Of course some factors may decrease otherwise active sexual behaviors in the older adult. Medications commonly found to decrease libido include some blood pressure medications, selective serotonin reuptake inhibitors, anti-anxiety medications, and opiod pain medications. Loss of a spouse considerably decreases sexual activity among the older adults as the majority of older adults in sexual relationships are in such a relationship with a spouse (Lindau et al., 2007). Lindau et al. found that 78% of older adult men had a spousal or other intimate relationship while only 40% of women had this type of relationship (2007). Twenty two percent of men interviewed in this same study continued to have a sexual relationship despite no spousal relationship, while this only applied to 4% of women. This may be attributed to longevity of life for women versus men. It may also be related to women reporting less interest in sex in older adulthood (Lindau et al., 2007). Arthritis, depression, anxiety, and other disorders may also cause a decrease in libido in the senior patient. Many of these problems could possibly be addressed by physicians who might change medications or otherwise treat the condition, however less than 40% of men and only 22% of women reported discussing sex with a physician beyond the age of fifty (Lindau et al., 2007).

Considering the number of older adults that believe sexuality relates to good health, physicians and other health care providers may want to consider including discussions about sex and sexual issues with the patient over the age fifty as a component of the routine patient encounter. Gott concluded that although patients and physicians have difficulty initiating discussions about sex and sexuality, an individual’s sexual habits remain unknown unless the older adult is asked specifically about his or her sexual behaviors (2001). Although sexual activity statistically decreases with age, the increasing number of older adults diagnosed with an HIV diagnosis and other sexually transmitted infections calls attention to the need for action on the part of researchers, physicians, nurses, and the older adult as well to mainstream this health problem.

Historically, perceptions of the cohort populations at risk for contracting HIV have been somewhat erroneous. “Originally perceived as a disease exclusive to homosexual men, society has begun to realize that HIV affects society as a whole, including the heterosexual [male] population, women, and children.” (Emlet, 1997, p. 69) HIV and AIDS are also mistakenly perceived to be diseases of young people.

Approximately 10% of Americans over age 50 have at least one risk factor for HIV infection. (Stall & Catania, 1994) Factors that place anyone at increased risk for contracting HIV include: men having sex with other men, blood transfusions before 1985, injection drug use, having a risk-taking sexual partner, and the lack of consistent condom use. These risk factors are directly related to the mode of transmission which includes any activity in which body fluids may be shared between an infected person and an uninfected person. Other risk factors include multiple sexual partners, contracting other sexually transmitted infections, and using substances such as alcohol that may affect inhibition. There are also biological factors that put the older adult at increased risk for contracting HIV. Post menopausal women exhibit normal physical changes that may increase risk of transmission and contraction of HIV. Mainly, thinning of the vaginal wall and a decrease in natural lubrication results in increased susceptibility to vaginal tears and thus provides direct access for HIV to enter the bloodstream (Lieberman, 2000). People often do not consider that the older adult may be having sex with multiple partners, may be having sex with someone of the same sex, may be sharing needles for prescribed medications, or using other illicit drugs and sharing needles, all factors which increase the risk for HIV. (Mueller, 1997) It is difficult to rank these routes of transmission for this population as many infected older adults report that they are unaware how they actuallycontracted the virus. However, men who have sex with men, do comprise the majority of individuals over fifty with HIV (Center for Disease Control and Prevention e, 2007). For all males, transmission category ranks as follows: Men having sex with men (64%), intravenous drug use (16%), heterosexual contact (12%) and a combination of male to male contact and intravenous drug use (7%) (Center for Disease control and Prevention, 2007). For females, high risk heterosexual contact far supercedes any other transmission category at 72% and intravenous drug use at 26% (Center for Disease control and Prevention e, 2007).

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