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The intimate lives of older adults living with HIV: a qualitative study of the challenges associated with the intersection of HIV and ageing

Published online by Cambridge University Press:  19 July 2017

ISABELLE WALLACH  and
SHARI BROTMAN
ISABELLE WALLACH*
Affiliation:
Département de sexologie, Université du Québec à Montréal, Montréal, Canada.
SHARI BROTMAN
Affiliation:
School of Social Work, McGill University, Montréal, Canada.
*
Address for correspondence: Isabelle Wallach, Département de sexologie, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal (QC), H3C 3P8, Canada E-mail: [email protected]
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Abstract

Older adults living with human immunodeficiency virus (HIV) are at risk of experiencing difficulties in their intimate lives due to the combined effects of HIV and ageing. To date, little research has focused on the lived experience of sexuality. This article seeks to fill in the gap by documenting the challenges faced by this population with respect to their intimate relationships and sexual lives. Based upon the results of a qualitative study conducted in Montreal (2010–2012) using semi-structured interviews with a diverse sample of 38 people aged 50–73 and living with HIV, this study revealed several difficulties, including those related to their social location, whereby HIV and ageing intersect with other social determinants (including gender, sexual orientation and drug use). Difficulties that were identified include lower sexual desire linked to ageing, erectile changes, difficulty in using condoms, stigma related to HIV and/or ageism, changes in appearance caused by HIV and/or ageing, along with the impact of their lifecourse experiences. Our results shed light on the specific nature of the difficulties experienced by older adults living with HIV with regard to their intimate lives, as well as on the importance of using an analysis that combines the theoretical approaches of intersectionality and lifecourse to enhance our capacity for understanding complex and unique experiences.

Keywords

ageingHIVsexualityintimacyintersectionalitylifecoursewomengay men
Type
Article
Information
Ageing & Society , Volume 38 , Issue 12 , December 2018 , pp. 2490 - 2518
Copyright
Copyright © Cambridge University Press 2017 

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References

Allen, K. R. and Roberto, K. A. 2009. From sexism to sexy: challenging young adults’ ageism about older women's sexuality. Sexuality Research and Social Policy, 6, 4, 13–24.Google Scholar
Asboe, D., Catalan, J., Mandalia, S., Dedes, N., Florence, E., Schrooten, W., Noestlinger, C. and Colebunders, R. 2007. Sexual dysfunction in HIV-positive men is multi-factorial: a study of prevalence and associated factors. AIDS Care, 19, 8, 955–65.Google Scholar
Bajos, N. and Bozon, M. 2012. Les transformations de la vie sexuelle après cinquante ans: un vieillissement genré. Gérontologie et Société, 140, 1, 95–108.Google Scholar
Bilge, S. 2009. Théorisations féministes de l'intersectionnalité. Diogène, 1, 225, 70–88.Google Scholar
Bilge, S. 2010. De l'analogie à l'articulation: théoriser la différenciation sociale et l'inégalité complexe. L'Homme et la Société, 2, 176/7, 43–64.Google Scholar
Blanco, J., Jarrín, I., Vallejo, M., Berenguer, J., Solera, C., Rubio, R., Pulido, F., Asensi, V., del Amo, J. and Moreno, S. 2012. Definition of advanced age in HIV infection: looking for an age cut-off. AIDS Research and Human Retroviruses, 28, 9, 800–6.Google Scholar
Brener, L., Wilson, H., Slavin, S. and de Wit, J. 2013. The impact of living with HIV: differences in experiences of stigma for heterosexual and homosexual people living with HIV in Australia. Sexual Health, 10, 4, 316–9.Google Scholar
Brennan, D. J., Emlet, C. A. and Eady, A. 2011. HIV, sexual health, and psychosocial issues among older adults living with HIV in North America. Aging International, 36, 3, 313–33.Google Scholar
Brennan, M. and Karpiak, S. E. 2009. HIV stigma and disclosure of serostatus. In Brennan, M., Karpiak, S. E., Shippy, A. and Cantor, M. H. (eds), Older Adults with HIV: An In-depth Examination of an Emerging Population. Nova Science Publishers, New York, 51–60.Google Scholar
