Ageing International

, Volume 36, Issue 3, pp 313–333 | Cite as

HIV, Sexual Health, and Psychosocial Issues Among Older Adults Living with HIV in North America

  • David J. BrennanEmail author
  • Charles A. Emlet
  • Angela Eady


It is estimated that by the year 2015, at least half of those living with HIV disease in the United States will be 50 years of age or older. Older adults with HIV disease are living longer than ever before and are living healthier and more normal lives. They continue to be involved in intimate and sexual relationships. This paper provides an overview of some epidemiological trends among older adults living with and at risk for HIV in North America and discusses the current and emerging needs and behaviours related to their sexual health. Included are issues of sexual orientation, sexual behaviour, sexual dysfunction, and sexual risk. In addition, a number of the important psychosocial needs of older adults who are living with HIV are discussed, along with recommendations for future practice, policy, and research. Given that increasingly more people living with HIV are aging, the issues of aging and HIV disease can no longer be seen as unrelated. Gerontological providers, researchers, and policy makers must begin to address the needs of this increasingly common, yet vulnerable population of older people.


HIV Aging Sexuality Older adults Sexual risk 


  1. Abdool Karim, Q., Abdool Karim, S. S., Frohlich, J. A., Grobler, A. C., Baxter, C., Mansoor, L. E., et al. (2010). Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science, 329, 1168–1174.CrossRefGoogle Scholar
  2. Abress, G. (2011). Presentation at Ontario HIV Clinics Day, St. Michael’s Hospital, University of Toronto, February 4, 2011.Google Scholar
  3. Amaro, H. (1995). Love, sex and power: considering women’s realities in HIV prevention. The American Psychologist, 50, 437–447.CrossRefGoogle Scholar
  4. Anderson, R., & Fetner, T. (2008). Cohort differences in tolerance of homosexuality: attitudinal change in Canada and the United States. Public Opinion Quarterly, 47, 311–330.CrossRefGoogle Scholar
  5. Asboe, D., Catalan, J., Mandalia, S., Dedes, N., Florence, E., Schrooten, W., et al. (2007). Sexual dysfunction in HIV-positive men is multi-factorial: a study of prevalence and associated factors. AIDS Care, 19, 955–965.CrossRefGoogle Scholar
  6. Berger, B. E., Ferrans, C. E., & Lashley, F. (2001). Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Research in Nursing & Health, 24, 518–529.CrossRefGoogle Scholar
  7. Bing, E. G., Burnam, M. A., Longshore, D., Fleishman, J. A., Sherbourne, C. D., London, A. S., et al. (2001). Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Archives of General Psychiatry, 58, 721–728.CrossRefGoogle Scholar
  8. Branson, B. M., Handsfield, H. H., Lampe, M. A., Janssen, R. S., Taylor, A. W., Lyss, S. B., et al. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Morbidity and Mortality Weekly, 55(RR14), 1–17.Google Scholar
  9. Brennan, M., Karpiak, S. E., Cantor, M. H., & Shippy, R. A. (Eds.). (2009). Research on older adults with HIV: An in-depth examination of an emerging population. Hauppauge: Nova Science.Google Scholar
  10. Campo, J., Perea, M., del Romero, J., Cano, J., Hernando, V., & Bascones, A. (2006). Oral transmission of HIV, Reality or fiction? An update. Oral Diseases, 12, 219–228.CrossRefGoogle Scholar
  11. Canadian AIDS Society and Health Canada. (2002) A guide to HIV/AIDS epidemiological and surveillance terms. Ottawa: Canadian AIDS Society. Modified in 2006. Retrieved from
  12. Catania, J., & Stall, R. (1994). AIDS risk behaviors among late middle aged and elderly Americans. The National AIDS Behavioral Surveys. Archives of Internal Medicine, 154, 57–63.CrossRefGoogle Scholar
