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Wednesday, November 30, 2016
Why over 45s are at risk of sexually transmitted infections – new findings
TheConversation: One consequence of our ageing population is that people are now sexually active later in life. Combined with a high rate
of older adults divorcing and changing partners, this has created a
conducive environment for sexually transmitted infections (STIs) among
those in middle age and beyond. While the under 25s and gay men remain most at risk from STIs, heterosexual adults over 45 have recently seen increases in HIV, gonorrhoea, herpes, syphilis, chlamydia and genital warts. In England, rates for chlamydia,
the commonest STI, rose 63% among 45-64s between 2011 and 2015 while
falling for 15-24s. Yet this is an area of public health that has so far
been ignored.
Knowledge about STIs [plays a]contributing role in reducing the
spread of infection. Recent evidence about older adults’ knowledge has
largely been confined to HIV, so our understanding of this age group’s
knowledge of STIs in general is limited.
In research
that I have just co-published, we sought to address this deficiency. By
carrying out in-depth interviews with 31 heterosexual men and women in
Glasgow aged between 45 and 65, we explored not only what middle-aged
adults know about HIV and other STIs but also the social circumstances
surrounding that knowledge.
Most of the study participants lived in the most deprived areas in
Scotland and had been through divorce, separation or the death of their
partner. The interviews led us to four main observations.
1. STI knowledge is limited
Most participants had heard about gonorrhoea, syphilis, chlamydia,
herpes, general warts and HIV, but beyond recognising the names they
were often unsure about any further detailed information. They tended to
know more about HIV, often remembering the national HIV/AIDS campaign in the 1980s and the celebrity deaths in the years before treatment improved.
In keeping with the association of early HIV epidemic with specific
risk groups such as gay men and intravenous drug users, the participants
often viewed STIs as riskier for other people than for themselves. Is ignorance bliss?Cate Frost
2. Old stigmas have endured
The participants had first learned about STIs as teenagers and young
adults between the 1960s and 1980s. Most said their sex education at
home had been very limited and unclear, with overtones of moral
disapproval, and that school sex education was extremely basic and did
not cover STIs. As one put it:
And it was always make sure you don’t get into trouble and I didn’t
know what the hell getting into trouble was so that was that.
The little they had learned about STIs was usually in the context of
promiscuous sexual behaviour being condemned and disease being seen as a
consequence – with worse stigma where women were concerned. As a
result, many participants had gone through life regarding STIs as
something to be ashamed of.
During the years when they were in long-term relationships, several
participants also did not see it as relevant to improve their knowledge
about STIs. And now in middle age, several continued to prefer not to
engage with the subject. In the words of one person:
None of them are anything that I’d want to trawl the internet to find
out more about you know; don’t know anybody that’s ever had them or
even if they’d admit to it.
3. Parents learn about STIs from their children
We found that parenting had the capacity to influence how much
participants knew about STIs. Women in particular had sometimes learned
about STIs either to find out about the risks to their children or
because their children had been diagnosed with one.
Studies have previously shown
that it is women who mostly provide sex education to their children.
Our study is the first to indicate that parenting can also be a source
of sex education for the parents themselves.
4. Knowledge is not the only problem
Participants who were well informed about STIs did not necessarily
practice safer sexual behaviour. Despite the lack of discernible
symptoms with many STIs, several participants said they had not sought a
test after having unprotected sex with a new partner. Instead they had
waited to see if symptoms would appear:
She’s been sleeping with other people and I let her sleep with me and
never used a condom and … then you worry that something happens, that
something’s going to come out of it, or are you lucky and I was just
praying that something didnae happen.
These findings should be useful for developing interventions for
middle-aged adults that help them to learn more about STIs and to make
wiser decisions in relation to their sexual health. Public health policy in the UK makes reference to the life-long nature of sexual health, but few health promotion programmes directly address older adults taking risks with STIs.
Public health officials need to be aware that people emerging from
lengthy relationships often know little about STIs and are poorly
equipped to make good decisions about their sexual health. The sense of
stigma around STIs with this age group is a barrier that needs to be
addressed. Policymakers need to fully engage with gendered attitudes to
older women’s sexuality, as well as the full range of lengths and
varieties of relationships that people get involved in regardless of
their stage in life.