Brotman, S., Ferrer, I., Sussman, T., Ryan, B. and Richard, B. 2015. Access and equity in the design and delivery of health and social care of LGBTQ older adults: a Canadian perspective. In Orel, N. A. and Fruhauf, C. A. (eds), The Lives of LGBT Older Adults: Understanding Challenges and Resilience. American Psychological Association, Washington DC, 111–40.Google Scholar
Brotman, S. and Lévy, J. J. 2008. Intersections: Cultures, sexualités et genres. Presses de l'Université du Québec, Québec, Canada.Google Scholar
Brotman, S., Ryan, B. and Cormier, R. 2003. The health and social service needs of gay and lesbian elders and their families in Canada. The Gerontologist, 43, 2, 192–202.Google Scholar
Calasanti, T. and Slevin, K. 2001. Gender, Social Inequalities, and Aging. AltaMira Press, Oxford.Google Scholar
Calasanti, T. and Slevin, K. 2006. Age Matters: Re-aligning Feminist Thinking. Routledge, New York.Google Scholar
Caradec, V. 2008. Sociologie de la Vieillesse et du Vieillissement. Second edition, Armand Colin, Paris.Google Scholar
Carpenter, L. M. 2010. Gendered sexuality over the life course: a conceptual framework. Sociological Perspectives, 53, 2, 155–78.Google Scholar
Carpenter, L. M. and DeLamater, J. 2012. Sex for Life: From Virginity to Viagra, How Sexuality Changes Throughout Our Lives. New York University Press, New York.Google Scholar
Clarke, H. L. and Korotchenko, A. 2011. Aging and the body: a review. Canadian Journal on Aging, 30, 3, 495–510.Google Scholar
Collins, P. 2000. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. Routledge, New York.Google Scholar
Cooperman, N. A., Arnsten, J. H. and Klein, R. S. 2007. Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS Education and Prevention, 19, 4, 321–33.Google Scholar
Crenshaw, K. 1995. Mapping the margins: intersectionality, identity politics, and violence against women of color. In Crenshaw, K., Gotanda, N., Peller, G. and Thomas, K. (eds), Critical Race Theory: The Key Writings that Formed the Movement. The New Press, New York, 357–83.Google Scholar
Creswell, J. W. 2012. Qualitative Inquiry and Research Design: Choosing Among Five Approaches. Third edition, Sage, Thousand Oaks, California.Google Scholar
Creswell, J. W. and Miller, D. L. 2000. Determining validity in qualitative inquiry. Theory into Practice, 39, 3, 124–30.Google Scholar
Dannefer, D. 2003. Cumulative advantage/disadvantage and the life course: cross-fertilizing age and social science theory. Journals of Gerontology: Psychological Sciences and Social Sciences, 58B, 6, S327–37.Google Scholar
Davidson, K. 2001. Gender differences in new partnership choices and constraints for older widows and widowers. Aging International, 27, 4, 43–60.Google Scholar
De Jong Gierveld, J. 2004. Remarriage, unmarried cohabitation, living apart together: partner relationships following bereavement or divorce. Journal of Marriage and Family, 66, 1, 236–43.Google Scholar
DeLamater, J. and Hyde, J. S. 2004. Conceptual and theoretical issues in studying sexuality in close relationships. In Harvey, J. H., Wenzel, A. and Sprecher, S. (eds), The Handbook of Sexuality in Close Relationships. Lawrence Erlbaum Associates, Hillsdale, New Jersey, 7–30.Google Scholar
DeLamater, J. and Koepsel, E. 2015. Relationships and sexual expression in later life: a biopsychosocial perspective. Sexual and Relationship Therapy, 30, 1, 37–59.Google Scholar
Effros, R. B., Flechter, C. V., Gebo, K., Halter, J. B., Hazzard, W. R., Horne, F. M., Huebner, R. E., Janoff, E. N., Justice, A. C., Kuritzkes, D., Nayfield, S. G., Plaeger, S. F., Schmader, K. E., Ashworth, J. R., Campanelli, C., Clayton, C. P., Rada, B., Woolard, N. F. and High, K. P. 2008. Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions. Clinical Infectious Disease, 47, 4, 542–53.Google Scholar
Elder, G. 1994. Time, human agency, and social change: perspectives on the life course. Social Psychology Quarterly, 57, 1, 4–15.Google Scholar
Ferrer, I., Grenier, A., Brotman, S. and Koehn, S. 2017. Understanding the experiences of racialized older people through an intersectional life course perspective. Journal of Aging Studies, 47, 10–17.Google Scholar
