Older adults’ understandings of risks for sexually transmitted infections are influenced by a complexity of factors
It’s not just young people who have sex; we know from studies that older adults have sex too. But do we know enough about how they understand risks? We spoke to older adults to ask them about their understandings and negotiations of ‘risks’ for sexually transmitted infections (STIs). It became clear that ideas about ‘risk’ depended on a range of what we call psycho-social factors – those related to social norms, and how they influence what people think and how they behave.
Love and trust
We conducted research with older adults aged 45-65 years, speaking to 31 heterosexual men and women, in individual interviews to allow for greater privacy and confidentiality compared with group discussions. We asked about their understanding of risk for STIs when having sex for the first time with new partners. Our data revealed the importance many older adults placed on the type of relationships they perceived they were in, as to whether they were at risk of a STI. An intimate relationship, based on love and trust, was considered safe from STIs. Reliance on love and trust in each new relationship reduced concerns about transferring STIs from one partner to the next. Decisions to proceed with unprotected sex could be complex, involving a mixture of feeling comfortable with a partner, prioritising emotional needs and ‘getting carried away’, sometimes with alcohol described as a contributing factor. Our participants’ personal risk assessments were generally based on information about a partner’s sexual past and their character, with feelings of love and trust prioritised. For some men, finding women respectable reduced their concerns about STI risk. The prioritisation of intimacy in perceptions of risk is a similar finding to research with young people, so this alerts us to be aware that it is not just young people who consider intimacy as protective of STIs.
Pregnancy as the main risk from sex
Both men and women had experienced pregnancy as the major risk from sex across their sexually active lives. As they grew older, and the risk of pregnancy diminished following menopause or sterilisation, for several there was no feeling of risk at all for STIs. Most of the men and women in the study had never used condoms or only used them to avoid pregnancy when young. This means most of this group would have to start using condoms to protect against STIs for the first time in middle age.
Transition related risks
Periods of emotional upset following the death of a partner or relationship break-ups following divorce or separation were experienced as times when men and women took risks for STIs. Emotional needs were often prioritised over concerns about STI risk with new partners. Several men and women also experienced a loss of confidence in their now older body when having sex with new partners, resulting in concerns about STI risk being side-lined. Even when transitions in middle age did not involve emotional trauma, middle aged adults, in associating sex with a new partner with feeling young again, did not protect themselves against STIs, suggesting that transitions, whether emotionally upsetting or not, were linked with risky sex among this age group.
Age appropriate behaviour
Many of the older adults we spoke to associated STIs with casual sex and STIs were often considered irrelevant to older adults’ lives. Middle-aged adults tended to view young people as sexually irresponsible and more at risk for STIs. Being older was associated with an expectation of increased maturity, and a feeling that being older meant that they “should know better”, resulting in self-blame and barriers to seeking STI care when things went wrong.
What does all this tell us?
Although young people under 25 and men who have sex with men are most at risk of STIs, rates among adults aged over 45 are rising. The increase in life and healthy life expectancies, and the peaking age of divorce in the 40s, suggest that this group of adults deserve help in keeping safe from STIs. Key findings from this research suggest that focussing on love and trust, prioritising pregnancy as a risk, transitional experiences and expectations of age related behaviour are all factors which influence risk taking for STIs.
Following on from this work, it is suggested that attention should be paid to risky periods of transition from relationships, not just among older adults but across the life course. By including adults of all ages, this approach should include those older adults who may be at risk for STIs and start to break down the old/young barriers that tend to dominate thinking around where the sexual risks lie. In doing so, sex would be viewed as relevant to adults throughout the life course and not just when young, enabling middle aged and older adults to feel comfortable seeking the help and treatment they may need around STI related concerns.
This blog article is based on the following paper:
Dalrymple J, Booth J, Flowers P, Lorimer K. Psychosocial factors influencing risk-taking in middle age for STIs Sexually Transmitted Infections In Press; Published Online First: 7 July 2016
Jenny Dalrymple is a clinical academic research fellow, based at Glasgow Caledonian University and also works as a sexual health nurse in NHS Greater Glasgow and Clyde’s Sandyford sexual health service.
You can contact Jenny by email Jenny.Dalrymple[at]gcu.ac.uk and follow her on Twitter on @Jenny Dalrymple1