  13. Centers for Disease Control and Prevention. (2008). HIV prevalence estimates—United States, 2006. MMWR, 57, 1073–1076.Google Scholar
  14. Centers for Disease Control and Prevention. (2010a). Basic Information about AIDS. Retrieved from
  15. Centers for Disease Control and Prevention. (2010b). HIV in the United States: An overview. Atlanta, U.S.: Department of Health and Human Services. Retrieved from
  16. Centers for Disease Control and Prevention. (2010c). HIV surveillance report, 2008. Vol. 20. Atlanta: U.S.: Department of Health and Human Services. Retrieved from
  17. Chen, Z., Branson, B., Ballenger, A., & Peterman, T. A. (1998). Risk assessment to improve targeting of HIV counseling and testing services for STD clinic patients. Sexually Transmitted Diseases, 25, 539–543.CrossRefGoogle Scholar
  18. Ciesla, J. A., & Roberts, J. E. (2001). Meta-analysis of the relationship between HIV infection and risk for depressive disorders. The American Journal of Psychiatry, 158, 725–730.CrossRefGoogle Scholar
  19. Coleman, C. L., & Ball, K. (2010). Sexual diversity and HIV risk among older heterosexual African American males who are seropositive. Applied Nursing Research, 23, 122–129.CrossRefGoogle Scholar
  20. Conrad, P. (1989). The social meaning of AIDS. In R. C. Rist (Ed.), Policy issues for the 1990s (pp. 75–87). New Brunswick: Transaction.Google Scholar
  21. Cooperman, N. A., Arnsten, J. H., & Klein, R. S. (2007). Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS Education and Prevention, 19, 321–333.CrossRefGoogle Scholar
  22. Craig, S., Beaulaurier, R., Newman, F., De La Rosa, M., & Brennan, D. (2010). The determinants of voluntary counseling and testing for older Latinas. Manuscript submitted for publication.Google Scholar
  23. Crepaz, N., Marks, G., Liau, A., Mullins, M. M., Aupont, L. W., Marshall, K. J., et al. (2009). Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: A meta-analysis. AIDS, 23, 1617–1629.CrossRefGoogle Scholar
  24. Dandona, P., & Rosenberg, M. T. (2010). A practical guide to male hypogonadism in the primary care setting. International Journal of Clinical Practice, 64, 682–696.CrossRefGoogle Scholar
  25. DeCarlo, P., & Linsk, N., Center for AIDS Prevention Studies. (1997, September). What are HIV prevention needs of adults over 50? Retrieved from .
  26. Deeks, S. G., & Phillips, A. N. (2009). HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ, 338, 288–292.CrossRefGoogle Scholar
  27. Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualization to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13, 1160–1177.CrossRefGoogle Scholar
  28. Elford, J., Ibrahim, F., Bukutu, C., & Anderson, J. (2008). Over fifty and living with HIV in London. Sexually Transmitted Infections, 84, 468–472.CrossRefGoogle Scholar
  29. Elliott, R. (1999). After Cuerrier: Canadian criminal law and the non-disclosure of HIV positive status. Montréal: Report of the Canadian HIV/AIDS Legal Network.Google Scholar
  30. Emlet, C. A. (2006a). A comparison of HIV-stigma and disclosure patterns between older and younger adults living with HIV/AIDS. AIDS Patient Care and STDs, 20, 350–358.CrossRefGoogle Scholar
  31. Emlet, C. A. (2006b). An examination of the social networks and social isolation of older and younger adults living with HIV/AIDS. Health & Social Work, 31, 299–308.Google Scholar
  32. Emlet, C. A. (2006c). You’re awfully old to have this disease: experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. The Gerontologist, 46, 781–790.CrossRefGoogle Scholar
  33. Emlet, C. A. (2007). Experiences of stigma in older adults living with HIV/ AIDS: a mixed-method analysis. AIDS Patient Care and STDs, 21, 740–752.CrossRefGoogle Scholar
  34. Emlet, C. A. (2008). Truth and consequences: a qualitative exploration of HIV disclosure in older adults. AIDS Care, 20, 710–717.CrossRefGoogle Scholar