Fisher, L. L. 2010. Sex, Romance, and Relationships: AARP Survey of Midlife and Older Adults. American Association of Retired Persons (AARP), Washington DC.Google Scholar
Flyckt, R. and Kingsberg, S. A. 2011. Sexuality and ageing. In Stuart-Hamilton, I. (ed.), An Introduction to Gerontology. Cambridge University Press, Cambridge, 283–316.Google Scholar
Furman, F. 1997. Facing the Mirror: Older Women and Beauty Shop Culture. Routledge, New York.Google Scholar
Gagnon, M. 2010. Femmes vivant avec le VIH/sida et lipodystrophie. Aporia, 2, 3, 32–40.Google Scholar
Gagnon, M. and Holmes, D. 2012. Women living with HIV/AIDS and the bodily transformation process known as the lipodystrophy syndrome: a grounded theory study. Journal of Research in Nursing, 17, 3, 215–28.Google Scholar
George, L. 1993. Sociological perspectives on life transitions. Annual Review of Sociology, 19, 1, 353–73.Google Scholar
Golub, S. A., Botsko, M., Gamarel, K. E., Parsons, J. T., Brennan, M. and Karpiak, S. E. 2011. Dimensions of psychological well-being predict consistent condom use among older adults living with HIV. Aging International, 36, 3, 346–60.Google Scholar
Golub, S. A., Grov, C. and Tomassilli, J. 2009. Sexual behavior among HIV+ older adults. In Brennan, M., Karpiak, S. E., Shippy, A. and Cantor, M. H. (eds), Older Adults with HIV: An In-depth Examination of an Emerging Population. Nova Science Publishers, New York, 43–50.Google Scholar
Gott, M. 2005. Sexuality, Sexual Health and Ageing. Open University Press, Buckingham, UK.Google Scholar
Gott, M. and Hinchliff, S. 2003. Sex and ageing: a gendered issue. In Arber, S., Davidson, K. and Ginn, J. (eds), Gender and Ageing: New Directions. Open University Press, Buckingham, UK, 63–78.Google Scholar
Grenier, A. 2012. Transitions and the Lifecourse: Challenging the Constructions of ‘Growing Old’. Policy Press, Bristol, UK.Google Scholar
Grenier, A. and Brotman, S. 2010. Les multiples vieillissements et leurs représentations. In Charpentier, M., Guberman, N., Billette, V., Lavoie, J. P., Grenier, A. and Olazabal, I. (eds), Vieillir au Pluriel: Perspectives Sociales. Presses de l'Université du Québec, Québec, Canada, 23–54.Google Scholar
Grodensky, C. A., Golin, C. E., Jones, C., Mamo, M., Dennis, A. C., Abernethy, M. G. and Patterson, K. B. 2015. ‘I should know better’: the roles of relationships, spirituality, disclosure, stigma, and shame for older women living with HIV seeking support in the south. Journal of the Association of Nurses in AIDS Care, 26, 1, 12–23.Google Scholar
Hancock, A.-M. 2007. Intersectionality as a normative and empirical paradigm. Politics & Gender, 3, 2, 248–54.Google Scholar
Heaphy, B. 2009. Choice and its limits in older lesbian and gay narratives of relational life. Journal of GLBT Family Studies, 5, 1/2, 119–38.Google Scholar
Herdt, G. and de Vries, B. 2004. Gay and Lesbian Aging: Research and Future Directions. Springer, New York.Google Scholar
Hooyman, N. R. and Kiyak, H. A. 2008. Love, intimacy, and sexuality in old age. In Hooyman, N. R. and Kiyak, H. A. (eds), Social Gerontology: A Multidisciplinary Perspective. Eighth edition, Allyn and Bacon, Boston, 271–300.Google Scholar
Hughes, J. 2011. Are older men taking sexuality as prescribed? The implications of the competing influences on ageing male heterosexuality. Australian Feminist Studies, 26, 67, 89–102.Google Scholar
Illa, L., Brickman, A., Saint-Jean, G., Echenique, M., Metsch, L., Eisdorfer, C., Bustamante-Avellaneda, V. and Sanchez-Martinez, M. 2008. Sexual risk behaviors in late middle age and older HIV seropositive adults. AIDS and Behavior, 12, 6, 935–42.Google Scholar
Karlsson, S. G. and Borell, K. 2002. Intimacy and autonomy, gender and ageing: living apart together. Ageing International, 27, 4, 11–26.Google Scholar
Keegan, A., Lambert, S. and Petrak, J. 2005. Sex and relationships for HIV-positive women since HAART: a qualitative study. AIDS Patient Care and STDs, 19, 10, 645–54.Google Scholar
Klein, H. 2012. A comparison of HIV risk practices among unprotected sex-seeking older and younger men who have sex with other men. The Aging Male, 15, 3, 124–33.Google Scholar
