Communicating about HIV and risk behaviors related to sex or substance use can be difficult. Even when they know how to keep themselves safe, people often have a hard time talking to their partners about things like safer sex. Older adults who grew up at a time when discussion of sexuality was considered improper or vulgar can find these conversations particularly awkward. While everyone fears rejection, the stakes can be even higher for older adults who regularly struggle with feelings of social isolation and loneliness. Older people living with HIV appear to be particularly vulnerable: 71% of ROAH respondents aged 50 and older lived alone, as compared to 35% of their HIV-negative peers aged 65 and older.1
Especially for seniors, it’s a rough time simply because they have few family and friends left—they don’t want to lose them. So they’re afraid to identify themselves as HIV-positive people —Bill Rydwels, age 77
Who’s gonna be there for you? You still need people that you can share certain things with and feel comfortable. All those things are fairly common for everyone, whether you’re gay or straight… —Larry McKeon, age 61
Open communication with loved ones about health concerns can play an important role in staying healthy, but some older adults may find it difficult to discuss their sexuality or HIV status with family members, especially their children.
Seniors don’t want their kids to find out that they’re having sex, and so they will avoid going to the doctor because their daughter drives them, goes in with them because they’re hard of hearing… They don’t want to have this conversation. And the older you get, the more likely you are to have a physician who is probably significantly younger than you are, talking to someone who seems like his grandmother about sexual issues. It just doesn’t happen. —Jeanine Reilly, Nursing Home Administrator
Patients and their health care providers can find it difficult to discuss sexual behaviors, substance use, and HIV for a variety of reasons. Providers may make assumptions about their patients’ sexual orientation or risk behaviors, and their patients may not feel comfortable correcting them. HIV testing guidelines differ from state to state, with some states still requiring a separate informed consent in writing before an HIV test will be administered. Many older adults may assume that they will automatically be tested for the virus when their blood is drawn or may feel uncomfortable asking for the test, and some providers may feel awkward initiating this discussion with their older patients. Linguistic and cultural barriers can make these discussions even more difficult.
There was, like, one section in one chapter about sexuality and the elderly. Not really how to ask an 80 year old…anything. —Male nursing student, age 25
I went to the doctor for regular checkups and blood work, and I was called back because something was not right. There was a problem, because I didn’t speak English. We had many problems finding an interpreter to explain things, who could help us. —Apolonia, age 66
Finally, the way providers communicate with their patients can have a huge impact on the patients’ mental and physical health.
Sometimes I think you get the attitude, “What the hell? You’re 60, you’re 65, you’re 70, you’re gonna die anyway, so why should we worry?” —Larry McKeon, age 61
The last time I had a cancer the doctor thought maybe the treatments weren’t working and she said to me, “Bill, have you got everything prepared?” And I thought, “Oh my God, what are you saying?” And I went home depressed and she called me, she says,”Well, Bill, we’re not saying you’re going to die. Let us do one more test.” —Bill Rydwels, age 77