Sexuality is an integral part of human identity. A healthy sex life may include relationships that evolve into friendships and sometimes lifelong commitments. And it can contribute to happiness, confidence, and pride. Yet persistent stigmas surrounding aging and HIV often limit the opportunities for sexual expression among older adults, especially those with HIV. When combined with other stigmas, such as homophobia, transphobia, or racism, it's a wonder that many ever get out of their beds, much less into someone else's!
Persistent ignorance and prejudice contribute to many older adults with HIV being afraid to speak openly about their sexuality with their physicians and services providers, who too often, perhaps unwittingly, exhibit biases of their own. For an older adult with HIV who wishes to enjoy a full life that includes a healthy sex life, persistent and pervasive stigmas can lead to social isolation, depression, and selfesteem issues. And they can create other challenges like failing to practice safer sex consistently.
People with HIV of every age face tremendous disclosure challenges in sexual relationships. Widespread myths that fuel HIV stigma lead some to conclude that people with HIV are a public health danger and shouldn't be having sex at all. Facts relating to safer sex, treatment that leads to undetectable viral loads, and other prevention methods are ignored. Worse, where HIV is criminalized, people with HIV are effectively banned from having sex if they aren't prepared to disclose, no matter their sexual behavior or the level of risk, and are frequently prosecuted even when they do.
Notwithstanding the challenges and pervasive myths (including that older adults are either monogamous or asexual), there is substantial evidence that many people remain sexually active well past age 50, and often with multiple partners. And, like others, older adults have unprotected sex. But unlike virtually all other at-risk populations, there are very few HIV or STI prevention interventions targeted to those who are in middle age or beyond. For a host of reasons, many older adults have drastically different experiences with and perceptions about HIV than their younger counterparts, including the belief that they are less at-risk than others.
What to do? Here's a short and smart advocacy and policy agenda for leaders in the U.S. and around the world:
Aging is challenging -- as is living with HIV -- but it doesn't have to be. A coalition of advocates, public health agencies, and service providers must work to ensure that older adults, regardless of their HIV status, are able to age gracefully, soundly, and healthily. And that includes having exciting and healthy sex lives!