Lagrave, R.-M. 2009. Ré-enchanter la vieilesse. Mouvements, 59, 3, 113–22.Google Scholar
Lindau, S. T., Schumm, L. P., Laumann, E. O., Levinson, W., O'Muircheartaigh, C. A. and Waite, L. J. 2007. A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357, 8, 762–74.Google Scholar
Lodge, A. and Umberson, D. 2012. All shook up: sexuality of mid- to later life married couples. Journal of Marriage and Family, 74, 3, 428–43.Google Scholar
Loe, M. 2004. The Rise of Viagra: How the Little Blue Pill Changed Sex in America. New York University Press, New York.Google Scholar
Lovejoy, T. I., Heckman, T. G., Sikkema, K. J., Hansen, N. B., Kochman, A., Suhr, J. A., Garske, J. P. and Johnson, C. J. 2008. Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS and Behavior, 12, 6, 943–56.Google Scholar
Maes, C. A. and Louis, M. 2003. Knowledge of AIDS, perceived risk of AIDS, and at-risk sexual behaviors among older adults. Journal of the American Academy of Nurse Practitioners, 15, 11, 509–16.Google Scholar
Malta, S. and Farquharson, K. 2014. The initiation and progression of late-life romantic relationships. Journal of Sociology, 50, 3, 237–51.Google Scholar
Marshall, B. L. 2006. The new virility: Viagra, male aging and sexual function. Sexualities, 9, 3, 345–62.Google Scholar
Marshall, B. L. and Katz, S. 2002. Forever functional: sexual fitness and the ageing male body. Body & Society, 8, 4, 43–70.Google Scholar
Maticka-Tyndale, E., Adam, B. D. and Cohen, J. 2002. Sexual desire and practice among people living with HIV and using combination anti-retroviral therapies. Canadian Journal of Human Sexuality, 11, 1, 33–40.Google Scholar
McCormick, M. 2008. Women's bodies aging: culture, context, and social work practice. Affilia: Journal of Women and Social Work, 23, 4, 312–23.Google Scholar
Ménard, A. D., Kleinplatz, P. J., Rosen, L., Lawless, S., Paradis, N., Campbell, M. and Huber, J. D. 2015. Individual and relational contributors to optimal sexual experiences in older men and women. Sexual and Relationship Therapy, 30, 1, 78–93.Google Scholar
Minichiello, V., Hawkes, G. and Pitts, M. 2011. HIV, sexually transmitted infections, and sexuality in later life. Current Infectious Disease Reports, 13, 2, 182–7.Google Scholar
Neundorfer, M. M., Harris, P. B., Britton, P. J. and Lynch, D. A. 2005. HIV-risk factors for midlife and older women. The Gerontologist, 45, 5, 617–25.Google Scholar
Nevedal, A. and Sankar, A. 2016. The significance of sexuality and intimacy in lives of older African Americans with HIV/AIDS. The Gerontologist, 56, 4, 762–71.Google Scholar
Nokes, K. M., Nicholas, P. K., Rivero, M., Rosa, M. E., Kirksey, K., Moezzi, S., Corless, I. B., Maryland, M., Willard, S., Robinson, L., Hamilton, M. J., Sefcik, E., Wantland, D., Holzemer, W. L. and Portillo, C. 2011. Sexual function in younger and older HIV+ adults in the United States and Puerto Rico. Ageing International, 36, 3, 334–45.Google Scholar
Önen, N. F., Shacham, E., Stamm, K. E. and Overton, E. T. 2010. Comparisons of sexual behaviors and STD prevalence among older and younger individuals with HIV infection. AIDS Care, 22, 6, 711–7.Google Scholar
O'Rand, A. 1996. The precious and the precocious: understanding cumulative disadvantage and cumulative advantage over the life course. The Gerontologist, 36, 2, 230–8.Google Scholar
Paillé, P. and Mucchielli, A. 2012. L'analyse Qualitative en Sciences Humaines et Sociales. Armand Colin, Paris.Google Scholar
Potts, A., Grace, V. M., Vares, T. and Gavey, N. 2006. ‘Sex for life’? Men's counter-stories on ‘erectile dysfunction’, male sexuality and ageing. Sociology of Health & Illness, 28, 3, 306–29.Google Scholar
Prati, G., Mazzoni, D. and Zani, B. 2014. Psychosocial predictors and HIV-related behaviors of older adults versus late middle-aged and younger adults. Journal of Aging and Health, 27, 1, 123–39.Google Scholar
Psaros, C., Barinas, J., Robbins, G. K., Bedoya, C. A., Safren, S. A. and Park, E. R. 2012. Intimacy and sexual decision making: exploring the perspective of HIV positive women over 50. AIDS Patient Care and STDs, 26, 12, 755–60.Google Scholar
