Should Older Adults Be Taking HIV PrEP

While one might assume that the popularity of erectile dysfunction drugs like Viagra or Cialis is fueling these high transmission rates, the simple fact is that we, as a society, tend to assume that people over the age of 60 and 70 don’t have healthy, and even robust, sex lives.

Approved by the U.S. Food and Drug Administration in 2012, the once-daily pill strategy has been shown to reduce risk of HIV by around 96 percent in certain high-risk population.Yet despite government efforts to increase PrEP uptake, many older adults remain uncertain as to whether it is right for them, often citing medication cost or the burden of daily drug adherence as key barriers. Others, meanwhile, believe themselves adequately protected by condoms or by sexual activities considered to be of lower risk.

An HIV Advocate Questions PrEP Use in Seniors

Despite the current practice to get the newly infected on medical treatment," argued Sokol, "we know it takes years from the initial exposure to HIV until the first symptoms make themselves known. This could be as long as from eight to 12 years, or even 15. Sokol further questioned whether people of his age group, who may likely have medical concerns that require regular check-ups and lab tests, would be willing to submit to additional blood tests to monitor both their HIV status and possible drug side effects. And while Medicaid and most health insurance policies would cover PrEP in their drug formularies, the co-payments and deductibles could alone be prohibitive for some.

Arguments in Support of PrEP in Seniors

Despite lagging figures, PrEP usage was nearly four times higher among people in their mid- to late-40s than those in their 20s, suggesting that older age (as well as income, attitudes, and a greater awareness of preventive health in general) offered fewer barriers to treatment. Supporters of PrEP further point sexual attitudes and practices that can place many seniors at higher risk of infection. Among the concerns:

  • Condom use tends to decrease as one gets older, from 24 percent in persons aged 50-59 to as little as 17 percent in person aged 60-69.
  • 62 percent of men and 78 percent of women have never discussed their sexual health with a doctor since turning 50.
  • A number of studies have shown that older males often do not use condoms due to the inability to sustain an erection.
  • Additionally, many older women with HIV believe neither they nor their HIV-negative partner needs a condom because they are post-menopausal.
Avoiding HIV becomes even more imperative in older adults given that high incidence of co-existing medical conditions when compared to younger populations. HIV therapy can also be complicated in older adults as they are more likely to be treated for other conditions such as high blood pressure, cardiovascular disease, lung disorders, and diabetes. 

Making the Right Choice for You

Whether PrEP is the appropriate for you is something you and your doctor need to decide on an individual basis, with full disclosure of both the pros and cons of use based on your personal circumstances and risk. What it certainly is not is a one-size-fits-all solution.