Lisa Bernstein, MD
Lisa Bernstein, MD, assistant professor, general medicine, Emory University School of Medicine, Atlanta, Georgia.
It’s common to think of the risk for sexually transmitted diseases as just a problem for young people — and it’s also wrong. While media campaigns encourage younger folks to practice safe sex and get HIV testing if they’ve taken chances, new research makes clear that resources also need to be focused on educating the older set about risk — particularly women.
I recently read that Lisa Bernstein, MD, and a team of researchers at Emory University School of Medicine, had assessed the knowledge of older women about sexual transmission of the HIV virus. Though this was a particular population of inner city women of low income and educational status, I realized as I was reading the findings that their story had relevance to lots of women I know. What you don’t know can hurt you — especially if you are sexually active. Those with multiple partners are clearly at risk. Sadly, as headlines have revealed all too often, people may wrongly believe they are in a monogamous relationship when in fact a partner’s infidelity has put them at risk.
In the study I was reading, researchers found that the majority of women were at moderate or high risk and didn’t realize their risk status. Three-quarters considered their risk level to be low, but Dr. Bernstein told me that more than half (55%) were actually at moderate or high risk. “That’s a big difference between their perception and the reality,” she noted.
In this study, researchers asked 514 women (patients at a medical clinic that provides free or low-cost health care) nine questions to test their awareness about the risk of HIV transmission and prevention, assigning one point for each question answered correctly. Not a single participant knew the answers to all nine questions and the average knowledge score was just 3.7 — not even half. The most frequently identified source of information on the HIV virus and how it is transmitted was television. The women weren’t hearing about HIV from their doctors. “Health care providers aren’t talking to these women about HIV,” Dr. Bernstein said when we discussed these findings.
When researchers asked the study participants whether they would be interested in being tested that same day for HIV, only 22% said yes. Most cited as the reason for their lack of interest that they didn’t feel they were at risk. “The less they knew, the less they wanted to be tested,” said Dr. Bernstein.
Given that the study was done at a clinic in an inner-city hospital, socioeconomic status was a factor. Even though some of these women now practice safe sex, many had engaged in high-risk behaviors and most had never been tested. Their risk factors include having had sexual intercourse with a high-risk male partner in the past or having more than six sexual partners since 1978. There was clearly a major disconnect between perceived and actual risk.
The important finding from this study relates not to the personal histories of these women but to the broader implications, said Dr. Bernstein. “Older women are an overlooked population. They are still sexually active yet they haven’t been the target of media attention and their health care providers aren’t talking to them about HIV.” With stories in the news about the infidelity and dangerous practices of even people in long-term marriages, it’s evident that doctors need to start educating older people about being tested for sexually transmitted diseases. “Even though older Americans haven’t been the target of the educational efforts on sexually transmitted diseases, they should be — because they, too, are at risk,” says Dr. Bernstein.