Is PrEP Safe for Seniors?

The rules of sex do not change when you get older — awkward sex and surprise cases of chlamydia suck at any age. But how we prevent HIV transmission is certainly evolving. PrEP use is seeing an uptick among people older than 50 and here’s why: an estimated 42 percent of Americans living with diagnosed HIV are aged 50 and older, reports the Centers for Disease Control and Prevention.

According to HIV.gov, people over 50 are also less likely to be tested for HIV than younger adults. In addition, less than 10 percent of people over 50 wear a condom during sex, even though the CDC estimates that 17 percent of new HIV infections occur in people 50 and over. 

People living with HIV over 50 may have partners who can’t use a condom because it’s harder to sustain an erection. Because most women tend to associate condom usage with unwanted pregnancies, once they hit menopause (where pregnancy is no longer a threat), they may not insist on using condoms, either 

“Age is just a number and HIV and STIs do not discriminate based on age, sexual orientation, gender identity, and a host of other factors,” says Kelsey Louie, the CEO of GMHC. “For that very reason, menopause doesn’t change the need to practice safe sex.” 

While our immune systems become less robust with age, PrEP is still an important tool to prevent HIV transmission if your partner is HIV-negative. Navigating PrEP in addition to comorbidities like high blood pressure, diabetes, and osteoporosis, should be handled strategically with your healthcare provider to prevent any possible interactions with other meds. A recent report showed that adverse kidney changes due to using Truvada—the only medication currently approved as PrEP—are rarely serious and usually reverse after stopping the medication. But, because Truvada can cause bone and kidney problems in some cases, consistent monitoring is necessary. 

The physical changes of aging increase everyone’s susceptibility to STIs. For cisgender women and transgender men who haven’t had bottom surgery, the vaginal wall gets thinner due to loss of estrogen. This can increase risks of HIV transmission, but that’s information rarely shared by healthcare providers. 

Regardless of age, those in serodiscordant relationships (where one partner is HIV-positive and the other is negative) should always consider PrEP; unless the poz partner is undetectable — in which case they can no longer transmit HIV.