Why The Over 50's Are Not Practising Safe Sex

Read about the author Samantha Evans

Many men and women over 50 are dating again after being divorced or widowed. Meeting someone new after having been with the same partner for many years can be daunting, but exciting. Many are using websites, dating apps, and holidays to hook up with other people to have sex and form new relationships.

However, according to the Family Planning Association, too many older people are ignorant to the need for safer sex and using a condom.

According to a survey conducted by Saga Magazine, 65% of over-50s are sexually active: with 46% claiming to have sex once a week and 25% of 75-85 year olds claiming to have had sex within the last 12 months.

The dating website Match have a dating site for older generations called OurTime. They published findings from a survey that showed 24% of over 50s said they’d sleep with a new partner within one month of dating, compared to just 18% of 18-24 year olds, which is why sex education is needed for the older generation.

Most educational sexual health campaigns and condom avertising target younger people because it is commonly believed that they are the generation having the most sex and are more likely to practice unsafe sex, but the over 50s generation are being ignored when it comes to safe sexual practices. This generation is more likely to feel embarrassment, fear and stigma about STIs, making them less likely to seek help or information. Often they may feel uncomfortable attending a sexual health clinic, and some people have told me the staff in these clinics do not know how to talk to them.

A study conducted by Dr Cynthia Morton at the University of Florida highlighted the lack of sexual health resources available to older women. The study found that, although women are aware of sexually transmitted diseases, they are uncomfortable seeking sexual health advice from their family doctor because they believe that their family doctor will assume they are already knowledgeable about the issue or may consider them too old to be having sex.

Many people understand the importance of using a condom, but worry that asking their new partner to wear a condom during sexual intercourse may lead to the relationship ending. Many people have not had to use a condom for many years, having been with the same person, and may believe that condoms are still made just like the ones their granny used!

A 2010 study of sexual health from Indiana University found the lowest rates of condom use were among people ages 45 and older.

Who is at risk?

For many women and men over 50, there was little or poor sex education taught in schools. HIV/AIDS had not yet been discovered, and sexually transmitted diseases were not discussed. This lack of knowledge is manifesting itself in the steady rise of STDs in the over 50s, as reported by the US Centre for Disease Control and Prevention. The same goes for Hepatitis B/C, both of which can be transmitted through unprotected penetrative sex

• 50% of all people living with HIV/AIDS in the US are over 50 years old.

• The British Journal, Student BMJ reported that new diagnoses of HIV in the UK had risen by 50%, from 11% to 20% in the over 50s between 2000-2009.

• The diagnosis of STDs in the 50-90 year old age group has doubled within the past 10 years.

• Approaching half of people receiving specialist HIV care in 2019 were aged 50 or over (42%), compared to less than one in five in 2007 (Terrance Higgins Trust, 2022)

• In the US, Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases. In fact, Hepatitis B is 50–100 times more infectious than HIV and can be passed through the exchange of body fluids, such as semen, vaginal fluids, and blood.

A disturbing trend from the World Health Organisation (WHO) 2017 has found that the rise in people not practising safe sex is leading to drug resistant gonorrhoea, leaving us with few antibiotics able to fight this super bug. It is thought that about 78 million people are infected with gonorrhoea each year, although this figure may be higher as it is much harder to track many of the cases in poorer countries where resistance is harder to detect. Of those infected, about one in 10 heterosexual men and more than 75% of women and gay men, have no easily recognisable symptoms.

The WHO has found three countries, Spain, Japan and France have untreatable strains of gonorrhoea.

A new survey of single Canadian adults between the ages of 40 to 59 shows many of them are not at all concerned. Research at the University of Guelph (2016) found that most of 1,200 single adults surveyed had little or no concern of contracting a sexually transmitted infection

That, she said, “is really an unrealistic level of confidence in your ability to stay sexually healthy.”

They found that university students are more likely to have used a condom in their last sexual encounter when compared to people who could be their parents.

Worryingly, a report by England Chief Medical Dame Sally Davies (2016) found that cases of chlamydia and genital warts had risen by one third within a decade in the 50-70 year old age group. In 2010, sexual health clinics recorded 11,366 new infections among this age group, which rose to 15,726 in 2014 – an increase of 38 per cent.

Awareness and knowledge around HIV continues to drop in the UK: only 45% of the population know HIV is and isn’t transmitted.

“Older people don’t have sex and therefore are not at risk for HIV”

This common myth contributes to the growing rise of HIV in the over 50 populations. Since the early 1980s HIV in the over 50s has contributed for 10% of the cases when the main mode of transmission was due to blood transfusion. Today, the main modes of transmission are heterosexual contact and needle sharing among IV drug users. Heterosexual transmission is up by 94% in men and over 50% in women as safer sex education campaigns fail to target the older population.

New research published in the Lancet HIV journal (2017) has found that around one in six new cases of HIV diagnosed in Europe are in people over the age of 50. The study found that older people, aged 50 or older, were more likely than younger people (aged 15–49 years) to be diagnosed with advanced HIV disease, and acquire HIV through heterosexual sexual contact. Between 2004-2015, new cases per 100,000 rose from 3.1 to 4.32, a 3.6 per cent increase in the UK.

Approaching half of people receiving specialist HIV care in 2019 were aged 50 or over (42%), compared to less than one in five in 2007 (Terrance Higgins Trust, 2022)

Many older people still believe that HIV can only be transmitted by blood transfusion and homosexual activity. The lack of HIV knowledge and the belief that safer sex is only for younger women who want to avoid pregnancy is leading older people to practice unsafe sex.

