Racial/ethnic variations in sexual behaviors, healthcare interaction characteristics, and HIV-related perceptions among adults age 60 years and older

Background: Older adults are remaining sexually active for longer periods of time, which emphasizes the need to assess their sexual activity patterns and identify differences by race/ethnicity.

Methods: Using 2010 National Social Life, Health, and Aging Project data, this study examined responses of 1,429 adults 60-plus years of age. Multinomial logistic regression compared sexual behaviors, health-related indicators, interactions with healthcare professionals, and HIV-related perceptions across participants' race/ethnicity.

Results: Approximately 81% of participants self-reported as non-Hispanic white, 10.6% as African American, and 8.1% as Hispanic. On average, participants were 69.9 years of age (+/-6.9). In the previous year, 49.3% of participants engaged in sexual intercourse; only 3% used condoms. The majority of participants (83.1%) visited a physician at least twice in the previous year, 30.9% had discussed sex with a physician since turning 50, and 14.2% had ever been tested for HIV. Relative to non-Hispanic whites, African Americans were more likely to: (1) be divorced [OR=3.23, p<0.001] or widowed [OR=2.90, p<0.001]; (2) have more lifetime sexually transmitted infection (STI) diagnoses [OR=1.67, p=0.030]; and (3) have paid for sex [OR=2.83, p=0.002]. Although African Americans had greater perceived risk for HIV infection [OR=1.66, p=0.046], they were less likely to have discussed sex with a physician since turning 50 [OR=0.45, p=0.009].

Conclusions: There is a clear need for contextualized interventions to improve patient-provider communication and proactive screening behaviors in aging African Americans. Interventions are also needed to increase providers' ability to identify and screen patients at elevated risk for STI and HIV transmission.