Sexuality and aging: Is it time for a new sexual revolution?

People in Western cultures live increasingly longer, and medical advancements, health care availability, and lifestyle changes have widened the possibilities of continued sexuality, sexual activity, and sexual diversity well into older adulthood. Yet, research studies have mainly eschewed discussions of sexual possibilities. Although studies have examined the benefits of sexual activity, often they focus purely on sexual function and sexual dysfunction, physical limitations, and the practicalities (such as finding a partner) of sex as persons age. This commentary posits that, in many instances, the social constraints around aging and sexuality inhibit sexuality in older adults in ways that may be more significant than functional or practical limitations. Portrayals in the media either reinforce social norms of the asexual older adult or portray images of the "sexy oldie" that may be unattainable for many older adults. We provide a brief review of sexuality research and prevailing sexual social norms. As Towler et al.'s (2021) elaborate study illustrates, many sexually active older adults struggle with ageism, stigma, and shame arising from the perceived social unacceptability of their sexuality. Studies of older adults from other Western countries reveal similar stories. Accordingly, achieving sexual well-being may be more dependent on changing social norms around sexuality and aging than on discovering new arousal medication to treat physical limitations. Moreover, we advocate for changing the social and academic dialogue from successful aging, which requires maintaining health and vitality-to the aging experience, which incorporates aspects of positive aging such as sexual wisdom, sexual experience, and the sexual diversity that comes with older adulthood. This "new sexual revolution" would elevate sexuality and aging as socially admirable and desirable.

Pleasure and PrEP: A Systematic Review of Studies Examining Pleasure, Sexual Satisfaction, and PrEP.

Pre-exposure prophylaxis (PrEP) is an effective form of Human Immunodeficiency Virus (HIV) prevention for people at potential risk for exposure. Despite its demonstrated efficacy, PrEP uptake and adherence have been discouraging, especially among groups most vulnerable to HIV transmission. A primary message to persons who are at elevated risk for HIV has been to focus on risk reduction, sexual risk behaviors, and continued condom use, rarely capitalizing on the positive impact on sexuality, intimacy, and relationships that PrEP affords. This systematic review synthesizes the findings and themes from 16 quantitative, qualitative, and mixed methods studies examining PrEP motivations and outcomes focused on sexual satisfaction, sexual pleasure, sexual quality, and sexual intimacy. Significant themes emerged around PrEP as increasing emotional intimacy, closeness, and connectedness; PrEP as increasing sexual options and opportunities; PrEP as removing barriers to physical closeness and physical pleasure; and PrEP as reducing sexual anxiety and fears. It is argued that positive sexual pleasure motivations should be integrated into messaging to encourage PrEP uptake and adherence, as well as to destigmatize sexual pleasure and sexual activities of MSM.

The Impact of COVID-19 on Access to HIV Prevention Services Among Opioid-Dependent Individuals.

The COVID-19 pandemic has necessitated restrictive orders and programmatic changes that may be associated with disruptions in services, including those for opioid-dependent people who inject drugs (PWID). This study aims to assess the impact of COVID-19 pandemic on access to and utilization of various HIV prevention services among PWID with opioid use disorder (OUD). We interviewed 110 PWID enrolled in medication for opioid use disorder (MOUD) treatment (e.g., methadone) between May and October, 2020 to identify if this sample experienced changed in access to the following services due to the COVID-19 pandemic: (a) HIV or sexually transmitted infection (STI) testing, (b) pre-exposure prophylaxis (PrEP) services, (c) HIV counselor or doctor appointments, and (d) clean injection equipment. A majority of the sample reported that COVID-19 had not changed their access to HIV testing or access to STI testing. Almost half of the sample reported that getting an appointment with a doctor decreased due to COVID-19. Participants reported that access to a lab or blood testing, access to injection equipment, and sessions with a case manager or counselor decreased. One-fourth of the 32 participants who were taking PrEP before the onset of COVID-19 reported that they had trouble getting their PrEP prescription due to COVID-19, and some reported that they had difficulty getting the PrEP prescription filled at their pharmacy. Our results indicate that PWID did not experience reduced access to HIV or STI testing, but difficulties in obtaining appointments with HIV counselors or doctors and limited access to PrEP were presented. Innovative strategies are needed to reduce the adverse effects of COVID-19 on HIV prevention among PWID.