The increased popularity of erectile dysfunction drugs have made it possible for millions of older men to continue to have sex into their twilight years, and many are not practising safe sex or get tested.

During menopause, the walls of the vagina thin and levels of vaginal lubrication decrease as a result of depleting oestrogen, making the tissues of the vulva and vagina sore, dry and open to microabrasions, especially if lubrication is not used, which in turn, makes transmission of sexual diseases easier; therefore, it is important that older women use condoms in new relationships and get tested.

A new report published by Terrance Higgins Trust and the Sophia Forum called Women and HIV Invisible No Longer is a national study of the experiences of women living with HIV and includes the menopause and difficulties many faces when accessing the right treatment for HIV and the menopause. It also includes the impact of late diagnosis, when many women may not be aware that they have been exposed or recognise symptoms. HCPs also need to ask their patients about their sexual relationships and not assume they are not having sex.

Terrance Higgins Trust released their report “Still Got It” looking at the sexual health of the over 50s. In 2016, 63% of those aged 65 and over were diagnosed late with HIV (once the immune system has already been damaged). This is more than double for the figure of those diagnosed late among 15- to 24-year-olds. STIs are also on the increase in the over 65’s. Public Health England (2019) saw the biggest proportional increase in gonorrhoea and chlamydia in people over 65. Cases of gonorrhoea increased 42% from 236 to 336 and chlamydia by 24% from 416 to 517. This is why we need better sexual health campaigns to include older people and to educate healthcare professionals to encourage them to ask patients about their sexual activity.

Get Tested

Around 101,200 people were living with HIV in the UK at the end of 2015. Of these 101,200, over 13,156 (one in seven) don’t know they have HIV because they have never had an HIV test, or they got HIV since their last test. If you don’t know you are HIV+, you cannot be treated. This is why you need to get tested if you have unprotected sex, whatever your age or sexual orientation.

There has been significant uptake of self-sampling and self-testing in the UK, making it easy to get tested. In 2018 138,000 people ordered a self-sampling kit from their local sexual health service website (eSHS); 24,000 from the national HIV self-sampling service at www.freetesting.hiv; and 56,000 bought a self-testing kit online or at a pharmacy (Aids map Jan 2021)

Advances in Drug Treatment

Drug treatment has proven to be extremely effective.

Medical evidence has shown that people on effective HIV treatment can’t pass it on. The Terrence Higgins Trust (THT) launched their Can’t Pass It On campaign, to spread this message far and wide

THT say if everyone knew this, we could bring an end to stigma around HIV. Not only that, but we could stop HIV transmissions altogether. For the past 20 years, evidence has been building to show that your likelihood of passing on HIV is linked to the amount of the virus in your blood.

In 2016, the landmark PARTNER study looked at over 58,000 instances of sex without a condom, where one partner was HIV positive and one was HIV negative and found that where the HIV positive partner was on effective treatment (reducing the amount of the virus to ‘undetectable’ levels), there were zero cases of HIV transmission.

Lack of medical information

Many medical professionals neglect to discuss sexual health practices with their older patients under the false assumption that they are not sexually active, are already informed or do not feel comfortable discussing sexual health issues.

When a 59-year-old man complains about problems with his waterworks or a 64-year-old woman reports lower abdominal pain, many doctors do not consider sexually transmitted diseases as being as the cause because they fail to ask the patient about their sexual activity or the type of sexual activity they have. Many of these diseases are completely preventable, but are being overlooked by both the doctor and patient as being a cause of their symptoms.

The importance of accessible sexual health information

Better education of both patients and the medical profession about STDs and HIV transmission is required to prevent the growing number of infections in the over 50s. Not recognising or understanding the symptoms of STDs can lead to a delay in seeking treatment, thus allowing the disease to worsen and become increasingly difficult to treat. As we age, our immune systems weaken and are unable to fight infections as effectively as they did when we were younger.

Many STDs initially cause no symptoms, especially in women:

• When symptoms develop, they may be confused with those of other diseases that are not transmitted through sexual contact

• STDs can still be transmitted from person to person even if they do not show symptoms

• Health problems caused by STDs tend to be more severe for women than for men

If left untreated in women, STDs can lead to pelvic inflammatory disease (PID) and cancer of the reproductive tract. In men, untreated STDs can lead to cancers of the penis and anus, and swollen or tender testicles.

Older People enjoy Sex too

There are 11 million people over the age of 65 in the UK, 19% of the population, 3.2 million are over 80 and 1.6 million aged 85 and over. These figures are projected to rise to 19 million over 65 years and 8 million over 80 years by 2050. The elderly population is growing as a result of the 1960s baby boom, better health and new medical interventions and drugs that prolong people’s lives as well.

Considering these statistics, sexual health educators and condom brands need to take note and target their sexual health campaigns at the older generation for whom STDs and HIV/AIDS is a serious problem to encourage them to practice safe sex and to get tested if they think they may have been exposed during unprotected sexual practices.

Useful websites

Terrance Higgins Trust : www.tht.org.uk
Sophia Forum :www.sophiaforum.net
NAZ : www.naz.org.uk
Sexual Health Association: www.sexualadviceassociation.co.uk
British Association for Sexual Health and HIV : www.bashh.org
NHS One You Sexual Health :www.nhs.uk/oneyou/sexual-health
Faculty of Sexual and Reproductive Health : www.fsrh.org
Brook :www.brook.org.uk
Family Planning Association:www.fpa.org.uk
Royal College of General Practitioners :www.rcgp.org.uk