0001).

Conclusion

Older adults engage in high-risk sexual behaviour. It is necessary to encourage safer sex practices, stigma reduction and couple HIV counseling and testing.

Culture-based stigmatizing attitudes toward condom use among Chinese older adults: An interpretative phenomenological analysis

OBJECTIVE

To explore their perceptions and attitudes toward condom use and the underlying reasons for the low usage frequency among Chinese older adults.

METHODS

A qualitative study design utilizing interpretive phenomenological analysis was employed. Data were collected through field observation and face-to-face in-depth interviews among older adults aged 50 years or above and having engaged in sexual activities within the previous year.

RESULTS

Three main themes emerged: perceiving unnecessary due to misconceptions and low awareness, interactive stereotypes rooted in sociocultural beliefs, and stigmatized social norms including gender inequity and economic unbalance.

CONCLUSIONS

Tailored interventions focusing on addressing misconceptions, increasing awareness, and reducing culturally ingrained stereotypes and stigma surrounding condom use are essential to promote condom use among older adults in order to prevent HIV transmission in China.

The trend analysis of HIV and other sexually transmitted infections among the elderly aged 50 to 69 years from 1990 to 2030

Background

The HIV and other sexually transmitted infections (STI) excluding HIV among the elderly population urgently require more attention and in-depth study. We aimed to present and predict the worldwide of its burden from 1990 to 2030 using data from the Global Burden of Disease (GBD) study.

Methods

Leveraging the 2019 GBD study, we investigated the average annual percentage change (AAPC) of HIV and other STI in incidence, prevalence, disability-adjusted life years (DALYs), and mortality rates for individuals aged 50-69 across different age groups, genders, sociodemographic index (SDI) regions, and nations. The incidence of STI in the population from 2020 to 2030 was explored by Bayesian age-period-cohort (BAPC) prediction model.

Results

The HIV incidence rate experienced its fastest growth 1990-1992, peaked in 1996, and gradually declined thereafter, with the 2019 rate being lower than that of 1990. The prevalence rate didn't present a sharp turning point. After 2006, its growth rate accelerated. Both DALYs and mortality rates plateaued high between 2002 and 2005, followed by a decline. The decline was steepest from 2005-2012, yet the rate of decrease slowed noticeably from 2012-2019.When segmented by age, HIV was more prevalent among those aged 55-59 and 50-54, with the 50-54 age group witnessing the fastest decline in incidence rates. However, the fastest growth in prevalence rates was seen among the 60-64 and 65-69 age groups. The other STI incidence rate declined from 1990-1996, increased up to 2006, declined until 2015, and then saw a resurgence with accelerated growth thereafter. The prevalence rate showcased varied trends, with a notable increase in the past five years. The highest growth in incidence rate was among the 65-69 age group. We predict that the incidence rate of STI will increase in the future.

Conclusions

Overall, despite the evident decline in incidence, mortality rates, and DALYs, the prevalence of HIV and other STI among the elderly is rising, and both demonstrated significant trend variations across different ages, genders, SDI regions, and nations. Comprehensive sexual health education, clinical care and adjustments in health service strategies based on the evolving trends of HIV and other STI among the elderly are paramount.

Correlates of sexual and reproductive health service utilization among older adults in China: Findings from the sexual well-being (SWELL) study

BACKGROUND

Sexual and reproductive health (SRH) is critical to the overall health of older adults. We assessed the utilization of SRH services and its correlates among older adults in China.

METHODS

We recruited community-dwelling adults aged 50 and above in five Chinese cities between June 2020 and December 2022. In this study SRH services included reproductive health examination, cervical cancer screening, and sexual life counselling. Logistic regression was used to assess correlates of SRH services utilization.

