Recent data (Tavoschi & Pharris) about HIV diagnosis from the European surveillance system for the period 2004-2015 point to, amongst other things, the rising importance of the category of older people (>50 years). This trend is something that we have long been aware of (Savona/STI; Bodley-Tickell & Goold/STI). It is less than obvious, however, first, because incidence in younger people is – as might be expected – much higher in absolute terms (11.4 as opposed to 2.6 per 100,000), second, because, in the 16 countries (mostly clustered in central and eastern Europe) where incidence in older people is rising, the incidence in younger people is rising too. (The exceptions to this rule are the UK and Norway, where increasing incidence amongst older people is accompanied by a declining incidence amongst younger ones.) Yet, the data, averaged out over the decade, show a year-on-year rise in the incidence for older people of 2.1%; whereas, for younger people incidence remains relatively stable.
The data for HIV in the older population also shows a relatively distinctive pattern of demographic factors. Older people are more often native to the reporting country, and they are more likely to have acquired the infection through sex – generally heterosexual. They more frequently present with a late diagnosis, having not previously tested, and are more likely to be diagnosed incidentally while in hospital. In the light of the greater engagement of older people with health services, the authors speak of ‘missed opportunities’ for diagnosis, and stress the importance of an ‘active offer of an HIV test’ being made by service providers. Dalrymple & Lorimer/STI, in an interesting recent qualitative study of psychosocial issues affecting the older age group, discuss the impact of factors influencing openness to health professionals such as self-blame and cultural expectations around sex in older age – as well as other factors that render older people more vulnerable to infection, such as relationship transition, the prioritization of intimacy, and the freedom from fears about pregnancy.
It is clear that the needs of the older population should not be regarded as irrelevant to the concerns of sexual health provision. Lest we were at all tempted to do so, it is worth remembering that one, no doubt small, but recently controversial population – those termed ‘swingers’ – are made up predominantly of those who fall into the category of older people: 55% according to a series of studies recently undertaken in the Netherlands (Spauwen & Dukers-Muijrers/STI; Dukers-Muijrers/STI). That said, it should be pointed out that even in Limburg they represented only 11.6% of attendees – though, according to these studies – they absorb disproportionate time and resources. In any case – contrary to popular opinion (NHS: swingers) – they did not show significantly increased levels of HIV.