November 07, 2016
By Lorraine L. Janeczko
NEW YORK (Reuters Health) - Older sexually active Americans need more HIV testing and guidance on preventing HIV transmission, new research reports.
Few older sexually active Americans, even those who self-identify as homosexual or bisexual, have ever had an HIV test or have been informed about HIV prevention interventions, according to three researchers from ICF International in Atlanta, Georgia who talked with Reuters Health by phone.
Adults 65 years of age and above are more sexually active than people in this age group have been in the past; but sexually active senior adults comprise only 18% of HIV diagnoses in the country, and they are more likely than younger people to be diagnosed with HIV late in its course, they reported September 21 at the Centers for Disease Control and Prevention 2016 STD Prevention Conference in Atlanta.
Yet no national programs currently exist to provide this group with increased HIV testing, they noted.
"The results surprised us. It's very alarming that so few elderly adults are even aware of their HIV status," said technical specialist and lead author Emeka Oraka.
Oraka and his colleagues examined data from the General Social Survey (GSS) in-person biennial survey of non-institutionalized civilian U.S. residents conducted by the National Opinion Research Center at the University of Chicago.
They analyzed data from 458 respondents age 65 through 89 age who reported at least one sex partner in past 12 months, weighting averages across the 2008 through 2014 GSS survey cycles.
The authors calculated HIV testing prevalence by age, education, income, marital status, race or ethnicity, gender, sexual orientation, condom use at last sex, and HIV-related risk behaviors including injection drug or crack cocaine use, three or more opposite sex partners in the past 12 months, and, for men only, sex with a partner of the same sex. They used logistic regression models to calculate prevalence ratios and confidence intervals.
Overall, 87.5% (95% CI, 84.0 to 90.4) of sexually active senior adults reported never having been tested for HIV; 10.9% (95% CI, 8.3 to 14.2) reported having been tested for HIV more than 12 months ago; and 1.6% (0.8 to 3.0) reported being tested within the past 12 months.
In the model adjusted for age, marital status, race or ethnicity, sexual identity, and increased HIV infection risk, compared to respondents who were 71 or older, heterosexual, and married, HIV testing was more likely in sexually active adults ages 65 through 70 (adjusted prevalence ratio = 2.18; 95% CI 1.33 to 3.58) who were not married (aPR = 2.71; 95% CI, 1.72 to 4.25) or who self-identified as homosexual or bisexual (aPR = 5.09; 95% CI, 2.58 to 10.1).
HIV testing prevalence was higher among older adults who self-identified as homosexual or bisexual than for those who were at increased risk for HIV infection.
"This is the first national representative study of sexually active elderly people to provide an estimate of how many of them have been tested for HIV," Oraka said.
The authors acknowledged that limitations to their study include self-reported data that may be influenced by social desirability and recall bias and that the data's cross-sectional nature limits the ability to establish temporal relationships between HIV testing and covariates.
"With the advent of prescription drugs sildenafil and tadalafil, adults of advanced age are able to continue to experience sexual relations. We need to include them in the conversation about protecting their sexual health," Oraka said.
"We have a population of elderly people who are actually at advanced risk for HIV due to drug use, paid sex workers, and crack cocaine use - all behaviors that have extremely low levels of condom use," he added.
"Many sexually active elderly people are not receiving adequate sexual health care. It's up to clinicians to be better trained about talking to older patients about sexual health. We found that many are not comfortable about initiating conversations with clinicians about their sexual health but are open to talking about their concerns when clinicians bring up the topic," said co-author Stacey Mason.
Dr. Mingjing Xia, co-author and data analyst for the study, advised, "With their older sexually active patients, clinicians need to provide screening tests and start the conversation about their sexual health, including their risk for HIV and other STDs and how to prevent disease transmission."
2016 CDC STD Prevention Conference.
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