RESULTS

A total of 3001 older adults (1819 men and 1182 women) were enrolled. Among them, 11.4 % (343/3001) of participants received a reproductive health examination, 35.4 % (418/1182) of female participants received cervical cancer screening, and 30.1 % (401/1332) of sexually active participants sought help for their sexual lives. Older men with an annual income of USD 7500 or more (aOR = 3.21, 95%CI: 1.39-7.44), two or more chronic conditions (2.38, 1.39-4.08), and reproductive health problems (2.01, 1.18-3.43) were more likely to receive a urological examination. For older women, individuals who were younger (aged 50-59 years: 5.18, 2.84-9.43; aged 60-69 years: 2.67, 1.49-4.79), lived in an urban area (1.88, 1.31-2.71), were employed (1.73, 1.21-2.47), had two or more chronic conditions (2.04, 1.37-3.05), were sexually active (1.72, 1.15-2.58) and talked about sex (1.69, 1.21-2.36) were more likely to receive a gynecological examination.

CONCLUSION

SRH services utilization among older adults was low, with urological examination among older men particularly low. SRH messages and services tailored for older adults are needed to enhance their utilization of SRH services.

Trends and projections in sexually transmitted infections in people aged 45 years and older in England: analysis of national surveillance data

AIMS

We describe the epidemiology of sexually transmitted infections (STIs) and HIV in people aged ⩾45 years in England and provide future projections about the burden of STIs in this age group.

METHODS

Analysis of national surveillance data in England from 2014 to 2019 for chlamydia, gonorrhoea, herpes, syphilis, anogenital warts and HIV was carried out. Time trends were assessed by the Poisson regression and reported using incidence rate ratios (IRRs). Two scenarios were modelled to predict the number of new STI diagnoses and associated costs in 2040.

RESULTS

In 2019, there were 37,692 new STI diagnoses in people ⩾45 years in England. Between 2014 and 2019, there was a significant increase in the rate of new STI diagnoses in men (IRR = 1.05, p = .05) and those aged 45-64 years (IRR = 1.04, p = .05). Absolute numbers of new STI diagnoses in men who have sex with men increased by 76% between 2014 and 2019 (IRR = 1.15, p < .001). In adults aged ⩾50 years, the number of episodes of care for HIV increased over time (age = 50-64 years, IRR = 1.10; age = 65+ years, IRR = 1.13; p <.001). The modelled scenarios predicted an increase in STI diagnoses and costs in older people by 2040.

CONCLUSION

STI rates in England are increasing in people aged ⩾45 years. The population is ageing and older people will contribute an increasing burden to STI costs if this trend continues. The reasons for this trend are not fully understood and further longitudinal epidemiological research is needed. Sexual health promotion campaigns and healthcare interventions targeted at older people should be prioritised.

Multidimensional Sexual Well-being Scale for Older Adults: Validity Evidence from a Polish Sample

Here, we report the results of a Polish adaptation of the Multidimensional Sexual Well-being Scale (MSWBS) for older adults. The MSWBS is a short self-report scale for assessing the five dimensions of an individual's sexual well-being: frequency of caressing, sexual intimacy, sexual compliance, sexual satisfaction, and sexual distress. The aim of our adaptation was to examine the utility of the scale in a country with conservative views on the sexuality of older people, which will help health care providers and researchers to better understand the sexual needs of older people. The study included 507 participants, aged 60-92. We found the reliability of the scale to be satisfactory (Cronbach's alpha = .71-.87). Confirmatory factor analysis (CFA) showed a good fit of the data to a five-factor model. This study demonstrates that the MSWBS-PL is connected to general life satisfaction and diversity of sexual activity, confirming the scale's validity.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.1991535.