  35. Emlet, C. A., Brennan, D. J., Brennenstuehl, S., Rueda, S., Karapita, S., Hart, T. A., et al. (2011). Protective and risk factors associated with HIV stigma in a population of older adults living with HIV. Canadian Journal of Infectious Diseases & Medical Microbiology, 22, Supplement B P172, page 90B.Google Scholar
  36. Foster, P. P., & Gaskins, S. W. (2009). Older African American’s management of HIV/AIDS stigma. AIDS Care, 21, 1306–1312.CrossRefGoogle Scholar
  37. Gaeta, T., LaPolla, C., & Melendez, E. (1996). AIDS in the elderly. The Journal of Emergency Medicine, 14, 19–23.CrossRefGoogle Scholar
  38. Gallup Organization. (June 18, 2008). Americans evenly divided on morality of homosexuality. Retrieved from
  39. Gott, M., Hinchliff, S., & Galena, E. (2004). General practitioner attitudes to discussing sexual health issues with older people. Social Science & Medicine, 58, 2093–2104.CrossRefGoogle Scholar
  40. Grov, C., Golub, S. A., Parsons, J. T., Brennan, M., & Karpiak, S. E. (2010). Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care, 22, 630–639.CrossRefGoogle Scholar
  41. Hall, H. I., Song, R., Rhodes, P., & Janssen, R. S. (2008). Estimation of HIV incidence in the United States. JAMA, 300, 520–529.CrossRefGoogle Scholar
  42. Henry, K. (2009). Internal medicine/primary care reminder: what are the standards of care for HIV-positive patients age 50 years and older? Current HIV/AIDS Reports, 6, 153–161.CrossRefGoogle Scholar
  43. Herbst, J. H., Jacobs, E. D., Finlayson, T. J., McKleroy, V. S., Neumann, M. S., & Crepaz, N. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS and Behavior, 12(1), 1–17.CrossRefGoogle Scholar
  44. Herek, G. M., Mitnick, L., & Burris, S. (1998). Workshop report. AIDS and stigma: A conceptual framework and research agenda. AIDS Public Policy Journal, 13(1), 36–47.Google Scholar
  45. Herek, G. M., Widaman, K. F., & Capitanio, J. P. (2005). When sex equals AIDS: Symbolic stigma and heterosexual adults’ inaccurate beliefs about sexual transmission of AIDS. Social Problems, 52, 15–37.CrossRefGoogle Scholar
  46. Hillman, J. (2008). Sexual issues and aging within the context of work with older adult patients. Professional Psychology: Research and Practice, 39, 290–297.CrossRefGoogle Scholar
  47. Hinchliff, S., Gott, M., & Galena, E. (2005). ‘I daresay I might find it embarrassing’: general practitioners’ perspectives on discussing sexual health issues with lesbian and gay patients. Health & Social Care in the Community, 13, 345–353.CrossRefGoogle Scholar
  48. Hooyman, N. R., & Kiyak, H. A. (2011). Social gerontology: A multidisciplinary perspective (9th ed.). Boston: Allyn and Bacon.Google Scholar
  49. Illa, L., Brickman, A., Saint-Jean, G., Echenique, M., Metsch, L., Eisdorfer, C., et al. (2008). Sexual risk behaviors in late middle age and older HIV seropositive adults. AIDS and Behavior, 12, 935–942.CrossRefGoogle Scholar
  50. Jacobs, R. J., & Kane, M. N. (2010). HIV-related stigma in midlife and older women. Social Work in Health Care, 49, 68–89.CrossRefGoogle Scholar
  51. Justice, A. (2010). HIV and aging: time for a new paradigm. Current HIV/AIDS Reports, 7, 69–76.CrossRefGoogle Scholar
  52. Kang, E., Rapkin, B. D., & DeAlmeida, C. (2006). Are psychological consequences of stigma enduring or transitory? A longitudinal study of HIV stigma and distress among Asians and Pacific Islanders living with HIV illness. AIDS Patient Care and STDs, 20, 712–723.CrossRefGoogle Scholar
  53. Karpiak, S. E., Shippy, R. A., & Cantor, M. H. (2006). Research on older adults with HIV. New York: AIDS Community Research Initiative of America.Google Scholar
