Clinical Geriatrics

Dr. Warner-Maron is from the University of the Sciences in Philadelphia, PA.

Introduction
Recent recommendations put forth by the Centers for Disease Control and Prevention (CDC) include HIV testing in all clinical settings, the testing of high-risk patients annually, and screening for patients age 13-64 years.1 With the advent of erectile dysfunction medications and increased longevity of patients, the rate of HIV infections among older people has increased. Statistics from the CDC reporting cumulative HIV cases for all ages from 2001-2005 found that 7767 of the 40,607 reported cases of the virus were in those 50 years of age and older or 19% of all reported cases of HIV. This reflects those who have aged with the virus as well as new cases.2

The National Council on Aging (NCOA)3 surveyed the sexual behavior of adults over the age of 60 years and found that in the population of people age 60-69 years, 71% of men and 51% of women engaged in vaginal intercourse, oral or anal sex, or masturbation. Fifty-seven percent of men in their 70s and 25% of men in their 80s reported being sexually active. Similar data were obtained by the AARP4 survey of 1999, which noted that approximately one-half of women age 45-59 years had engaged in sexual intercourse during the previous six months and 25% of women age 60-74 years were sexually active. Although 19% of men over the age of 75 years reported being sexually active for the previous six months, only 7% of women in this age group were sexually active. A number of other researchers have concluded that older people remain sexually active throughout the lifespan if they are otherwise healthy,5 limited primarily by the absence of a willing and able partner.

Health policies aimed at providing education and screening for this age group have been virtually non-existent. The elderly generally do not see themselves as being at risk for HIV, do not practice safe sex, and do not recognize symptoms of HIV infection. Older men report difficulty maintaining an erection while putting on a condom and older women have very limited knowledge about the use of female condoms.6,7 Researchers have noted that older women, particularly older women of color, are less likely to insist that their partner use a condom than younger women or Caucasian women.8 The fear of losing the relationship with a partner outweighs the issue of condom use in general for this population.

Healthcare professionals, in general, do not impart information about HIV risk to older patients, and do not routinely include questions about sexually transmitted diseases, sexual behaviors, or safe sex practices while performing history and physical examinations for older people, primarily because of the assumption that advanced age precludes sexual activity.9 There is also a misconception that sexual practices should only be discussed with married patients7; however, the absence of a spouse does not mean that the older adult lacks one or more sexual partners.