How Do Older Portuguese and Mexican Adults Experience Their Sexual Well-Being? A Cross-Cultural Qualitative Study

Sexual well-being (SWB) refers to the subjective emotional and cognitive evaluation of the quality of the individual's sexuality. SWB plays a relevant role in quality of life and health promotion on old age and has cross-cultural implications. In addition to the scarcity of in-depth qualitative studies in this area and studies with cross-cultural samples, no studies have compared perceptions of SWB among Portuguese and Mexican older adults. The aim of this study was to comparatively analyze perspectives on SWB among older adults residing in Portugal and Mexico. Data were collected from 86 Portuguese and 80 Mexican community-dwelling participants aged 65 years and older, using a semi-structured interview protocol. Older adults were asked about factors that significantly contribute to their SWB. Sociodemographic data were also gathered. Content analysis was used to identify key themes. Eight themes were identified across both studied samples: eroticism, supportive relationship, positive self-concept, health and self-care, romance, active life, tenderness and care, and no pain and no pregnancy restrictions. Eroticism was most pertinent to Portuguese participants (31.4%). Health and self-care was most frequently reported by Mexican participants (26.5%). The findings of this study indicate that SWB is strongly influenced by sociocultural and psychosocial values. Cross-cultural comparisons between older Portuguese and Mexican people provide a broader understanding of SWB in older age and suggest a scenario for future culture-adapted interventions and comprehensive policies.

Postmenopausal women in gynecological care

Menopause is one of the most important events in the female reproductive life cycle, being a transition from the reproductive to the nonreproductive stage. It is a milestone that may have a negative influence on quality of life and one that brings in several physiological changes that affect the life of a woman permanently. According to a Polish epidemiological forecast, in 2050 the average female life expectancy will be 87.5, which is 6.4 years longer than today. Thus, the life expectancy of women who will be 60 or older in 2050 will also extend. Therefore, strategies need to be optimized to maintain postreproductive health, in part because of increased longevity. The general gynecologist can expect to see more elderly female patients as the population continues to age. Office management of the gynecologic problems of geriatric women requires sensitivity to the special needs of this group. Nowadays, most women spend more than one-third of their lives after menopause; therefore there is plenty of opportunity for gynecologists to cater to the needs of postmenopausal women. It is in their scope of practice to help postmenopausal women through "healthy aging". In this review we look into screenings, early identification, lifestyle modifications and appropriate intervention that may prevent many chronic conditions that cause morbidity and mortality during the postmenopausal years.

Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018

Background This study examined trends in chlamydia, gonorrhoea and syphilis diagnosis, and chlamydia testing and positivity, among older women in Australia between 2000 and 2018.

METHODS

Using national notifiable disease data and Medicare data, diagnosis rates were calculated for each sexually transmissible infection (STI), as well as testing and positivity rates for chlamydia. Data were compared between two older groups (55-64 and 65-74 years) and two younger groups (15-24 and 25-34 years). Poisson regression examined trends for 2000-18 and 2014-18 separately.

RESULTS

Rates for all STIs increased across all age groups and were highest in the two youngest age groups. From 2014 to 2018, chlamydia rates increased the most among those aged 55-64 years [incidence rate ratio (IRR) = 1.06; 95%CI: 1.02-1.10] and declined in those aged 15-24 years (IRR = 0.99; 95%CI: 0.99-0.99). Gonorrhoea rates increased the most among those aged 65-74 years (IRR = 1.47; 95%CI: 1.23-1.77) and least in those aged 15-24 years (IRR = 1.12; 95%CI: 1.10-1.13). Syphilis rates increased the most among those aged 55-64 years (IRR = 1.58; 95%CI: 1.25-1.99) and least in those aged 15-24 years (IRR = 1.29; 95%CI: 1.23-1.35). Chlamydia test positivity declined among younger women but remained stable in older women.

CONCLUSIONS

In general, STIs are increasing among older women in Australia at a faster rate than among younger women. Although the greatest burden is among younger women, STIs need to be considered and monitored among older women.

Barriers to older adults seeking sexual health advice and treatment: A scoping review

BACKGROUND

Sexual health is an integral part of overall health in older age. Research consistently reports that heterosexual and queer older people tend not to disclose sexual concerns and difficulties which increases the risks for sexually transmitted diseases. Older people are often absent from policies and information programmes and healthcare providers experience difficulties in initiating conversations around sexual health and history.

OBJECTIVES

To identify what are the barriers that stop older people seeking sexual health advice and treatment.

