Older women represent 56% of all women with HIV, and in a 2009 study, they had the highest rates of HIV- and AIDS-related deaths. But few HIV prevention and education programs focus on older women, says Christopher Coleman, PhD, MPH, department chair and professor, Department of Health Promotion and Disease Prevention, The University of Tennessee Health Science Center, College of Nursing. Moreover, sexual health studies mainly concentrate on younger women and reproductive health, not risk factors for HIV among older women.
Coleman says the “confluence of lack of knowledge and absent communication about HIV risk has created a significant health crisis” for this group. He reviewed 41 articles that provide some insight.
Ageism, biological factors, and lack of education all play a part. Some research has found that older women are less likely to engage in safe sex practices because they no longer use condoms to prevent pregnancy. The National AIDS Behavior Survey found that > 85% of respondents aged ≥ 50 years reported never using condoms or using them inconsistently. However, women in the postmenopausal age group are sexually active, and because they may be divorced or widowed, may not be in committed relationships. Also, age-related physical changes, such as thinning vaginal tissue and a weakened immune system, can make them more vulnerable to infection.
The problem is compounded when an older woman is unwilling to bring up the topic with health care providers—and health care providers are unwilling to believe that she is sexually active. Women aged > 50 years may also avoid seeking HIV testing due to social factors. And they may be prevented from traveling to health care or testing by poor physical health or other age-related issues.
We need new methods of reaching them, Coleman says. Existing HIV/AIDS instructional programs may not be effective tools for women with age-related comorbidities, such as cognitive, visual, or auditory deficits. Other options should be considered: For instance, small peer groups have been more successful than large groups, providing a sense of safety and belonging that encourages disclosure.
Health care providers should include education during routine office visits, Coleman advises, using non-ageist and nonstereotyping strategies and questions. Nurses are well positioned to educate women about the risks of HIV transmission; he says: discussing sexual activity with older women requires the “art of therapeutic communication without judgment.”