Sexually transmitted infections pose new threat to aging adults

The incidence of HIV and other STIs among people aged 60 to 89 years is increasing in some regions of the world. More awareness about the issue, stigma reduction and preventive measures are needed, according to a new Lancet Healthy Longevity study.

People around the world live longer than ever before. The number of people above the age of 60 will almost double by 2050, according to WHO.

As we grow older, our health typically decreases. The immune system becomes weaker, and we become more susceptible to infections. This includes HIV and other sexually transmitted infections (STIs) such as syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes.

HIV and other STIs are equally prevalent in the sexually active older population as in the young population."

Evandro Fei Fang, Associate Professor, Institute of Clinical Medicine, University of Oslo

"We need to pay attention to STIs in the older population," he continues.

Fang and colleagues have analysed the global trends in the incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of HIV and other STIs, among older adults aged 60 to 89 years from 1990 to 2019.

The study included data from 204 countries and was recently published in The Lancet Healthy Longevity journal.

Increasing numbers of HIV and other STIs in some regions

Globally, the number of older adults with HIV and STIs has decreased over the last decades.

Even so, the number of new cases indicate that STIs in older adults continues to be a public health challenge. At the global level, there were more than 77 000 new cases of HIV and almost 26,5 million new cases of other STIs in older adults in 2019.

Furthermore, in some regions, the number of people who become infected is increasing.

"Despite the global decrease in the age-standardised incidence rate of HIV and other SITs in older adults from 1990 to 2019, many regions showed increases. The largest increases were in eastern Europe, central Asia, and high-income Asia Pacific.", Fang explains, continuing:

"This is a concerning trend."

Older adults are more susceptible to STIs than younger people

Sexually active older adults often are more susceptible to HIV and other STIs than younger people. Various health conditions, especially the weakened immune system in older adults, can explain why.

However, the picture is more complex. Various biological, psychological, cultural, and societal factors contribute to the higher susceptibility.

Prevention programmes often exclude older populations

Since we live longer and more of us get divorced, older adults more often than before get new partners. Even so, fewer in this age group use protective methods such as condoms and they are less likely to get tested for STIs.

"In general, there is a lot of attention on the prevention of HIV and other STIs in younger populations. Older individuals are often excluded from prevention programmes," Fang explains.

Lack of awareness about sexuality in older adults

Also, healthcare professionals are not always aware about sexuality and sexual activity in older adults.

This may lead to inadequate communication to older people regarding sexual health and the risk of HIV and other STIs.

On the other hand, advances in the treatment of HIV and STIs likely also contribute to a higher incidence in some parts of the world since people who have these conditions live longer than before.

Some older adults become infected during foreign travel

Travelling to foreign countries has become more accessible to a considerable part of the world's population over the last decades.

The researchers describe that the widespread use of erectile dysfunction medications and accessible sex industries in some countries and regions, further contribute to the spread of HIV and other STIs among older adults.

UN Decade of Healthy Ageing

As people around the world grow older, the international society has put older adults' health and quality of life on the agenda.

In fact, the UN General Assembly declared 2021 – 2030 the UN Decade of Healthy Ageing. The goal is to foster longer and healthier lives for older adults.

In response to and preparation for this challenge, activities on the education, research, and knowledge dissemination on ageing are increasing in Norway.

Together with researchers Hilde Loge Nilsen, Linda Hildegard Bergersen, and Jon Storm-Mathisen, Fang has been central in these endeavours.

"We have built the Norwegian Centre on Healthy Ageing network (NO-Age) and released the first Biology of Ageing course at UiO," Fang says.