Russel, C. 2007. What do older women and men want? Gender differences in the ‘lived experience’ of ageing. Current Sociology, 55, 2, 173–92.Google Scholar
Sandberg, L. 2011. Getting Intimate: A Feminist Analysis of Old Age, Masculinity and Sexuality. Linköping University Electronic Press, Linköping, Sweden.Google Scholar
Sandberg, L. 2013. Just feeling a naked body close to you: men, sexuality and intimacy in later life. Sexualities, 16, 3/4, 261–82.Google Scholar
Schiltz, M.-A., Bouhnik, A.-D., Préau, M. and Spire, B. 2006. Sexuality of HIV positive people: the impact of a sexual transmitted infection. Sexologies, 15, 3, 157–64.Google Scholar
Schope, R. D. 2005. Who's afraid of growing old? Gay and lesbian perceptions of aging. Journal of Gerontological Social Work, 45, 4, 23–39.Google Scholar
Schwartz, P., Diefendorf, S. and McGlynn-Wright, A. 2014. Sexuality in aging. In Tolman, D. L. and Diamond, L. M. (eds), APA Handbook of Sexuality and Psychology. Volume 1: Person-based Approaches. American Psychological Association, Washington DC, 523–51.Google Scholar
Settersen, R. A. 2006. Aging and the life course. In Binstock, R. H. and George, L. K. (eds), Handbook of Aging and the Social Sciences. Sixth edition, Academic Press, San Diego, California, 3–19.Google Scholar
Siegel, K. and Schrimshaw, E. W. 2003. Reasons for the adoption of celibacy among older men and women living with HIV/AIDS. Journal of Sex Research, 40, 2, 189–200.Google Scholar
Smit, P. J., Brady, M., Carter, M., Fernandes, R., Lamore, L., Meulbroek, M., Ohayon, M., Platteau, T., Rehberg, P., Rockstroh, J. K. and Thompson, M. 2012. HIV-related stigma within communities of gay men: a literature review. AIDS Care, 24, 4, 405–12.Google Scholar
Sontag, S. 1972. The double standard of aging. Saturday Review of Literature, 39, 29–8.Google Scholar
Strauss, A. and Corbin, J. 1998. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Second edition, Sage, Thousand Oaks, California.Google Scholar
Taylor, T. N., Munoz-Plaza, C. E., Goparaju, L., Matrinez, O., Holman, S., Minkoff, H. L., Karpiak, S. E., Gandhi, M., Cohen, M. H., Golub, E. T., Levine, A. M., Adedimeji, A. A., Gonsalves, R., Bryan, T., Connors, T., Schechter, G. and Wilson, T. E. 2016. ‘The pleasure is better as I've gotten older’: sexual health, sexuality, and sexual risk behaviors among older women living with HIV. Archives of Sexual Behavior, 46, 4, 1137–50.Google Scholar
Vares, T. 2009. Reading the ‘sexy oldie’: gender, age(ing) and embodiment. Sexualities, 14, 4, 503–24.Google Scholar
Vespa, J. 2009. Gender ideology construction: a life course and intersectional approach. Gender & Society, 23, 3, 363–87.Google Scholar
Wallach, I. 2013. De l'acceptation à la résistance: expériences et gestion des changements de l'apparence chez les femmes vieillissant avec le VIH. Recherches féministes, 26, 2, 145–63.Google Scholar
Wallach, I., Ducandas, X., Martel, M., Trottier, B. and Thomas, R. 2013. Le VIH et le vieillissement au Québec. Une recherche qualitative sur les expériences, les difficultés et les besoins des personnes vivant avec le VIH de 50 ans et plus. Rapport de recherche. Available online at http://realizecanada.org/wp-content/uploads/Wallachetal_2013_RapportVIHvieillissement1.pdf [Accessed 07 April 2017].Google Scholar
Walz, T. 2002. Crones, dirty old men, sexy seniors: representations of the sexuality of older persons. Journal of Aging and Identity, 7, 2, 99–112.Google Scholar
Watson, W. K., Bell, N. J. and Stelle, C. 2010. Women narrate later life remarriage: negotiating the cultural to create the personal. Journal of Aging Studies, 24, 4, 302–12.Google Scholar
Weeks, D. J. 2002. Sex for the mature adult: health, self-esteem and countering ageist stereotypes. Sexual and Relationship Therapy, 17, 3, 231–40.Google Scholar
Wentzell, E. and Salmerón, J. 2009. You'll ‘get viagraed’: Mexican men's preference for alternative erectile dysfunction treatment. Social Science & Medecine, 68, 10, 1759–65.Google Scholar
Zablotsky, D. and Kennedy, M. 2003. Risk factors and HIV transmission to midlife and older women: knowledge, options, and the initiation of safe sexual practices. Journal of Acquired Immune Deficiency Syndromes, 33, 2, S122–30.Google Scholar