California Family Health Council, Inc.

Older Adults and Sexual Activity

Ms. Carlisle shares a sentiment that has become more and more common among older adults. Either by divorce, the death of a spouse or partner or for other reasons, many older Americans are back on the dating scene. Like Ms. Carlisle, many do not always realize that they may be at risk for HIV and other sexually transmitted infections (STIs).

Generally speaking, older Americans are living longer, eating healthier and exercising more. Healthy older Americans are likely to be sexually active. Indeed, a 2007 national survey of Americans ages 57 to 85 found that the majority of older adults are sexually active.(1)

Risk Factors for Older Adults

Like other sexually active men and women, older adults are at risk for sexually transmitted infections, including HIV. In 2005, people over the age of 50 accounted for:

• 15 percent of new HIV/AIDS diagnoses;
• 24 percent of people living with HIV/AIDS; and
• 35 percent of all deaths of people with AIDS.(2)

Women are increasingly at risk. The number of women over 50 with HIV/AIDS has grown sharply over the past few years.

Adults over the age of 50 may be especially vulnerable to STI exposure and infection for several reasons:

• Older men and women may wrongly assume that since birth control is no longer a primary concern, they have less need for preventive measures and reproductive health care services.
• Many older adults may not realize that they are at risk for HIV or other STIs.(3) Many grew up before AIDS was an issue and may not have learned the information about HIV prevention that younger people are taught in school. Others were in stable, long-term relationships for many years and didn’t pay attention to information about HIV or other STIs. Now, after being widowed or divorced, they may be in new sexual relationships for the first time in years.
• Biological changes that occur with age add an additional risk for HIV and other STIs. In older women, menopause reduces the natural lubrication in the vagina, making older women susceptible to small tears and abrasions caused by friction. As a result, they may be more likely to become infected when exposed to pathogens that cause sexually transmitted infections such as HIV.
• While older adults need information about STI prevention, many do not talk to their doctors about their sex lives. In a recent survey, only about a third of older men and just a fifth of older women surveyed had discussed sex with a doctor since age 50. In addition, some health care providers may not take an adequate sexual history.
• Providers and their older patients may mistake the early symptoms of AIDS for the aches and pains of normal aging and neglect testing for HIV. Health care professionals may underestimate their older patients’ risk for HIV and other STIs and thus may miss opportunities to discuss prevention or offer testing and treatment.

The Role of Health Care Providers

For sexually active adults of any age, the most effective way to prevent HIV and other STIs is to use condoms properly and consistently. Health care providers can play an important role in increasing awareness of this issue and encouraging their older clients to protect themselves. To address these health concerns, providers should actively promote services targeting this group.

As a part of standard health care for older adults, providers should take a sexual history and provide appropriate information that responds to clients’ questions and concerns. Providers should be prepared to discuss:

• Sexually transmitted infections and their risk factors;
• Safer sex practices including correct condom use and lubrication;
• Early screening, diagnosis and treatment, including genital exams, Pap tests, and HIV tests as appropriate.
• Support service referral for those who are HIV positive.

Increasing awareness about, and responding to, the sexual health needs of older men and women allows health care providers to address sexual health along the continuum of their clients’ lives. Though programmatic modifications may be needed to accomplish this, the benefits to older adults will be immeasurable as we all work to promote sexual health across the lifespan.

List of Sources

1. Tessler-Lindau, S., Schumm, P., Laumann, E.O., et al. (2007).  A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357(8):762-774. 
2. Centers for Disease Control and Prevention. National Center for HIV, STD and TB Prevention. Divisions of HIV/AIDS Prevention. (2007). HIV/AIDS surveillance report, 2005. Vol. 17. Retrieved 10/21/08.
3. Sormanti M, Shibusawa T. Predictors of condom use and HIV testing among midlife and older women seeking medical services. (2007). Journal of Aging Health;19(4):705-19.

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