HIV and Older Adults; a Forensic Perspective

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Nurses are actively involved in HIV/AIDS prevention, care, treatment and support. Their expertise and commitment positions them to effectively identify best practices and innovative strategies addressing the needs of individuals, families and communities.

Older adults, including those that are residents of residential facilities often continue to be sexually active. Why then has the profession neglected to identify the increased vulnerability of this population?

For many people working with older adults in residential facilities there appears to be an ethical dilemma surrounding this topic. Individuals have failed to acknowledge that “grandma and grandpa” might still be doing “it”, or prefer not to think about it. However, we have all learned about Maslow’s Hierarchy of Needs, yet when it comes to physical pleasures – kissing, cuddling or couples sleeping in the same bed or other forms of sexual expression; health care professionals and resident care workers, as well as, families chose to ignore this need in our elderly or older adults.

Working in health promotion in a college setting, I purchase approximately one-half million condoms each year, which are liberally distributed to students in the name of safer sex. Can the same be said for residential facilities for the older adult?

This ethical dilemma is one that many have faced. How to meet the needs of older adults by respecting their rights to chose behaviors that may conflict with the family’s need to ignore sexuality or protect the person and our need to always control the environment of institution – thereby refusing closed doors and privacy for intimacy, or making condoms available for individuals not able to obtain them on their own.

The face of the HIV epidemic has changed in recent years and it is important for nurses to be aware of the transmission risks of this population. Nurses have a role to play, both in advocating for the availability of condoms, providing information to clients that they may need to keep them safe and thirdly, to develop an open-mindedness.

Applying the Steps for Ethical Decision-Making will aid health care professionals recognize, discuss and hopefully develop tolerance of non-threatening behaviors.

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