Many studies have shown that sexual minorities have higher rates of STDs than heterosexuals, but does this pattern apply to older adults? Florida State University Ph.D. alumnus, Lacey Ritter and Professor of Sociology, Koji Ueno sought to answer this question in an article titled, “Same-Sex Contact and Lifetime Sexually Transmitted Disease (STD) Diagnoses Among Older Adults.” The article was recently published in Journal of Aging and Health.
Past studies have proposed several key explanations for sexual minorities’ higher rates of STD rates. For example, some sexual minority subgroups perceive lower risks of STD infection and thus are more likely to take sexual risks than heterosexuals. Sexual minorities also experience stress in everyday life due to marginalization in society, which may manifest into various emotional and behavioral responses including sexual risk-taking. Further, some sexual minorities face financial barriers to health care due to discrimination and their lower chance of obtaining health care through spouses.
Ritter and Ueno analyzed data from the National Social Life, Health, and Aging Project (NSHAP), which included measures of STD diagnoses among approximately 2,500 adults aged 57 and older. They determined study participants’ sexual orientation by whether the participants had any same-sex sexual contact in their lifetime (defined as sexual minorities) or not (defined as heterosexuals). The authors found that sexual minority older adults reported 2.37 times as many STD diagnoses as the heterosexual counterpart. This difference persisted even when controlling for sex, race, education, age, military status, and any past incarceration.
The study also reported that this difference in STD rates between the two groups was partially explained by sexual minorities’ higher numbers of sexual partners in their life time (13.87 partners on average) than heterosexuals (6.28 partners on average).
This difference was fairly consistent across different types of STDs. Compared to the heterosexual counterpart, sexual minority older adults reported higher lifetime diagnoses of five out of six STDs. The exception to this pattern was Chlamydia, for which heterosexual older adults were more likely to receive diagnoses in their life time although the difference was too small to reach statistical significance.
Perhaps the difference in STD diagnoses reflects the fact that some people tend to engage in unconventional sexual behaviors (i.e., same-sex contact) and also take sexual risks? The authors actually considered the possibility and accounted for the factor by using a statistical technique called propensity score matching. This technique calculates “propensity” to engage in same-sex contact and examine STD difference between sexual minorities and heterosexuals who have similar levels of propensity for such a behavior. Even with this stringent test, sexual minorities reported more lifetime diagnoses than heterosexuals.
The study used sexual contact an indicator of sexual orientation, and an obvious drawback is that people who reported having same-sex contact may not identify as gay, lesbian, or bisexual. But this is also a strength of the approach especially for older adults, who may be hesitant to identify as gay, lesbian, or bisexual because they grew up observing serious stigma attached to non-heterosexual orientation. The approach thus helps look at a broader sexual minority population.
This research calls for greater attention from policy makers and researchers because sexual orientation differences in STDs may exacerbate sexual minorities’ disadvantages in overall health status and quality of life in the older adult population.
The project began as part of Dr. Lacey Ritter’s dissertation, for which Dr. Ueno served as the advising faculty. Dr. Ritter is now an Assistant Professor in Sociology at Wingate University, North Carolina.
Dr. Koji Ueno is a Professor of Sociology at Florida State University. Dr. Ueno studies sexuality, mental health, and the life course.
The feature image is from STDCheck.com.