Can We Talk About Sex?

Doctors, who also were interviewed for the study, said they considered female patients in their late teens and early 20s to be much more susceptible to HIV and AIDS, and in many cases never thought of their older, single patients as being sexually active, Grant said. “When doctors have their own biases that lead them not to think of a particular group as having sexual health concerns, then they don’t bother to bring the subject up and many patients don’t feel comfortable discussing it,” she said. 

A 2005 study conducted by AARP found that more than one-third of Americans between the ages of 40 and 69 are single, with the majority divorced, said Grant. 

Although AIDS has declined in recent years among some age groups, such as between ages 25 and 34, the rate for acquiring new infections has remained steady since the 1990s: about 11 percent for people age 50 and older.

Grant decided to do the study after reading a magazine article about Jane P. Fowler, a Midwestern woman who contracted HIV in her mid-50s. When Fowler started dating after her divorce, she asked her doctor if she should be tested for HIV, only to be told, “Not you, you don’t need that test,” said Grant. “Our society’s cultural emphasis on sexuality and youth leads us to discount that sexuality continues to be an important part of life for many people – regardless of their gender or marital status — well into their 80s and beyond,” Grant said.

As the large population of baby boomers ages, senior sexuality is expected to become even more important as a social and clinical issue, she said.

Grant interviewed 44 newly single women between the ages of 45 and 68 who attended a displaced homemaker program in Jacksonville and 31 physicians who practiced in a family practice clinic. Her research was funded by the National Science Foundation and a Woodrow Wilson/Johnson and Johnson Women’s Health grant.        

Nearly half of the women, 44 percent, said it was the patient’s responsibility to bring up sexually related health issues with their physician, while 28 percent thought the responsibility belonged with doctors, and an equal number thought it belonged with both parties, Grant said. In contrast, 74 percent of the physicians said they believed it was the role of both doctors and patients to bring up these topics, and 26 percent said the physician was the responsible party.           

Many women said doctors should encourage patients to bring up the matter by providing a comfortable atmosphere and “opening the door” with a global question about how things were going in their lives, Grant said. Others lamented the hurried nature of the visit and said doctors often seemed to have “one foot out the door,” she said.        

Doctors said time constraints often limited the topics they could discuss, particularly with patients who had multiple illnesses. Some doctors mentioned they were afraid to offend older patients by discussing sexual issues, while others said they were simply less likely to consider them at risk for AIDS, she said.     

Slightly more than 40 percent of the women Grant interviewed volunteered that they had been tested for HIV. Said one widow in her late 50s who believed in taking precautions, “AIDS doesn’t pick its victims – anybody is susceptible to it. I don’t care if it’s the archbishop. I wouldn’t sleep with anybody who wasn’t wearing a condom.”        

Marcia Ory, a professor in Texas A&M University’s School of Rural Public Health, said Grant’s research is important. “To be successful, AIDS prevention efforts must cross the age barrier and target anyone who engages in risky sexual behavior, no matter what their age.”