Sex Ed for Seniors: You Still Need Those Condoms
Sexually transmitted diseases stalk older singles, too
When Jane Fowler hit the dating scene after her 23-year marriage ended in divorce, she didn't think she needed to use protection when she had sex. "I wasn't worried about getting pregnant," says the 72-year-old retired journalist from Kansas City, Mo., "and the man I was seeing was an old friend, also recently divorced." So she was shocked to learn, after having a routine blood test in 1991, that she'd been infected with HIV, a nightmare she hopes to help others avoid by lecturing at senior health fairs. "My mantra is that you never know the sexual history of anyone but yourself."
With Viagra and Internet dating sites at their fingertips, a growing number of seniors are enjoying a renaissance between the sheets, but some are paying the piper, contracting sexually transmitted diseases. As HIV carriers live longer, the majority will be over age 50 by 2015, and even now about 15 percent of new infections occur in this age group, according to the Centers for Disease Control and Prevention. Other STDs, including herpes, chlamydia, and human papillomavirus, which is linked to cervical cancer, are also making the rounds. "While it's a good thing that older people are more sexually active, they need to connect the dots, see that they're at increased risk, and make sure they use condoms," says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Unsafe at any age. But many folks haven't gotten the message. In a small survey conducted by University of Chicago researchers, nearly 60 percent of unmarried women ages 58 to 93 said they didn't use a condom the last time they had sex. Even more disturbing, an Ohio University study found that about 27 percent of HIV-infected men and 35 percent of HIV-infected women over 50 sometimes have sex without using condoms.
Researchers believe doctors, unwilling to broach the topic of STDs, may be partly to blame. The University of Chicago survey found that nearly half of the respondents didn't talk to their doctors about their sex life. "Older women think doctors should ask them about it but won't initiate the discussion themselves," says study author Stacy Lindau. Doctors may also misdiagnose early symptoms of HIV infection—fatigue, weakness, memory changes—as normal signs of aging. "I've seen HIV patients in their late 50s and early 60s who tell me they had gone to their doctors several times over many months before they were finally tested for HIV," says psychologist Timothy Heckman, who coauthored the Ohio University study.
Raising awareness. New HIV screening recommendations issued by the CDC last September may mitigate the problem. The agency urged doctors to do voluntary blood tests in all patients ages 13 to 64 in order to prevent the 50 to 70 percent of new infections spread by those who are unaware they have the virus. It says screening isn't cost effective in those over 65 because they cause just 2 percent of new infections. But Heckman, who doesn't think there should be an age limit, points out that the CDC's own data show higher death rates in older adults diagnosed with full-blown AIDS possibly because of complicating problems like diabetes, heart disease, or an aging immune system.
Postmenopausal women, moreover, may be particularly prone to getting infected with blood-borne diseases like HIV or chlamydia in the first place. That's because their thinner and more fragile vaginal lining can easily tear during penetration, allowing pathogens to enter the bloodstream. And new research indicates that older women are at risk of getting infected with HPV, which can give rise to genital warts or cervical cancer. "We once thought that they were just getting a reactivation of an old infection, but now we think these might be new infections from unprotected sex," says Lindau, who is actively researching this subject.
The most effective way to prevent disease is to use condoms consistently. Research indicates they're nearly 90 percent effective against HIV transmission. And a 2006 New England Journal of Medicine study found that women whose partners used condoms all the time were 70 percent less likely to acquire HPV than those whose partners rarely used them. The female condom is also an effective barrier, says Lindau.
Perhaps the most important first step, public health officials believe, is simply making seniors aware of the risks. Several weeks ago, New York City officials began handing out educational materials and condoms at more than 320 senior centers, while urging all older New Yorkers to get tested for HIV as part of their regular checkups. Southern Florida's Senior HIV Intervention Project distributes prophylactics and safe-sex advice at Jewish community centers, assisted-living facilities, and bereavement group meetings. Program volunteer Miriam Schuler, an 88-year-old great-grandmother from Tamarac, Fla., often finds a little humor helps to wash down the warnings. "If a man comes up and sees the condoms, I tell him, 'Put one in your pocket; make your friends jealous!'" she says. "For women, I tell them to put some condoms in a dish on their coffee table as a conversation piece."
This story appears in the August 13, 2007 print edition of U.S. News & World Report.