A physical assessment text book written by Carolyn Jarvis reccomends a serious of questions be asked of all adult patients relating to their sexual behavior (2004). The conversation need not be difficult. Questions should be matter of fact and communicate acceptance that sexual activity is is acceptable and important (Jarvis, 2004). Introducing the topic may be a relief for many patients. During this history, questions regarding satisfaction, arousal changes, and number of partners may raise the opportunity for further discussion (Jarvis, 2004). Regarding sexually transmitted infections and HIV, Jarvis reccomends the following questions: (1) “Have you had any sexual contact with a partner having a sexually transmitted disease such as gonorrhea, herpes, AIDS, chlamydia, warts, or syphilis?” (2)” When was this contact? Did you get the disease?” (3) “How was it treated? Any complications?” (4) “Do you use condoms to prevent STDs?” (5) Do You have any questions about any of these diseases?” (p. 727-773, 2004). Also important to determine is sexual preference as this relates strongly to HIV risk. (Jarvis, 2004) Specific questions for the older adult should continue to include those relating to sexual activity, satisfaction, and pain (Jarvis, 2004). It may also be appropriate to include questions about multiple partners and infidelity to married older adults as these activities are risk behaviors and choices that need not be judged. Related to the use of drugs, Jarvis also reccomends specific assessment of use of cocain, amphetamines, barbituates, and alcohol and relates high risk sexual behavior to their use. (Jarvis, 2004) It is also necessary, when assessing risk history for all patients, to specifically ask questions about the use of any intravenous substances including narcotics. Another assessment tool that is available for healthcare providers is called the PLISSIT model (Wallace, 2008). This model was written for utilization by healthcare providers when assessing the sexual health of their older adult patients but may also be effective in assessing risk behaviors related to HIV or other STDs. The model acknowledges that privacy is established when beginning a conversation about this topic (Wallace, 2008). It also reinforces that nonjudgemental and respectful attitude is important to show that the provider has an understanding of the older adults’ sexuality. To begin the discussion, the provider first asks for ‘permission’ to have a conversation about sexual health (Wallace, 2008). It may be appropriate to first acknowlege that many patients have difficulties with this aspect of life as they age. Once the provider has permission to begin, open ended questions about the patients concerns or past sexual health questions are appropriate (Wallace, 2008). Also, discovering what the patient knows about risky behavior is very helpful in developing a teaching plan. The topics can be narrowed once the provider has an understanding of the patients educational or therepeutic needs. More objective questions such as number of partners, sexual preference, STD preventative practices, and other potentially risky behaviors are important to discuss before moving on.

‘LI’ is for limited information (Wallace, 2008). This strategy is used when the provider discusses both normal and pathologic age-related changes (Wallace, 2008). In this segment of the tool, the specific risk behaviors that the patient may have been involved with may be further discussed. The provider should be sure the patient knows that he or she may be at risk for HIV or other sexually transmitted infections. ‘SS’ is for specific suggestions (Wallace, 2008). Following education and determining risk, the provider suggests behaviorial changes that may be necessary to reduce risk such as consistant condom and lubricant use, needle disposal or sterilization, and the provider should ask if the patient is willing to be tested for HIV. ‘IT’ is for intensive therapy, the last portion of the model (Wallace, 2008). This is appropriate for those those older adults requiring medication or psychotherapy for sexual problems or dysfunctions (Wallace, 2008). This can also be adapted to include lab work such as HIV testing and later, therapy if warranted.

Some educators and health care providers believe that the older adult may not want to learn about HIVand AIDS. To offset this myth, research was completed regarding the development of an educational program for older adults. Some 250 ethnically diverse adults over the age of fifty were surveyed about their interest in HIV/AIDS education (Altschuler, Katz, & Tynan, 2004). Seventy nine percent of those surveyed believed prevention was a good idea and 48% agreed to attend a group education seminar (Altschuler, Katz, & Tynan, 2004). Most (63%) perferred a same sex group while 22% prefered to learn from their primary care physician (Altschuler, Katz, & Tynan, 2004). Even with their receptiveness to HIV education, more than half reported that they do not know where they can obtain information about HIV and AIDS (Altschuler, Katz, & Tynan, 2004).

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