DESIGN AND METHOD

A scoping review methodology was employed. Published and unpublished literature was scoped through development of a research question, identification of potentially relevant studies, selection of relevant studies using an iterative team approach, charting data, collating, summarising and reporting findings, and considering the implications of study findings for further research.

DATA SOURCES

Electronic databases searches were run to identify published and unpublished literature, including Medline, Embase, PsycINFO, CINAHL, ASSIA, Social Sciences, RCN and Cochrane Libraries. Additional studies were located through hand searching.

RESULTS

Twelve studies from: the USA (n = 6); the UK (n = 3); Australia (n = 2); and one shared paper between New Zealand and UK met the inclusion criteria. Four barriers that stop older people seeking sexual health advice and treatment were identified, including (1) Cultural and societal views and beliefs toward sexual health; (2) Stigma, embarrassment and discrimination; (3) Lack of education and training of healthcare professionals; (4) Quality of relationship between patients and health professionals.

CONCLUSION

Barriers to seeking and receiving advice and treatment for sexual health in later life clearly exist and are both related to cultural and social factors. Overall, the papers reviewed in this scoping review indicate that healthcare providers are reluctant to initiate conversations around sexual health or offer appropriate advice or clinical tests, and that older people tend to be hesitant to seek medical help. Later life age groups independently from their sexual orientation represent a hidden population and are absent from sexual health campaigns and government policies. Efforts need to be made by influential institutions and healthcare providers to recognise sexuality in older age and give older people the opportunity to open up regarding their sexual health and experiences.

Factors Conditioning Sexual Behavior in Older Adults: A Systematic Review of Qualitative Studies

The sexual behavior of older adults, especially women, has undergone changes in recent years, though there are still certain stereotypes today related to pathophysiology, beliefs, culture and tradition that negatively affect older adults’ sexual activity. The aim of our review is to present the main qualitative studies analyzing how physiological and psychosocial factors affect sexual behavior in older adults. A systematic review of these qualitative studies was carried out. All stages of this review were carried out peer-to-peer in order to guarantee minimized bias. A bibliographical search was completed between February and April 2019, in Web of Science, Scopus, PubMed Medline, PsycINFO ProQuest and CINAHL. To analyze the findings of the selected qualitative studies, a “Thematic Synthesis Analysis” was performed, using Eppi-Reviewer 4 software (UCL Institute of Education, University of London, UK). The quality of the studies was assessed with a CASP-Qualitative-Checklist. A total of 16,608 references were screened and 18 qualitative studies were included in this review. The studies involved 2603 participants across seven countries, most being women (approximately 80%). We identified a wide variety of physiological and psychological factors that can influence the sexual behavior of older adults, such as the presence of pathologies (erectile dysfunction and menopause), the strength of spiritual beliefs, and patriarchal roles upheld by upbringings conveying that women’s role is to provide men with sexual pleasure. Biological age in relation to stereotypical models of sexual behavior, emphasized as a risk factor in the contraction of sexual diseases, seems to play a relevant role as a factor limiting sexual behavior in older adults.

Navigating new sexual partnerships in midlife: a socioecological perspective on factors shaping STI risk perceptions and practices

OBJECTIVE

Despite increases in STIs among those over 40, little is known about the social context of STI transmission among people experiencing relationship transition in midlife, and few sexual health promotion initiatives are targeted at this group. This study sought to identify factors shaping STI risk perceptions and practices among midlife individuals either contemplating or having sex with new partners following the end of a long-term relationship.

METHODS

Participants were purposively selected from respondents to Britain's third National Survey of Sexual Attitudes and Lifestyles, using three eligibility criteria: aged 40-59, reported experience of the end of a marital or cohabiting relationship with an opposite-sex partner in the past 5 years, and willingness to participate in a qualitative interview. Qualitative data were generated via face-to-face interviews with 10 women and 9 men and analysed inductively using thematic analysis, with themes then organised using a socioecological framework.

