Globally, older people’s voices and experiences tend to be left out of discussions on sexual health and well-being. Their sexual health needs are stereotyped as insignificant beyond the reproductive periods of life. Yet sexual activity is, of course, happening among older adults and between older and younger adults – making them vulnerable to sexually transmitted infections.
Where access to essential sexual health services is limited – as in many countries in Africa – this vulnerability is a concern.
Research around sexually transmitted infections (STIs) in adults older than 50 is growing gradually, with evidence of new cases and delays in diagnosis. The evidence also predicts a future increase in cases among older adults in developed and developing countries. Some evidence has already confirmed that older adults in African countries are vulnerable to new cases of sexually transmitted infections. Gonorrhoea, syphilis and HIV are at the top of the list.
Despite the emerging evidence, sexually active older adults are confronted with systemic, cultural and individual barriers in accessing the services they need. And it starts with a conversation on their sexual health. Among the barriers are the stigma around contracting STIs, poor attitudes of health professionals and unavailability of age-appropriate health services.
Existing research shows a lack of strategies to promote open communication on sexual health needs in African countries. In addition, there is little contextualised research on the unmet need for sexual health communication in later life.
Our research sought to identify some of the common sexual health needs and concerns among older adults in Nigeria. We also explored barriers to communicating these needs and how these barriers could be removed.
We found that older adults and their healthcare providers are sometimes overwhelmed by other health needs. Conversations on their sexual health needs are relegated to the background. Tensions and contradictions around personal beliefs, subjective well-being, cultural expectations and health system responsiveness also emerged as critical constraints.
Sexual health needs and concerns
We conducted 16 focus group discussions with adults over the age of 50 in two cities (Ibadan and Lagos) in Nigeria. We used a story about sexual behaviours in old age within the Yoruba cultural context to stimulate the discussion. The aim was to explore how older adults conceived of sexual health concerns and shared them with their peers and those they felt could be of help or support to them.