Safer Sex in Senior Communities

1. Safer Sex in Senior Communities MPH 515 Mark Thompson October 2013

2. Introduction and Background A surprising trend has developed since the late 1990s among men and women 50 years of age and older. • The incidence of gonorrhea, syphilis, and HIV/AIDS has increased sharply among baby-boomers (boomers) and the elderly (U.S. Department of health and Human Services, 2001). • Shifting social norms and access to hormone therapy and erectile dysfunction medication are contributors to the problem (Jameson, 2011). • Condom use is low in seniors as pregnancy is not a concern (Jameson, 2011). • Safe sex programs in the past have targeted the younger generations (Jameson, 2011). • Senior communities offer opportunities for seniors to find willing sex partners (Jameson, 2011).

3. Epidemiology and Statistics • Astudy at Indiana University found that men over 50 reported using a condom only 28% of the time compared to the 50% in men 18-39 (Jameson, 2011) • 67% of men and 39% of women age 65-74, and 38% of men age 75-85, reported having sex with in the past year (Jameson, 2011). • More than 10% of new U.S. AIDS cases in 1998 occurred in persons over 50 years of age(Karlovsky, Lebed, & Mydlo, 2004). • From 2007-2009, the prevalence of diagnosed HIV infection among older adults increased by around 19% (CDC. 2013) • Cases of syphilis and gonorrhea increasing by 43% in adults over 55 years of age warrant immediate attention (Jameson, 2011).

4. Protection Motivation Theory • Fear-based theory for developing the necessary education programs would be very effective in senior communities. • Proposed in 1975 by Doctor R. W. Rogers, explains the processes that effect attitude change in response to fear (DiClemente, Salazar, & Crosby, 2013).  • When faced with a fear-provoking stimulus, undergo a series of cognitive processes (DiClemente et al., 2013). • PMT is closely linked to two cognitive processes; a threat appraisal, and a coping appraisal. • In developing health programs, severity, vulnerability, and efficacy must be emphasized to achieve the adoption of protective behaviors. • Severity, vulnerability, and efficacy must outweigh response costs and intrinsic/extrinsic rewards.

5. Previously Implemented Programs • Numerous HIV/AIDS and STI prevention programs have been instituted in locations around the country in past decades. • Little information on programs that focus solely upon prevention of risky sexual practices among adults over 50.

6. Previous Interventions • North Carolina’s Early Identification of Individuals with HIV/AIDS (EIIHA) program is part of the 2012 HIV Care & Prevention Statewide Coordinated Statement of Need (SCSN) Needs Assessment and Comprehensive Plan. • The strategy of this program is to raise awareness • Encouraging citizens to know their HIV status through targeted, culturally sensitive, and non-judgmental testing (Clymore, 2012) • Solano County, California Health & Social Services Department’s STD Community Interventions Program (SCIP) • Seeks to raise awareness • “SCIP establishes or enhances partnerships with non-clinical, youth-serving, community-based programs, government and non-government family planning programs and schools” (Solano County Health & Social Services Department, n.d.). • Both of these programs are designed to raise awareness of STIs and to encourage prevention efforts. • They can be said to follow a fear-based model like the Health Belief Model (HBM).

7. Previous Interventions • Safer Sex for Seniors (n.d.) is a website promoting safe sex practices and STI prevention in the senior population. • The website features a public service announcement (PSA) video that is quite risqué by modern standards • This PSA can also be said to be based upon a fear=based model like the HBM. • Click the link below to view the PSA http://safersex4seniors.org/

8. Safer Sex in Senior CommunitiesA 3-Tiered Approach Based on the PMT • Partnering with organizations like AARP and the Department of Health and Human Services Administration on Aging, brochures will be mailed to seniors. • It will be an easily understood brochure highlighting recent statistics and proper condom use to promote self-efficacy. • Within senior communities, trained personnel will conduct educational courses designed to be fun and interactive while informing seniors about the risks of unprotected sex. • This step will be important and will require discussions with seniors, staff, and other stakeholders in the different communities in which it will be presented to ensure it is modified to be culturally sensitive and appropriate to different audiences. • Safer Sex in Senior Communities will provide materials to health professionals that stress the need for education in the senior population. • Doctors will be encouraged to council seniors receiving prescriptions for hormone therapy and ED medication to ensure they understand the risks they face. The program can be modified and adjusted to suit different communities and takes advantage of the medical professionals upon which so many seniors rely. The program seeks to raise awareness and promote efficacy to change risky sexual behaviors among seniors.