RESULTS

Participants' accounts of new sexual partnerships in midlife indicate that STI risk perceptions and practices are shaped by factors operating at multiple levels across the socioecological arena (individual, partnership, peers and communities, societal). Constraints on, and resources for, the navigation of sexual safety include self-perceived STI risk rooted in past rather than present circumstances; legacies of mistrust within former relationships; intersecting gender-age dynamics in negotiation of risk prevention strategies with new partners; peers and younger relatives' influences on understandings of sexual risk and safety; postrelationship change in social networks that increase or mitigate vulnerability to sexual risk; age-related barriers to accessing condoms; and disconnection from safer sex messaging and services culturally coded as for the young.

CONCLUSIONS

Improving sexual health among midlife adults requires age-sensitive interventions designed to address multilevel constraints, and harness positive influences, on the navigation of sexual safety at this stage of life.

Correction to: Emotional intimacy and sexual well-being in aging European couples: a cross-cultural mediation analysis

[This corrects the article DOI: 10.1007/s10433-019-00509-x.].

Emotional intimacy and sexual well-being in aging European couples: a cross-cultural mediation analysis

Sexual health research tends to focus on problematic aspects of sexuality. This also applies to research on sexuality in older men and women, where attention has been primarily on the negative impact of aging. To contribute to the emerging interest in positive (successful) sexual aging, we aimed to: (1) further validate a recently developed 5-dimensional measure of sexual well-being (Štulhofer et al. in J Happiness Stud, 2018. 10.1007/s10902-018-0049-1) and (2) explore the structure of associations among emotional intimacy, frequency of sexual intercourse, and sexual well-being in older European couples. Using data from a 2016 community-based survey of 218 Norwegian, 207 Danish, 135 Belgian, and 117 Portuguese couples aged 60-75 years, we applied actor-partner interdependence structural modeling approach to confirm the validity of the sexual well-being measure in couples and explore a path analytic model in which the frequency of sexual intercourse was hypothesized to mediate the association between emotional intimacy and sexual well-being. Although we observed consistent and significant actor effects, with emotional intimacy and frequency of sexual intercourse predicting both male and female partners' sexual well-being across countries, the proposed mediation was observed only in Norwegian and Portuguese men and Norwegian and Belgian women. Partner effects were gender-specific; male partner's emotional intimacy was related to his female partner's reported frequency of sex and sexual well-being but not the other way around. Apart from being one of the few cross-cultural assessments of successful sexual aging, this study's findings support the use of a new sexual well-being measure in research on older adults' sexuality.

Factors associated with declining to report the number of sexual partners using computer-assisted self-interviewing: a cross-sectional study among individuals attending a sexual health centre in Melbourne, Australia

Background The number of sexual partners is one of the most important risk factors for sexually transmissible infections (STIs), including HIV. The aim of the present study was to examine the association between declining to report the number of partners using computer-assisted self-interviewing (CASI) and HIV or STI positivity at a public sexual health centre in Melbourne, Australia, in 2016.

METHODS

Individuals were categorised into three risk populations: women, men who have sex with women only (MSW) and men who have sex with men (MSM). Logistic regression analysis was used to examine the association between declining to report the number of sexual partners in the past 12 months and HIV or STI positivity for women and MSW, with generalised estimating equations (GEE) used for estimation in MSM to address repeated-measures within individuals.

RESULTS

In all, 18085 individuals (5579 women, 6013 MSW, 6493 MSM) were included in the final analysis. There was no association between chlamydia positivity and declining to respond among women and MSW. MSM who declined to respond were more likely to be chlamydia positive (adjusted odds ratio1.21; 95% confidence interval (CI) 1.01-1.43). Known HIV-positive MSM and MSM newly diagnosed with HIV had 3.31-fold (95% CI 2.48-4.42) and 2.82-fold (95% CI 1.84-4.32) greater odds respectively of declining to respond compared with HIV-negative MSM. Gonorrhoea and syphilis positivity in MSM were not associated with declining to respond.

