Study examines sexual risk-taking, HIV prevention among older adults in Africa

January 31, 2017, Indiana University

One of the most common myths around older adults is that they are not sexually active. But a recent study conducted by researchers at Indiana University found that older men and women do maintain sexual relationships even into their 80s and beyond. Since older adults are often ignored in sexual health education, the possibility for HIV transmission is heightened.

The study, conducted by Molly Rosenberg, assistant professor of epidemiology and biostatics in the IU School of Public Health-Bloomington, was recently published in the Journal of Acquired Immune Deficiency Syndromes. It looked at the unmet needs for HIV prevention among older adults in sub-Saharan Africa, one of the first studies of its kind to report sexual risk-taking among older adults in that region.

"Our study found that older adults are sexually active, and they report sexual risk behaviors—low condom use, casual sex and multiple recent partners—that are consistent with sexual transmission of disease," Rosenberg said. "This marks a huge potential for ongoing HIV transmission in older South Africans, and highlights the need for expanded HIV testing and counseling that can change behavior and help reduce new HIV transmission."

Researchers analyzed data from 5,059 men and women age 40 and older from the study "Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities," conducted in rural Mpumalanga province in South Africa. Of those enrolled, 46 percent were men, 51 percent were currently married, and 46 percent had no formal education. The research looked at HIV prevalence, described their sexual behaviors and compared those behaviors across HIV status categories, using both self-reported and laboratory-confirmed HIV status data.

Older adults receive little attention when it comes to HIV prevention research and interventions, although growing evidence shows they make up a fast-increasing proportion of people living with HIV, in part because of the impact of large-scale HIV treatment on reducing deaths from the disease. Research on the group remains scarce, however, especially in sub-Saharan Africa, where most of the world's 37 million people infected with HIV live, and prevention measures focus mostly on younger adults.

"This is really the first generation of South Africans we've seen aging with HIV," Rosenberg said.

Overall, HIV prevalence among people in the study was high, at 23 percent, and did not differ between men and women. About one-third of respondents reported never having been tested for HIV, and among those with confirmed infections, nearly half did not yet know they were living with HIV.

Regarding sexual activity, more than half of participants reported at least one sex partner within the past two years. Men tended to maintain sexual partnerships at relatively high rates across older ages, only dropping to 52 percent at age 80 and older. The proportion of women with recent sexual partners decreased more steeply with age, dropping to 6 percent at age 80 and older.

Individuals who reported condom use decreased with age in both men and women, as did those reporting casual or anonymous sex. Condom use was highest, at 75 percent, among those who were HIV positive, but only if they knew their status. Of those who were HIV positive but unaware of their status, only 27 percent regularly used condoms.

One in 10 participants also reported that their most recent sex partners were casual or anonymous. Casual sex was lowest among HIV-negative adults, at 9 percent, and higher among both HIV-positive groups (29 percent of those aware of their HIV status and 18 percent of those who were unaware). The results, Rosenberg said, show not only a commonality among sexually active young people and older people, but also the need for targeted intervention among older adults.

The study calls for inclusion of older adults in HIV prevention, with messages created directly for that demographic, and intensified counseling and motivation about sexual transmission risk and universal HIV testing.

"To control the HIV epidemic in South Africa, we need to reach everyone who is vulnerable to HIV," Rosenberg said. "And our paper shows that should clearly be considered as HIV-vulnerable."

Explore further: STIs are not just a concern for the young

More information: Molly S. Rosenberg et al, Sexual Behaviors and HIV Status, JAIDS Journal of Acquired Immune Deficiency Syndromes (2017). DOI: 10.1097/QAI.0000000000001173

Related Stories

STIs are not just a concern for the young

September 8, 2015
A new study, involving the University of Adelaide, has found men over 60 are less likely than younger men to get tested for HIV.

Back on the market—understanding condom use in the over-50s

April 14, 2016
Sexually transmitted diseases are on the rise in the over-50 age group and, in fact, could surpass the infection rates of younger people, says a QUT researcher investigating the low use of condoms in this age group.

Why sex gets better in older age

December 15, 2016
Aging is generally associated with improvements in our quality of life: We become more proficient in our work, learn how to manage our finances better and our bonds with loved ones deepen. With time and practice, most of ...

Research finds that older people's sexual problems are being dismissed

December 6, 2016
Older people's sexual activity problems and desires are being dismissed by health practitioners due to their age, a new study has suggested.

Gender equality linked with higher condom use in HIV positive young women in South Africa

April 30, 2015
Young HIV positive women are more likely to practice safer sex if they have an equitable perception of gender roles, according to new research involving the University of Southampton.

HIV testing among older adults is declining, despite CDC recommendation

August 27, 2015
Researchers led by the UCLA Fielding School of Public Health examined HIV testing trends among adults ages 50 through 64 both before and after 2006, when the Centers for Disease Control and Prevention (CDC) recommended that ...

Recommended for you

Proof-of-concept HIV immunotherapy study passes Phase 1 safety trial

September 21, 2018
Preliminary results from a phase I clinical trial have demonstrated the safety and tolerability of a cell therapy involving the ex vivo expansion of T cells and their subsequent infusion into HIV-infected individuals previously ...

FRESH program combines basic science with social benefits for women at risk of HIV

September 14, 2018
A program established by investigators from the Ragon Institute of Massachusetts General Hospital (MGH), MIT and Harvard is addressing the persistently elevated risk of HIV infection among young women in South Africa from ...

New study finds HIV outbreak in Indiana could have been prevented

September 13, 2018
An HIV outbreak among people who inject drugs in Indiana from 2011 to 2015 could have been avoided if the state's top health and elected officials had acted sooner on warnings, a new study by the Yale School of Public Health ...

Largest study of 'post-treatment controllers' reveals clues about HIV remission

September 13, 2018
Most HIV patients need to take daily anti-retroviral therapy—if they suspend treatment, HIV will rebound within 3-4 weeks. But clinical trials have revealed that a small fraction of patients can stop taking medications ...

Very few sexually active gay and bisexual men use prophylactic drug to prevent HIV transmission, study finds

September 12, 2018
Only 4 percent of sexually active gay and bisexual men in the United States use Truvada, a highly effective medication used to prevent the transmission of HIV, according to the results of a first-of-its-kind study.

Special antibodies could lead to HIV vaccine

September 10, 2018
Around one percent of people infected with HIV produce antibodies that block most strains of the virus. These broadly acting antibodies provide the key to developing an effective vaccine against HIV. Researchers from the ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.