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Member Research and Reports

IU Bloomington Study Examines Sexual Risk-Taking, HIV Prevention Among Older Adults in Sub-Saharan Africa

One of the most common myths around older adults is that they are not sexually active. But a recent study conducted by Dr. Molly Rosenberg, assistant professor of epidemiology and biostatics in the IU School of Public Health-Bloomington found that older men and women do maintain sexual relationships even into their 80s and beyond. The study, recently published in the Journal of Acquired Immune Deficiency Syndromes, looked at the unmet needs for HIV prevention among older adults in sub-Saharan Africa, and is one of the first studies of its kind to report sexual risk-taking among older adults in that region.

“Our study found that older adults are sexually active, and they report sexual risk behaviors — low condom use, casual sex and multiple recent partners — that are consistent with sexual transmission of disease,” Dr. Rosenberg said. “This marks a huge potential for ongoing HIV transmission in older South Africans, and highlights the need for expanded HIV testing and counseling that can change behavior and help reduce new HIV transmission.”

Researchers analyzed data from 5,059 men and women age 40 and older from the study “Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities,” conducted in rural Mpumalanga province in South Africa. The research looked at HIV prevalence, described their sexual behaviors and compared those behaviors across HIV status categories, using both self-reported and laboratory-confirmed HIV status data.

“This is really the first generation of South Africans we’ve seen aging with HIV,” Dr. Rosenberg said.

Overall, HIV prevalence among people in the study was high, at 23 percent, and did not differ between men and women. About one-third of respondents reported never having been tested for HIV, and among those with confirmed infections, nearly half did not yet know they were living with HIV.

More than half of participants reported at least one sex partner within the past two years. Men tended to maintain sexual partnerships at relatively high rates across older ages, only dropping to 52 percent at age 80 and older. The proportion of women with recent sexual partners decreased more steeply with age, dropping to 6 percent at age 80 and older.

The study calls for inclusion of older adults in HIV prevention, with messages created directly for that demographic, and intensified counseling and motivation about sexual transmission risk and universal HIV testing.

“To control the HIV epidemic in South Africa, we need to reach everyone who is vulnerable to HIV,” Rosenberg said. “And our paper shows that older adults should clearly be considered as HIV-vulnerable.”

The Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities study was funded by the National Institute on Aging. Dr. Lisa Berkman, Harvard School of Public Health, is principal investigator. HAALSI is nested within the Agincourt Health and Socio-Demographic Surveillance System, led by Drs. Stephen Tollman and Kathleen Kahn, with funding from Wellcome Trust, University of the Witwatersrand, and Medical Research Council, South Africa. Rosenberg’s paper, “Sexual Behaviors and HIV Status: A Population-Based Study Among Older Adults in Rural South Africa,” was a collaborative effort with key co-authors from the Harvard School of Public Health and the University of the Witwatersrand.