We call on the Department of Health and Human Services for a policy change to include the population 55+ in the priority population and tailor toolkits and programs for STI prevention in this age group.
Historical public sector stakeholders in STI prevention
A committee report published in 2021 commissioned by the Center of Disease Control and Preventions (CDC) recounted the history of sexually transmitted diseases (STIs) prevention. According to this report, public interest organizations, such as the American Social Hygiene Association partners with the U.S. Armed Forces and Public Health Service took charge of sex education and efforts to prevent STIs in the early 20th century. Their strategies emphasized on the stigma and consequences of STIs (Crowley et al., 2021). These strategies influenced governmental policies. Social culture of blame and shame associated with STIs made discussing sexuality and sexual health difficult in the United States (Crowley et al., 2021).
Current public sector stakeholders in STI prevention:
In the federal level, The Department of Health and Human Services (HHS), as a policy setting agency, designated priority populations to focus its efforts and funding on STI prevention and treatments (HHS, 2020). However, despite the HHS’ efforts in the past two decades, STI rates are climbing. The CDC reported a downward trend of STIs in 2024. However, infection rates in people 55 and older continue to rise. Yet, the 55+ age group is not one of the priority populations identified by HHS.
The HHS Steering Committee “sets the vision, goals, and priority populations and discussed key challenges to be addressed in the STI Plan” (Crowley et al, 2021). The CDC developed several toolkits and programs for STI prevention, treatment, and monitoring based on the steering committee guidance. However, lack of priority population status and social bias of sexuality in older adults, resulted in the absence of imagery of older adults on the educational materials (Crowley et al., 2021).
Medicare and Medicaid cover screening and treatments for STIs. When they cooperate with other governmental agencies and private sector stakeholders, they can reach a larger portion of the 55+ population with the message and material support for inform, screen, and treat (Crowley et al., 2021).
In the state level, agency such as Arizona Departments of Health Services (ADHS), takes guidance from the federal agencies in setting local response plans in rising STIs. State health agencies allocate funding for STI management programs and generate reports on the trends of disease uptake, screening, and treatment (ADHS, 2024).
Private sector partners:
Providers, health organizations, and professional organizations
Penhallow (2024) stated only one in five healthcare providers routinely assess older adults of their sexual history and STI risks and prevention knowledge which can lead to the spread and untreated STIs. The American Medical Association (AMA) urged healthcare providers to start the conversation with their older clients on STI education and prevention (Lubell, 2025, January 6).
Senior advocacy groups
The American Association of Retired People (AARP) can be the catalyst in changing the social stigma of STIs and the myth that younger adults have the exclusive claim to sexual activity (Crowley et al., 2021). The AARP posted on their website educational materials about STI prevention and the importance of discussing sexual health with the healthcare providers. This (Goad, 2024, November 25).
Media and Social Influencers
News outlets, bloggers, and influencers focusing on senior health can play a key role in spreading accurate information and reducing stigma by addressing myths and misconceptions about sexuality in aging populations.
Private insurance and STI advocacy groups
They work with public agencies and health insurance to provide screening, education, and treatments for STIs. They can partner with public agencies and health professional organizations to raise awareness of STIs in older adults. This could lead to lower sick-care spending (Crowley et al., 2021).
You, the 55+
You are the most powerful stakeholder in STI prevention. You can empower yourselves by staying informed, talking to your providers and sexual partners about screening and protection (Goad, 2024, November 25). Age is not a preventative measure against STIs.
References:
Arizona Department of Health Services (2024). Sexually transmitted infections 2022. https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/disease-integrated-services/std-control/reports/2022-std-annual-report.pdf
Center for Disease Control and preventions (2024). Gonorrhea 2000-2023 [Data Set]. CDC. https://gis.cdc.gov/grasp/nchhstpatlas/charts.html
Crowley, J. S., Geller, A. B., & Vermund, S. H. (2021). Sexually transmitted infections: Adopting a sexual health paradigm. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Prevention and Control of Sexually Transmitted Infections in the United States. https://www.ncbi.nlm.nih.gov/books/NBK573147/
Goad, K. (2024, November 25). Is it an STI – or something else? AARP. https://www.aarp.org/health/conditions-treatments/info-2024/medical-conditions-that-mimic-sti-symptoms.html
Lubell, J. (2025, January 6). With STI on rise among older adults, here is what doctors can do. American Medical Association. https://www.ama-assn.org/delivering-care/population-care/stis-rise-among-older-adults-here-s-what-doctors-can-do
Penhollow, T. M. (2024). Sexuality in older adults: Comprehensive strategies for clinicians and patient-centered care. American Journal of Lifestyle Medicine.15598276241293100. https://doi.org/10.1177/15598276241293100
U.S. Department of Health and Human Services (2020). Sexually transmitted infections National Strategic Plan for the United States: 2021–2025. https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-2021-2025.pdf
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Hi Claudia!
Excellent blog post! I appreciate how you identified stakeholders throughout your article using bold and italicized headings, which makes it easy for readers to follow. Your blog explains how several key stakeholders, including historical and current public-sector figures and private-sector partners, are working to promote education and encourage safe sex practices among this population.
