Sexuality

Adults age fifty and over represent more than 10 percent of the annual AIDS caseload in the United States. In the early days of the epidemic, HIV infection occurred disproportionately among older persons through the receipt of contaminated blood or blood products during transfusions. Because of implementation of voluntary donor deferral and routine screening of blood donations implemented in 1985, the number and proportion of AIDS cases associated at any age with this risk factor is minute.

For persons age fifty and over, HIV has most often been transmitted through male-to-male sexual contact. The number of cases reported among homosexual and bisexual men, however, has been steadily declining. Despite this decrease, findings indicate that a sizable number of older men who have sex with men continue to engage in practices that put them at risk for HIV (Anderson). Meanwhile, the number of AIDS cases among men attributable to heterosexual contact increased by 94 percent between 1991 and 1996. Among women age fifty and over, cases attributed to heterosexual contact increased 106 percent. Injection drug use, either directly through using contaminated drug paraphernalia or indirectly through sexual partnering with a drug injector, accounts for a rising number of cases among older adults each year (Levy).

The behaviors that put older adults at risk for HIV also place them at risk for other sexually transmitted diseases (STDs): primary and secondary syphilis, gonorrhea, and herpes simplex. In 1997, 4 percent of the cases of primary and secondary syphilis and 1 percent of the cases of gonorrhea were reported in persons fifty-five and over (CDC, 1998). Actual incidence rates, however, may be higher than reported due to underdiagnosis and underreporting.

Despite such risks, older high-risk persons are much less likely to have adopted prevention strategies than their younger counterparts who engage in similar sexual practices. In a survey of over two thousand adults age fifty and over, Stall and Catania (1994) found that only a small percentage with a known behavioral risk for HIV infection use condoms during sex or have undergone HIV testing. More than 63 percent report having multiple sex partners. A study conducted by Durex on condom use found that older adults are more resistant to using condoms and modifying sexual behavior than are younger adults. In general, older men are less likely than their younger counterparts to use condoms because their partners, in general, are past childbearing age. Postmenopausal women may not recognize their risk for HIV or other STDs because they equate STD risk with risk of pregnancy. With the current extent of sexual activity in older age groups and the possibility of an increased activity due to medications for erectile dysfunction, safer sexual practices are important for STD and HIV prevention. Educational strategies and interventions targeting adults over age fifty can aid in these efforts (Strombeck and Levy).