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Pre-Exposure Prophylaxis (PrEP) is a prescription medication used to lower the chances of acquiring the human immunodeficiency virus (HIV). PrEP is generally free under the Affordable Health Care Act for most people with insurance, but access to the medication is far from universal. The CDC recommends that medical providers discuss oral and injectable PrEP options with all individuals who are sexually active. However, this would require providers to ask people about their sexual activity and health history — which many do not.  

“Most doctors don’t ask people who are older about their sexual lives,” said Wakefield, a 72-year-old PrEP user from Seattle with a background in HIV vaccine research. “They make assumptions that everybody is going down a heteronormative, monogamy road because we live in a society that seems to hold that as the standard.”  

In a study published by Clinical Gerontologist in 2021, it was found that only 17% of older Americans reported speaking to their health care provider about their sexual health in the past two years.  

Wakefield dispelled the myth that sex is only for the young. 

“Every man I know that’s in my age group is either having sex, thinking about it, or talking about it,” he said. “It’s not just about HIV for older adults, it’s that they are having sex, and nobody is talking to them about it.” 

According to the American Association of Retired Persons’ (AARP) Healthy Aging Poll of individuals aged 65–80 years, two-thirds of respondents said they were still interested in sex and more than 50% said sex was important to their quality of life.  

Sam Sheldon, the program manager for SAGEPositive, is familiar with this kind of stigmatization and ageism experienced by older people. 

“Doctors are [already] not talking to their patients about sex, and the older you get, the less likely that conversation is happening,” he said.  

Sheldon also spoke about the potentially life-threatening consequences that can occur because of ageism, involving older people not getting adequate and timely healthcare.  

“Because older adults are waiting longer to test [for HIV] or are less likely to get tested, by the time they do get tested, they are disproportionately likely to also have an AIDS diagnosis,” said Sheldon.  

For people that live in more conservative areas of the country, the thought of speaking with a healthcare provider about their sex life can seem particularly stressing and may even pose a safety risk. Fear of discrimination based on sexual orientation or sexual practices can further widen healthcare disparities and lower access to HIV prevention services, including testing, and treatment.  

“If someone lives in a place without guaranteed LGBTQ+-affirming medical care, you might not want to talk to your doctor about your sex life even if you want to get tested, because there’s a history of discrimination, prejudice, and internalized stigma,” said Sheldon.  

Wakefield also spoke about his experience with stigmatization in the past and how that can potentially affect a lot of queer elders in relation to access to healthcare now.  

“You didn’t think about going in there and telling your doctor about your sex life,” he said. “As a queer person, you had to learn to have a secret. You told other people that you knew it was safe to tell.”  

To support the well-being of people of all ages, it is imperative that we include LGBTQ+ elders in conversations about access to PrEP and routine HIV and STI testing. To learn more about PrEP, click here.