Breaking the silence around senior LGBTQ+ sexual health

The myth that sexual activity fades with age is just that—a myth. Across the country, older adults are staying sexually active well into their 60s, 70s and 80s. A 2023 AARP survey found that 26% of 60 to 69-year-olds had sex weekly, as did 17% of those 70 or older.

But this comes with its own set of challenges. According to a 2024 Fair Health study, sexually transmitted disease (STD) diagnoses among adults 65 and older rose 23.8% between 2020 and 2023—the sharpest increase of any age group. HPV cases alone jumped more than 30% in seniors, while syphilis, gonorrhea and HIV also saw steep national gains.

Cultural silence on the issue isn’t helping matters. Seniors are rarely asked about sexual health, and many don’t raise the subject with their providers. “It takes a backseat, but it’s also that other things become more urgent and more pressing,” says Dr. Lisa Navracruz, a family physician and American Academy of HIV Medicine specialist at Neighborhood Family practice (NFP). “Yes, you might be older, you might not need a Pap smear anymore, but if you’re sexually active, you still need sexual health conversations. You still need to make sure that you’re getting screened regularly.”

For LGBTQ+ older adults, stigma adds another layer of risk. National surveys show LGBTQ+ elders are less likely to use senior centers or meal programs because of fear of discrimination (SAGE, 2022).

Higher transmission rates in Cleveland

In Cleveland, STD transmission numbers are especially concerning. “Locally, we are higher than the national averages in terms of prevalence,” says Dr. Lisa Navracruz, a family physician and American Academy of HIV Medicine specialist at Neighborhood Family Practice (NFP). “Older folks are not necessarily increasing at a faster rate, but we’re staying steady at this higher rate”.

Smaller community size and intergenerational dating can raise exposure. “In smaller communities, folks are building bridges that aren’t necessarily typical of what we would think of,” Navracruz says. “And that also introduces another level of exposure, which could be risky or not, depending on how those relationships are happening.”

When seniors do get diagnosed, the shock can be severe. “I have had many of my patients who haven’t had a partner in a while and reconnect with someone and think it doesn’t need to be something they worry about,” Navracruz says. “And then they’re totally floored and surprised when something comes back positive. It’s psychologically devastating.”

Meeting people where they are

Biology itself can work against older adults. “Acquisition risk is higher post-menopausal for women just because of breakdown of those cellular barriers,” Navracruz says. “It’s definitely easier for women to acquire any of these things vaginally post-menopausal.”

Yet using protection isn’t a given. “A lot of folks are just not into barrier methods,” Navracruz says. “They’ve considered it, they’ve tried it, and they’ve moved past it. Which then relies a lot on self-verification, right? Like, ‘the person said that they were tested,’ and that is something, but it might not be everything.”

At NFP, those lapses are part of the conversation. “We are family docs, and family docs take care of you for everything, all the time,” Navracruz says. “There is nothing that isn’t ours on the table to talk about with folks. We are your point of first contact and we take responsibility for your whole-person care.”

Sexual health screenings are built into everyday care. “We have some reminders built into our electronic health record that trigger providers, like, ‘Oh, you know, this person needs HIV screening or this person needs hepatitis C screening,’” Navracruz says.

NFP also makes sure patients are tested at the actual sites of exposure. “If people are having oral sex, they need to be asking their providers for throat swabs. If people are having rectal intercourse, they need to be making sure that they’re getting checked there,” Navracruz says. The clinic also provides on-site labs and vaccines for hepatitis A and B and works with the county on emerging needs, such as mpox vaccination.

Building relationships brings results

Contrary to popular assumptions, older adults are embracing HIV prevention. 

“The uptake of PrEP has been great with older gay and bi men,” Navracruz says. “Older folks’ lives are a little more stable. It’s easier for them to adhere… and we have a whole team here that you can send the message to. The prior auth will get worked out, the shipments will get worked out. It all works nice and smooth.”

Relationships are central to that model. “The easiest thing — and the thing I like the best about my particular practice—is I’ve gotten older with my patients,” Navracruz says. “We’ve built those trusted relationships with our patients over many, many years. Our goal when we see people is not to just see them briefly. We plan on you being part of our family at Neighborhood Family Practice for a very, very long time.”

That long-term commitment makes vulnerable conversations less daunting. “Coming to the doctor is a very vulnerable thing,” she says. “None of us are perfect human beings, but this is part of whole-person care. Everyone deserves to have a medical provider who gets to know them, who gets to know what their goals are and what their wants are. This isn’t only a game of younger folks. We are all human and we are all susceptible to the same stuff. It doesn’t matter how old you are.” 🔥

IGNITE ACTION

• Learn more about Neighborhood Family Practice’s health and wellness services for elders by visiting their website or giving NFP a call at (216) 281-0872.