  54. Lamba, H., Goldmeier, D., Mackie, N. E., & Scullard, G. (2004). Antiretroviral therapy is associated with sexual dysfunction and with increased serum oestradiol levels in men. International Journal of STD & AIDS, 15, 234–237.CrossRefGoogle Scholar
  55. Lindau, S. T., Schumm, L. P., & Laumann, E. O. (2007). A study of sexuality and health among older adults in the United States. The New England Journal of Medicine, 357(8), 762–774.Google Scholar
  56. Linsk, N. L. (2000). HIV among older adults: age-specific issues in prevention and treatment. The AIDS Reader, 10, 430–440.Google Scholar
  57. Loe, M. (2004). Sex and the senior woman: pleasure and danger in the Viagra era. Sexualities, 7, 303–326.CrossRefGoogle Scholar
  58. Logie, C., & Gadalla, T. M. (2009). Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care, 21, 742–753.CrossRefGoogle Scholar
  59. Lovejoy, T. I., Heckman, T. G., Sikkema, K. J., Hansen, N. B., Kochman, A., Suhr, J. A., et al. (2008). Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS and Behavior, 12, 943–956.CrossRefGoogle Scholar
  60. Lyons, A., Pitts, M., Grierson, J., Thorpe, R., & Power, J. (2010). Ageing with HIV: health and psychosocial well-being of older gay men. AIDS Care, 22, 1236–1244.CrossRefGoogle Scholar
  61. Martin, C. P., Fain, M. J., & Klotz, S. A. (2008). The older HIV-positive adult: a critical review of the medical literature. The American Journal of Medicine, 121, 1032–1037.CrossRefGoogle Scholar
  62. Mavandadi, S., Zanjani, F., Ten Have, T. R., & Oslin, D. W. (2009). Psychological well-being among individuals aging with HIV: the value of social relationships. Journal of Acquired Immunodeficiency Syndromes, 51, 91–98.CrossRefGoogle Scholar
  63. Mykhalovskiy, E., Betteridge, G., & McLay, D. (2010). HIV non-disclosure and the criminal law: Establishing policy options for Ontario. Toronto. A report funded by a grant from the Ontario HIV Treatment Network.Google Scholar
  64. New York City Department of Health and Mental Hygiene. HIV Epidemiology and Field Services Program. (2009, June). HIV/AIDS Among Persons 50+ Years Old in New York City. Retrieved from
  65. Nokes, K. M., & Emlet, C. A. (2006). Health care strategies for older adults with HIV/AIDS. In P. M. Burbank (Ed.), Vulnerable older adults: Health care needs and interventions (pp. 235–250). New York: Springer.Google Scholar
  66. Nokes, K. M., Holzemer, W. L., & Corless, I. B. (2000). Health-related quality of life in persons younger and older than 50 who are living with HIV/AIDS. Research on Aging, 22, 290–310.CrossRefGoogle Scholar
  67. Nyblade, L., Stangl, A., Weiss, E., & Ashburn, K. (2009). Combating HIV stigma in health care settings: what works? Journal of the International AIDS Society, 12, 15. doi: 10.1186/1758-2652-12-15.CrossRefGoogle Scholar
  68. Önen, N. F., Shacham, E., Stamm, K. E., & Overton, E. T. (2010). Comparisons of sexual behaviors and STD prevalence among older and younger individuals with HIV infection. AIDS Care, 22, 711–717.CrossRefGoogle Scholar
  69. Orel, N. A., Wright, J. M., & Wagner, J. (2004). Scarcity of HIV/AIDS risk reduction materials targeting the needs of older adults among state departments of public health. The Gerontologist, 44, 693–696.CrossRefGoogle Scholar
  70. Padian, N. S., Shiboski, S., & Jewell, N. (1990). The effect of the number of exposures on the risk of heterosexual HIV transmission. The Journal of Infectious Diseases, 161, 883–887.CrossRefGoogle Scholar
  71. Parsons, J. T., VanOra, J., Missildine, W., Purcell, D. W., & Gomez, C. A. (2004). Positive and negative consequences of HIV disclosure among seropositive injection drug users. AIDS Education and Prevention, 16, 459–475.CrossRefGoogle Scholar
  72. Public Health Agency of Canada. (2010). HIV and AIDS in Canada. Surveillance Report to December 31, 2009. Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada.Google Scholar
