Risk factors and HIV transmission to midlife and older women: knowledge, options, and the initiation of safer sexual practices.

Despite the increased impact of HIV/AIDS on women in the United States, the HIV-related experience of mature and older women has been largely overlooked by behavior scientists. Appropriate strategies for increasing awareness, assessing personal risk, and implementing safer sex behaviors among women in their 50s or older have not been developed. Relative to knowledge of personal risk and self-protective measures, older women have lower levels of knowledge about HIV/AIDS and the effectiveness of condoms than their younger counterparts. Although a significant portion of postmenopausal women remain sexually active, little is known about how mature women in long-term relationships can initiate self-protective behaviors if they come to recognize a risk or how those who meet new sexual partners can be motivated to use condoms. Investigations regarding safer sexual practices must be conducted in a way that addresses biologic events (e.g., menopause), life course changes, and cohort effects. Rather than trying to generalize findings from studies performed with younger women, it is necessary to integrate risk reduction strategies into models of sexual health and well-being for women across their life course.