CONCLUSIONS

There was no association between declining to report the number of partners and chlamydia positivity among women and MSW. However, MSM who declined to report the number of partners were slightly more likely to have chlamydia and substantially more likely to be HIV positive.

Sexual Aging: A Systematic Review of Qualitative Research on the Sexuality and Sexual Health of Older Adults

Negative stereotypes regarding the sex lives of older adults persist, despite sexuality being an important factor that influences the quality of life. We conducted a systematic review of the qualitative literature on the sexuality and sexual health of older adults to address which topics have been researched and the quality of research within this field. We searched PsycINFO, SocINDEX, MEDLINE, and CINAHL for qualitative articles investigating the sexuality of adults aged 60+ years. We analyzed 69 articles using thematic analysis to synthesize their findings. We identified two overarching thematic categories: psychological and relational aspects of sexuality (personal meanings and understandings of sex, couplehood aspects, and sociocultural aspects) and health and sexuality (effects of illness and/or treatment on sexuality, and help-seeking behaviors). Research is needed into male sexual desire and pleasure, culture-specific and sexual/gender identities and their effect on outcomes such as help-seeking behavior and sexual satisfaction, and sexual risk-taking in older adults.

Perceived sexual self-control and condom use with primary and casual sex partners: age and relationship agreement differences in a Portuguese sample

OBJECTIVE

Consistent condom use is still not ideal. Research showed that perceived sexual self-control is associated with greater likelihood of using condoms. However, this association seems to vary according to age and relationship agreement (i.e. non-consensual non-monogamy, NCNM vs. consensual non-monogamy, CNM).

DESIGN

Cross-sectional study with 307 heterosexual users of a dating web site for romantically involved individuals (81.8% men; M_age = 42.24, SD = 9.65, range: 23-76 years). All individuals were in a romantic relationship (M_length = 13.47 years, SD = 9.39).

MEASURES

Demographic information, perceived sexual self-control, condom use frequency (casual sex partners; primary partner in the last 3 months) and relationship agreement.

RESULTS

Independently of relationship agreement, perceived sexual self-control was positively associated with condom use frequency with casual sex partners among younger and middle age participants, but not older ones (>49 years). Regarding the primary partner, a similar pattern emerged for CNM participants. In contrast, no significant association between perceived sexual self-control and condom use frequency with the primary partner emerged for NCNM individuals, regardless of age.

CONCLUSION

Our findings can inform evidence-based strategies to promote consistent condom use as an effective behaviour to prevent sexually transmitted infections, especially among older and NCNM individuals.

Emotional intimacy and sexual well-being in aging European couples: a cross-cultural mediation analysis

Sexual health research tends to focus on problematic aspects of sexuality. This also applies to research on sexuality in older men and women, where attention has been primarily on the negative impact of aging. To contribute to the emerging interest in positive (successful) sexual aging, we aimed to: (1) further validate a recently developed 5-dimensional measure of sexual well-being (Štulhofer et al. in J Happiness Stud, 2018. 10.1007/s10902-018-0049-1) and (2) explore the structure of associations among emotional intimacy, frequency of sexual intercourse, and sexual well-being in older European couples. Using data from a 2016 community-based survey of 218 Norwegian, 207 Danish, 135 Belgian, and 117 Portuguese couples aged 60-75 years, we applied actor-partner interdependence structural modeling approach to confirm the validity of the sexual well-being measure in couples and explore a path analytic model in which the frequency of sexual intercourse was hypothesized to mediate the association between emotional intimacy and sexual well-being. Although we observed consistent and significant actor effects, with emotional intimacy and frequency of sexual intercourse predicting both male and female partners' sexual well-being across countries, the proposed mediation was observed only in Norwegian and Portuguese men and Norwegian and Belgian women. Partner effects were gender-specific; male partner's emotional intimacy was related to his female partner's reported frequency of sex and sexual well-being but not the other way around. Apart from being one of the few cross-cultural assessments of successful sexual aging, this study's findings support the use of a new sexual well-being measure in research on older adults' sexuality.

"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.