Growing risks of STIs in over-45s

Over-45s are at a higher risk of contracting STIs than ever before because of society's unwillingness to talk about middle-aged and older people having sex, a new report has found.

A study undertaken by the University of Chichester, alongside organisations in the UK, Belgium, and Netherlands, revealed negative attitudes and limited knowledge towards the age group's sexual health needs is associated with a generation unaware of the dangers of unprotected intercourse.

It also found that over-45s living in socially and economically-disadvantaged areas are at particularly risk of contracting sexually-transmitted infections with little awareness of available healthcare services and limited access to doctors and nurses.

The report is part of the SHIFT project: a three-year initiative which aims to develop a training model that can be used by professionals working in healthcare to improve the sexual health and wellbeing of middle-aged and older people across the UK and Europe.

University of Chichester senior lecturer Dr. Ian Tyndall, who is leading the project's evaluation, said that major changes in sexual behavior in recent decades has seen increasing numbers of sexually active older-people.

"Over-45s at most risk are generally those entering new relationships after a period of monogamy, often post-menopause, when pregnancy is no longer a consideration, but give little thought to STIs," he added. "Given improvements in life expectancy, sexual healthcare needs to improve its intervention for older adults and vulnerable groups to provide a more utilised, knowledgeable, compassionate, and effective service."

The three-year SHIFT study was launched in 2019. Following a 2.5million grant from the EU Interreg 2Seas programme, its intention is to address growing rates of STIs in over-45s and improve engagement of older people in sexual health services, including those facing socioeconomic disadvantage.

The latest SHIFT report included around 800 participants across the south coast of England and northern regions of Belgium and the Netherlands, nearly 200 of which face socioeconomic disadvantage. Initial findings have highlighted four critical areas where, the researchers believe, an intervention can address the gaps in current healthcare provision: awareness, access, knowledge, and stigma.

• Awareness: The results showed that a significant number of participants were unaware of the risks of STI, while 46 per cent did not know the location of their nearest healthcare centre. Researchers did, however, find that social media was the most effective tool for encouraging engagement with sexual health services—ahead of leaflets or GP appointments.
• Knowledge: The participants highlighted that their health professionals, including doctors and nurses, lacked sufficient sexual health knowledge—and consequently only half had a recent STI test. There is therefore an "urgent need" to create a tailored training programme to increase understanding in the wider healthcare workforce, the researchers wrote.
• Stigma: Shame was identified as the biggest barrier to accessing sexual healthcare services, according to the report. A number of participants felt that sexual health has become a "dirty" term which is discouraging people from attending regular check-ups.
• Access: Limited information around the location of sexual health centres and restricted opening times were a consistent problem for many participants. Others living in more rural locations also mentioned that growing costs of public transport was a barrier to appointments.

Fellow SHIFT researcher Dr. Ruth Lowry added: "It is clear from the numbers reporting fear of being judged by important others who know them and by health professionals that stigma remains a crucial barrier to address in any sexual health promotion intervention.

"The findings have also shown that groups with one or more socio-economic disadvantages, such as homeless people, sex workers, non-native language speakers and migrants, are at even greater risk of being unaware of their sexual health and unable to access the appropriate services."

The SHIFT partners intend to have an effective intervention ready by 2021, after which it will be rolled out to healthcare professionals, with the research published in 2022. It intends to reach as many as 150,000 people across the south coast of the UK, France, Belgium, and the Netherlands.

The survey was distributed prior to the Covid-19 pandemic, while focus groups and interviews are taking place via video calls to navigate restrictions in jurisdictions across participating countries.

To find out more about the SHIFT project go to http://www.interreg2seas.eu/en/shift.