As a Women’s Health NP student, collecting sexual histories is a routine part of my day in the clinic; therefore, I was surprised to read how few healthcare providers routinely assess sexual history and STI risk and prevention knowledge in the older adult population. As noted in an article by Milien (2024), omitting discussions about safe sexual practices with older adults can have serious consequences, especially since at least two-thirds of adults over age 60 remain sexually active. As you mentioned in your post, the culture of shame and stigma surrounding sexually transmitted infections complicates this discussion, often leading it to be overlooked. According to Milien (2024) and the Centers for Disease Control and Prevention (CDC), the rise in STIs among this population is not new, and current research indicates that rates of chlamydia, gonorrhea, and syphilis have more than doubled among individuals aged 55 and older over the past ten years.
Co et al. (2023) discuss the multifactorial nature of the increase in STI cases among older people in a research article. The researchers elaborate on how older adults may engage in risky behaviors due to perceived lesser consequences, such as not using condoms, mainly since there is no concern for pregnancy in postmenopausal women (Co et al., 2023). The authors identify several interventions to address the rising trend of STIs among older adults, including enhancing their knowledge of STI risks, prevention methods, and safe sex practices (Co et al., 2023). Milien (2024) expands on these points, highlighting that older adults are currently the fastest-growing population in the United States and live longer than ever before. While the CDC and the American Academy of Family Physicians (AAFP) provide guidelines on the appropriate treatments and diagnosis of STIs, more research and advocacy work must be done to tailor these efforts to older adults.
References:
Co, M., Moreno-Agostino, D., Wu, Y. T., Couch, E., Posarac, A., Wi, T., Sadana, R., Carlisle, S., & Prina, M. (2023). Non-pharmacological interventions for the prevention of sexually transmitted infections (STIs) in older adults: A systematic review. PloS One, 18(5), e0284324-. https://doi.org/10.1371/journal.pone.0284324
Milien, C. (2024). Provider Education to Increase Sexually Transmitted Infections Screening Rates Among Older Adults Seen in Primary Care Practice. Journal for Nurse Practitioners, 20(10), 105202-. https://doi.org/10.1016/j.nurpra.2024.105202
Most people cringe at the idea of their grandparents or older parents having sex. Therefore, we adopt the out-of-sight, out-of-mind attitude and try not to consider it. However, by doing so, we ignore the implications unsafe sex practices in this population can have. This is why your attention to this important topic is much appreciated, as it is something with very real consequences that are affecting the overall health of our grandparents and older parents. In fact, as adults age, there comes a weakening of the immune system that could lead to increased susceptibility of HIV and other sexually transmitted infections (Fu et al., 2024).
Your examination of the stakeholders involved in this issue was very comprehensive and highlighted the important role the stakeholders play to make progress. However, there is always room for more improvement and to understand how to do so there must be attention to the barriers that these stakeholders face. In the care of the 55+, the primary beneficiaries, some barriers faced could include lack of social support, inaccessibility to resources, and stigma and shame. In the digital age of today’s society this population is at higher risk for being unaware how to access the plethora of online education and would more likely benefit from printed materials and in person conversation with medical professionals. This ties into another stakeholder you mentioned which are healthcare providers. Healthcare professionals may be naïve to sexual activity in other adults which can result in poor communication regarding sexual health and HIV risk (Fu et al., 2024). Additionally, healthcare providers may feel uncomfortable discussing this sensitive topic with their older patients. This coupled with time constraints of appointments and lack of screening protocols could result in missed opportunity for early identification of STIs and proper education.
While all the stakeholder you discussed play an important role in STI prevention in the older adult population, attention should also be placed on the barriers these stakeholders face in order to best understand how to make improvements in this critical topic.
Reference
Fu, L., Tian, T., Wang, B., Lu, Z., Bian, J., Zhang, W., Wu, X., Li, X., Siow, R. C., Fang, E. F., He, N., & Zou, H. (2024). Global, regional, and national burden of HIV and other sexually transmitted infections in older adults aged 60-89 years from 1990 to 2019: Results from the Global Burden of Disease Study 2019. The Lancet. Healthy Longevity, 5(1), e17–e30. https://doi.org/10.1016/S2666-7568(23)00214-3
Claudia,
Thank you for such an informational post! I agree that sexual transmitted infections are a topic that healthcare providers usually don’t focus on unless we suspect it based on the patient’s chief complaint during their visit.
All of the stakeholders involved in preventing STI in older adults play a big role in this matter and their efforts to stop this issue are definitely appropriate. I agree with you that the individuals in this age group are mainly responsible for their own health and education on topics such as STIs in order to minimize the number of infections and preventing their spread.
Smith et al. (2020) present a study conducted to assess the reliability of a sexually transmitted disease knowledge questionnaire and the overall knowledge of STDs in participants 65-94 years old. The conclusion of this study mentions the STD knowledge questionnaire to be a strong tool to assess the overall STD knowledge of individuals. Another conclusion presented by Smith et al. (2020) includes a suggestion to educate older adults on STDs based on the knowledge questionnaire results and the increasing prevalence of STDs among this population.
It is immensely important to educate older adults on the subject of STDs, but also, bring up the concept during their visits to have the ability to help and assist if the patient becomes at risk. I am glad that many stakeholders are involved in this matter and that each of them is cooperating so greatly to the issue of STDs in older adults.
References
Smith, M. L., Bergeron, C. D., Goltz, H. H., Coffey, T., & Boolani, A. (2020). Sexually transmitted infections knowledge among older adults: Psychometrics and test-related reliability. International Journal of Environmental Research and Public Health, 17(7), 2462. https://doi.org/10.3390/ijerph17072462