Although the average age of the HIV-positive population is increasing, in
both richer and poorer countries, and though sex between older people
has often been cited as a possible risk factor for HIV, there has
been surprisingly little investigation into the sex lives of people
with HIV who are over the age of 50.
small qualitative study presented to the Tenth AIDS Impact conference
of 38 people with HIV in Montreal, Canada, equally balanced between
different affected groups, sought to establish patterns of sexual
activity in this population and to ask people about the factors
behind their behaviour.
primary finding was that HIV-positive people, at least in this group,
were having relatively little sex – and not always by choice. It
also found clear differences between men and women, gay and straight,
and injecting drug user (IDU) and non-IDU respondents.
Isabelle Wallach of the Clinique l'Actuel in Montreal told the
conference that in Canada, in 2008, 15.3% of new HIV diagnoses
involved people aged 50 years and over, and one-quarter of the HIV-positive
population is now over 50. Her team's study aimed therefore to
document the experiences of sex and relationships in a group of
people with HIV who were over 50, with a view to shedding light on
the intersection of HIV, sex and ageing.
study consisted of individual semi-structured in-depth interviews,
with an average duration of two and a half hours, in 38 people with
HIV aged 50-74 years.
gay men, twelve heterosexual men, and 14 women took part in the
study. Twelve participants were of non-white ethnicity and eight had
acquired HIV through injecting drug use.
of the 38 interviewees, only 13 were currently in a relationship, and
while nine said they were happy in it, four stated they were having
difficulties in the relationship.
the 25 single people, eleven stated that it was their choice to be
single, while the other 14 said they were unwillingly so and would
like a relationship. There was a clear gender divide here: while
seven of the women were single by choice, only one of the men was.
five out of the 38 interviewees defined themselves as 'actively
sexual' and 17 stated they were not having sex at all. Again, there
was a clear sexuality and gender divide here: ten of the 14 women and
seven out of eight injecting drug users said they were having no sex,
but none of the gay men.
left 16 interviewees who were having some sex but described their sex
lives as "slow or not very active".
qualitative interviews shed a lot of light on participant's views of
stated that fear of transmitting HIV was important to them while four
stated the death of a partner to AIDS had changed their attitude
towards sex (none of the qualitative attitudes explored are
exclusive: participants could hold a number of different attitudes).
and disclosure was one of the most common reasons cited for problems
with sex. One 65-year-old gay man said “Nowadays, sometimes, I meet
someone, if I tell him 'I am positive', whoops, he is gone.”
stated that difficulties they or their partner had with condoms were
a reason they had little sex. One woman (59 years old) said that her
male partner had never used condoms, having come out of an 18-year
relationship, and could not maintain an erection while using one. A
60-year-old heterosexual man said he had encountered resistance to
condom use in female partners: “Some women take it as an insult
[when I say] we must have safe sex. One said, 'Who do you think I
people were reconciled to the fact that the need for sex diminishes
with age, as does sexual performance. One 62-year-old women in a
relationship said: “It's been five years since we met and, you
know, it's more 'tenderness love' these days.”
were less happy about it. Some mourned the fact that age brings with
it less power to seduce: “Once we get older we get less looked at,”
said one gay man who had reached that age. Others saw it as outright
discrimination: “I have already approached some people and...I get
told 'What is it that you want? You're old'”, said one 56-year-old
about the lack of sex and relationships was, however, balanced in
many cases by a positive attitude towards being single and a
determination not to let it spoil life. “If you delude yourself
about really wanting it, you're more disappointed because you don't
have it. If it happens, it happens,” said one 65-year-old gay man.
A 53-year-old woman said “You've lived such intense things that it
can't be an obsession. You can't want it at all costs ... just being
alive is already something.”
qualitative studies like this, reaching hard conclusions about older
positive people and sex is not the point, but Isabelle Wallach
commented that the clear gender, sexuality and transmission group
divides that came up even in this small study suggested further
avenues of exploration. While many participants regarded their sex
lives (or lack of them) with detachment, others were struggling with
problems of both HIV status and ageing. More research into sexuality
in the older person with HIV was warranted.