HIV Testing and Prevention is Overlooked for Older Sexually Active Americans

Older Americans who are sexually active are not being tested for HIV and are not being educated about how to prevent disease transmission, new research suggests.

"Very few US residents 65 years and older who are having sex—even those who identify themselves as homosexual or bisexual—have ever had an HIV test, so they don't know their serostatus. Nor have they been told how to prevent HIV transmission. This is very alarming," lead author Emeka Oraka, MPH told Contagion.

Even though adults in the United States who are 65 years of age and above are more sexually active than previous generations, those who are sexually active account for only 18% of HIV diagnoses, and older adults tend to be diagnosed with HIV later in the disease process than younger individuals, the three authors, from ICF International in Atlanta, Georgia, wrote in their poster presented September 21 at the Centers for Disease Control 2016 CDC STD Prevention Conference in Atlanta, Georgia.

"Currently, the CDC [Centers for Disease Control and Prevention] STD treatment guidelines stop at age 65 and people above that age stop being included in the conversation," Mr. Oraka noted. "We need to include our seniors in the conversation, not disbar them."

In what to their knowledge was the first national representative study of factors important for sexually active older adults in the United States, including their HIV testing prevalence and level of condom use, the research team analyzed data from the General Social Survey (GSS) in-person survey of US residents conducted every two years by NORC (the National Opinion Research Center) at the University of Chicago, Illinois.

Overall, 458 respondents aged 65 through 89 years who reported one or more sex partner within the past 12 months were included in the study, and averages were weighted across the 2008 through 2014 GSS survey cycles.

The authors determined HIV testing prevalence based on age, gender, race or ethnicity, education, marital status, income, sexual orientation, condom use at last sex, and HIV-related risk behaviors such as injection drug use; crack cocaine use; three or more partners of the opposite sex partners within the past 12 months; and for men, sex with someone of the same sex. Prevalence ratios and confidence intervals were calculated using logistic regression.

They found that 87.5% (95% CI [confidence interval], 84.0 to 90.4) of sexually active older adults reported that they had never had an HIV test; 10.9% (95% CI, 8.3 to 14.2) reported having had an HIV test more than 12 months earlier; and 1.6% (95% CI, 0.8 to 3.0) reported having an HIV test within the past year.

Adjusting for age, race or ethnicity, marital status, sexual identity and increased HIV infection risk, sexually active older adults age 71 years and above who were married and heterosexual were less likely to be tested for HIV than were those between the ages of 65 and 70 years (aPR [adjusted prevalence ratio] = 2.18; 95% CI, 1.33 to 3.58), not married (aPR = 2.71; 95% CI, 1.72 to 4.25), or self-identified as homosexual or bisexual (aPR = 5.09; 95% CI 2.58 to 10.1).

Limitations to the study include its use of cross-sectional self-reported data, the authors wrote.

"We are living longer and we need to understand that people desire to have sex into advanced age, that it does not stop. In communities where seniors live together, STD hotspots will continue until the residents' sexuality is acknowledged and discussed openly," Mr. Oraka said.

"Unfortunately, healthcare professionals do not emphasize to their older patients the risks involved with sexual behaviors. So the patients remain unaware and disease transmission increases," said co-author and data analyst, Mingjing Xia, MD. "Clinicians need to these patients for HIV and other STIs and educate them about their risks for transmission and what they can do to prevent it."

Stacey Mason, MPH, co-author and research associate, agreed, adding, "Clinicians and others need to become more aware of the health care needs of their sexually active elderly patients and allow them to be more comfortable talking about their sexual health."

Lorraine L. Janeczko, MPH, is a medical science writer who creates news, continuing medical education and feature content in a wide range of specialties for clinicians, researchers and other readers. She has completed a Master of Public Health degree through the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health and a Dana Postdoctoral Fellowship in Preventive Public Health Ophthalmology from the Wilmer Eye Institute, the Johns Hopkins University School of Medicine and the Bloomberg School.

DISCLOSURES: Mr. Oraka, Ms. Mason, and Dr. Xia are employed by ICF International, which supported the study.

SOURCES:

• 2016 CDC STD Prevention Conference (program book) p 112 (https://www.cdc.gov/stdconference/2016/STD_Conference_2016_Program_Book.pdf ; poster WP86
• Phone interviews

Study Presented: Emeka Oraka, MPH, Stacey Mason, MPH, Mingjing Xia, MD, ICF International, Atlanta, Georgia, Too Old to Test? Prevalence and Correlates of HIV Testing among Sexually Active Elderly Adults