  73. Public Health Agency of Canada. (n.d.). Summary: Estimates of HIV Prevalence and Incidence in Canada, 2008. Ottawa: Surveillance and Risk Assessment Division Centre for Communicable Diseases and Infection Control. Retrieved from
  74. R v Cuerrier (1998) 2 SCR 371. (Cuerrier)Google Scholar
  75. Raphael, S. (1997, June). Lesbian and gay elders. Paper presented at the National Center on Elder Abuse Conference, Long Beach, CA.: 459.Google Scholar
  76. Rodgers-Farmer, A. Y. (1999). HIV risk factors, HIV antibody testing, and AIDS knowledge among African Americans age 55 years and older. Social Work in Health Care, 29, 1–17.CrossRefGoogle Scholar
  77. Seal, D. W., & Ehrhardt, A. A. (2004). HIV-prevention-related sexual health promotion for heterosexual men in the United States: pitfalls and recommendations. Archives of Sexual Behavior, 33, 211–222.CrossRefGoogle Scholar
  78. Serovich, J. (2001). A test of two disclosure theories. AIDS Education and Prevention, 13, 355–364.CrossRefGoogle Scholar
  79. Sherr, L., Harding, R., Lampe, F., Johnson, M., Anderson, J., Zetler, S., et al. (2009). Clinical and behavioural aspects of aging with HIV infection. Psychology, Health & Medicine, 14, 273–279.CrossRefGoogle Scholar
  80. Smith, R., Rossetto, K., & Peterson, B. L. (2008). A meta-analysis of disclosure of one’s HIV-positive status, stigma and social support. AIDS Care, 20, 1266–1275.CrossRefGoogle Scholar
  81. Stout, J. E., Ratard, R., Southwick, K. L., & Hamilton, C. D. (2002). Epidemiology of human immunodeficiency virus testing among patients with tuberculosis in North Carolina. The Southern Medical Journal, 95, 231–238.Google Scholar
  82. Strong, J., & Miller, B. (2001). An analysis of adults’ knowledge of human immunodeficiency virus and acquired immunodeficiency syndrome. Clinical Gerontologist, 24, 153–158.CrossRefGoogle Scholar
  83. The White House Office of National AIDS Policy. (July, 2010). National HIV/AIDS Strategy for the United States. Retrieved from :
  84. Theall, K. P., Elifson, K. W., Sterk, C. E., & Klein, H. (2003). Perceived susceptibility to HIV among women. Research on Aging, 25, 405–432.CrossRefGoogle Scholar
  85. Topolski, J., Gothman, H., Klinkenberg, W., O’Neill, D., & Brooks, A. (2004). Older adults, substance abuse, and HIV/AIDS: Preparing for the future crisis. In C. A. Emlet (Ed.), HIV/AIDS and older adults: Challenges for individuals, families, and communities (pp. 185–199). New York: Springer.Google Scholar
  86. Walker, B. S. (December 2010). AARP Bulletin. Retrieved from
  87. Wallach, I. (2008). Interview with Louis-Marie Gagnon (Maison Plein Cœur). Vital Aging, 14(2), 12–14.Google Scholar
  88. Walters, K. L., Evans-Campbell, T., Simoni, J. M., Ronquillo, T., & Bhuyan, R. (2006). “My spirit in my heart”: identity experiences and challenges among American Indian two-spirit women. Journal of Lesbian Studies, 10, 125–149.CrossRefGoogle Scholar
  89. Weiss Wiewel, E. (2008, May). “HIV/AIDS Among Persons 50+ Years Old in the United States and New York City.” Slide presentation for New York City Department of Health and Mental Hygiene.Google Scholar
  90. Williams, E., & Donnelly, J. (2002). Older Americans and AIDS: some guidelines for prevention. Social Work, 47, 105–111.Google Scholar
  91. World Health Organization. (2002, January). Defining sexual health. Report of a technical consultation on sexual health 28–31 January 2002. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • David J. Brennan
    • 1
    Email author
  • Charles A. Emlet
    • 2
  • Angela Eady
    • 1
  1. 1.Factor-Inwentash Faculty of Social WorkUniversity of TorontoTorontoCanada
  2. 2.Social Work ProgramUniversity of WashingtonTacomaUSA

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