We may not talk about it or see it on movie screens, but sex and romance continue to play an important role in many people’s lives as they age. Some who have lost a long-term romantic partner are starting new intimate relationships for the first time since the HIV epidemic began. And some older adults have multiple partners or may be involved with someone who is not monogamous.1 Widespread availability of sexual enhancement drugs like Viagra have made it possible for many men to be more sexually active as they age.
At the same time, many older people have a limited understanding of HIV/AIDS and may assume that only younger people are at risk. In reality, anyone can be HIV-positive. It isn’t possible to determine a person’s HIV status just by looking at them.
HIV infection only occurs when the virus has a direct pathway out of the body of a person who is HIV-positive and into another person’s body. Breaks in a person’s skin and mucous membranes in the vagina, penis, anus, and rectum can act like open doors for the virus to pass through. Sexually active older women need to be especially careful about HIV: because the walls of the vagina thin and natural lubrication decreases with age, the tiny tears that can result from friction during sex become more common, increasing the risk of HIV infection. People who have anal sex face similar risks. Used correctly, a latex or polyurethane condom can act like a wall that stops infections from passing between people, and water-based lubricants (“lube”)—available at most drug stores—can prevent both the tearing of delicate skin and the breaking of condoms.
Whatever their HIV status, people can still enjoy a great sex life as they age, but they do need to use a condom, female condom, or other latex or polyurethane barrier (like a dental dam) to protect both their partners and themselves.
• If sexual partners are “sero-discordant” (have different HIV statuses), condoms can help keep HIV-negative partners from becoming infected with the virus.
• If all sexual partners are HIV-positive, condoms can protect against the possibility of cross-infection with a different “strain” of the virus.
• Condoms also protect everybody—no matter what their HIV status—from other sexually transmitted infections (STIs).
Even though condoms, when used correctly, have been proven to be an effective form of protection, many older people don’t use them consistently: a 2007 study found that only 18% of HIV-negative and 58% of HIV-positive sexually active men ages 49-80 said that they “always” used condoms.2
There are many reasons older adults may not use protection. They may, for example:
• no longer need to worry about pregnancy (for straight couples)
• worry about loss of sensation and erectile dysfunction
• not feel comfortable talking about safer sex
• have sex under the influence of drugs or alcohol, which can affect both their judgment and their communication skills.3
Some older adults with HIV/AIDS choose not to have sex at all. In addition to fears of infecting others or exposing themselves to other types of infections, some choose to be celibate because of shifting priorities or a decreasing interest in sex; negative body image; difficulty with sexual performance; and feelings like anger, distrust of potential partners, or fear of possible rejection.4 Whether or not they are sexually active, many older adults long for relationships, as both sex and dating can be vital sources of comfort, companionship, and human touch.