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, gonorrhoea, trichomoniasis, and genital herpes.
“HIV and other STIs are equally prevalent in the sexually active older population as in the young population, “says Evandro Fei Fang, Associate Professor at the Institute of Clinical Medicine at the 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 sexual health of older adults
Also, healthcare professionals are not always aware about sexuality and the sexual health of 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.
Subtle increase of STIs among older adults in Norway
The study analysed data for different countries and regions separately.
In Norway, HIV infections are very rare among older adults. Even so, the incidence of other STIs in this age group has subtly increased the last decades. Based on the Global Burden of Disease (GBD) database, the estimated incidence rate was increased from 1642 cases per 100,000 in the old population in 1990 to 1738 cases per 100,000 in the old population in 2019.
“This is an early alarm to the general older population and the Norwegian public health authorities,” Fang says.
Norwegian health authorities should focus on raising awareness and reducing stigma
Overall, the study shows that Norway is doing a good job in controlling HIV and STIs.
Fang has some recommendations for the Norwegian health authorities.
“The most important interventions are those focusing on education and awareness-raising among both health personnel and older adults about the issue. Addressing stigma and misconceptions is also central,” he says.
“Healthcare providers could also collaborate with senior centres and relevant organisations to address the issue,” Fang adds.
The international collaborative study published in The Lancet Healthy Longevity was co-led by Associate Professor Evandro Fei Fang from the University of Oslo together with Professor Hua-chun Zou and Professor Na He from Fudan University in China.
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References
Fu, L., Tian, T., Wang, B., Lu, Z., Bian, J., Zhang, W., ... & Zou, H. (2024). Global, regional, and national burden of HIV and other sexually transmitted infections in older adults aged 60–89 years from 1990 to 2019: results from the Global Burden of Disease Study 2019. The Lancet Healthy Longevity, 5(1), e17-e30. DOI: https://doi.org/10.1016/S2666-7568(23)00214-3.