title: "The Pleasure Is Better as I've Gotten Older": Sexual Health, Sexuality, and Sexual Risk Behaviors Among Older Women Living With HIV.
abstract: There is limited research examining the sexual health and well-being of older women living with HIV (OWLH). Most studies focus on sexual dysfunction, leaving aside the richer context of sexuality and sexual health, including the effect of age-related psychosocial and interpersonal changes on sexual health behaviors. Guided by the integrative biopsychosocial model and the sexual health model, this study explored the importance of sex and sexuality among OWLH to identify their sexual health and HIV prevention needs for program planning. A purposive sample (n = 50) of OWLH was selected from a parent study (n = 2052). We conducted 8 focus groups and 41 in-depth interviews with 50 African American and Latina OWLH aged 50-69 years old in three U.S. cities. The triangulation approach was used to synthesize the data. Six salient themes emerged: sexual pleasure changes due to age, sexual freedom as women age, the role of relationships in sexual pleasure, changes in sexual ability and sexual health needs, sexual risk behaviors, and ageist assumptions about older women's sexuality. We found that sexual pleasure and the need for intimacy continue to be important for OWLH, but that changing sexual abilities and sexual health needs, such as the reduction of sexual desire, as well as increased painful intercourse due to menopause-associated vaginal drying, were persistent barriers to sexual fulfillment and satisfaction. Particular interpersonal dynamics, including low perceptions of the risk of HIV transmission as related to gender, viral suppression, and habitual condomless sex with long-term partners without HIV transmission have resulted in abandoning safer sex practices with serodiscordant partners. These findings suggest that HIV prevention for OWLH should focus on how sexual function and satisfaction intersect with sexual risk. HIV prevention for OWLH should promote ways to maintain satisfying and safe sex lives among aging women.
authors.affiliation: College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA. Tonya.Taylor@downstate.edu.
authors.forename: Tonya N
authors.initials: TN
authors.lastname: Taylor
authors.affiliation: CMPconsulting, Santa Monica, CA, USA.
authors.forename: Corrine E
authors.initials: CE
authors.lastname: Munoz-Plaza
authors.affiliation: Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Goparaju
authors.affiliation: College of Public Health, Temple University, Philadelphia, PA, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Martinez
authors.affiliation: College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Holman
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Howard L
authors.initials: HL
authors.lastname: Minkoff
authors.affiliation: AIDS Community Research Initiative of America, New York, NY, USA.|School of Nursing, New York University, New York, NY, USA.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Karpiak
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gandhi
authors.affiliation: Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL, USA.
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.affiliation: City of Hope National Medical Center, Los Angeles, CA, USA.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Adebola A
authors.initials: AA
authors.lastname: Adedimeji
authors.affiliation: College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gonsalves
authors.affiliation: College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Bryan
authors.affiliation: College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Connors
authors.affiliation: College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Schechter
authors.affiliation: School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Wilson
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D060728:Reproductive Health; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology*; D014481:United States; D014930:Women / Q000523:psychology
keywords: Aging; HIV; Sexual Health; Sexual risk behaviors; Sexuality