Untitled Document

RESEARCH ARTICLES

 

The perception of the elderly man about sexuality and AIDS

 

Juliana Barbosa ArduiniI; Álvaro da Silva SantosII
INurse by the Federal University of Triângulo Mineiro. Uberaba, Minas Gerais, Brazil. E-mail: julianabarduini@yahoo.com.br
IINurse. Ph.D. in Social Science. Adjunt Professor II at Federal University of Triângulo Mineiro. Department of Nursing in Education and Communitary Health. Uberaba, Minas Gerais, Brazil. E-mail: alvaroenf@hotmail.com
IIIArticle as part of research project - Sexuality and AIDS: the representations of the elderly and his family, funded by the National Council of Scientific and Technologic Development and developed during the period from August 2010 through July 2011.


ABSTRACT: The objective of this study is to understand and analyze the perceptions of older men in relation to sexuality and AIDS. This is a qualitative research, which used focus group and content analysis, and was held between 2010 to 2011, with ten elderly men, users of a health unit in the city of Uberaba/MG, Brazil. The main results were: sexist idea about sexuality, relationship of slow performance of sexuality associated to the use of medicines, diseases and condom use; ignorance about AIDS and groups at risk, as well as AIDS related to death. The results show the need for health education activities, greater involvement of the media and public policy for elderly men to improve sexuality with the prevention of AIDS.

Keywords: Elderly; men’s health; sexuality; Acquired Immunodeficiency Syndrome.


 

INTRODUCTION

 

The story of life of men and women reflects their situation in agingIII. Biological setting, the life journeys, the roles and social norms, determined every one of the genres, will be reflected in the way men and women grow older, and also like they see this process and its various facets, such as sexuality, as well as its action on Sexually Transmitted Diseases (STD), in particular the Human Immunodeficiency Syndrome (AIDS).

The old man is not associated with sexual activity but he is associated with the impotence or sexual dysfunction. However, this man remains sexually active without the use of preventive methods. It is consensus that the man is limited his search to health service only in extreme situations. It is possible that this demand is even smaller when dealing with issues about his sexuality.

Participation in groups for the elderly is common among them, however these groups little is discussed about sexuality, prioritizing the leisure and entertainment1.
The objective of this study was to understand and analyze the perceptions of elderly men in relation to sexuality and AIDS.

REVIEW OF THE LITERATURE

The elderly population considered potentially with active sex life tends to be reduced compared to the elderly population. In 2000, for every person aged 65 or more had 12 people considered potentially active, the projections for 2050 suggest that for each elderly there will be little less than three people in active group2.

The elderly population is mainly female, there is a greater and growing proportion of women among the population segment with 60 years or more. This aspect generates more attention as a result of health planners to develop programs that meet this demand population, giving priority to women's health and segregating the health-illness process of male population3. The fact of having a feminization of old age does not justify the absence of care, incentives and actions directed to the health of the elderly man.

Sexual behavior relates to several principles such as culture, religion, education, values that influence sexual development, their experience and the way to deal with it throughout their lives. From this, the demonstrations and sexual perceptions during aging are comprise, and not generalization of different expectations of men and women4.

METHODOLOGY

The study had qualitative approach. This type of research relates to meanings that people attribute to their experiences trying to interpret social phenomena from fundamental questions and researchers about their nature5.

The researchers were older men, with 60 years or more, registered in a group to control systematic arterial hypertension (SAH) and diabetes mellitus (DM) - Hiperdia, of a Family Health Team (FHT) belonging to the Health District I in Uberaba/MG.

Data collection focal group technique was used, because it is a simple technique where the individual's perspective is shifted to the social group. Through the discussion among the participants, focused on specific topics, it facilitates the interaction and knowledge of community aspirations expressed by itself6.

There were listed as criteria for inclusion: male, age 60 years or more, register on Hiperdia of the FHT, and accept to participate in the research. The subjects were informed about the goals and purposes of the study, and later signed the Free and Informed Consent (FIC).

10 elderly men participated in this study, five in each group. Two focus groups were held, in the months of December 2010 and January 2011. Each meeting lasted about 35 minutes.

The questions that guided the interviews were: what is the meaning of sexuality before and after 60 years?; What is your knowledge of the Sexually Transmitted Diseases (STD), HIV/AIDS, and the prevention ways?.

After the interviews, the testimonials written were transcribed and subjected to content analysis technique of Bardin7.  To analyze under this optics, it is searched to systematize the contents of the message and its meaning, the semantics of messages is caught, and the communication process is understood in its entirety. The members received a letter, corresponding to their group (A and B), and a sequential number within the Group (1 to 5).

This project was approved by the Research Ethics Committee of the Federal University of Triângulo Mineiro, under n° 1583/2010.

The analysis of transcripts showed six categories: the woman does not feel the same sexual libido; The use of the male condom limits sexual satisfaction; The sexual potency can be changed by the use of drugs and diseases; Prevention is not required for married men and faithful; Old way of identifying risk groups (homosexual); Ignorance about AIDS and association with death.

RESULTS AND DISCUSSION

10 elderly men Participated in the research, divided into two groups. The age ranged from 60 to 88 years, and most were married.

The woman does not feel the same sexual libido.

According to the researchers, the initiative for the sexual act begins with the man, the woman does not manifest her desires, by absence or feel them in less frequently.

Because those seeking is the man, the woman hardly seeks.(B3)

The fact that women do not demonstrate the same voracity and the same sex desire, gives as justification for the betrayal. A study of adult married men8 reinforces the understanding noted in this research that fidelity in marriage depends on the female behavior.

It is easy to understand the sexist point of view, to take into account that often the elderly belongs to a generation in which even the woman was not recognized on their rights, including in terms of sexuality. The education they received, in the past, was the natural expression of repressive sexuality and was limited or favored a type of impoverished by rigid moral sexual intercourse9.

For individuals from other study10, carried out in an area frequented by old men, old age is experienced with difficulty for women, they lose their libido, but men can have an active sex life even until 90 years old.

With advancing age the testosterone levels in women tend to fall and testosterone is related directly with the sexual appetite. Taking into account this assertive comprises partly reducing menopausal female pleasure11. However, there are several profiles of women and each one handles their sexuality of a distinct form, and despite some physiological changes, can keep sexual interest and libido.

The use of the male condom limits sexual satisfaction

The elderly have implied the prerogative that the sexual act becomes satisfactory and complete with the use of the male condom.

Because it is really an incomplete relationship [...].(B4)

You know to me it's very dull [...]I don't agree [...].(A3)

Some studies done with students12,13 corroborate the idea that condom use is disadvantageous because it decreases the sensitivity of the sexual act, leading to discomfort and an artificial feel. In another study, it was found that there is no knowledge of the correct way of handling it. This result confirms another research, carried out with young people, in which the majority has shown do not understand the steps of condom use14.

The sexual potency can be changed by the use of drugs and diseases

The elderly related diseases arising with senescence, and the use of drugs as triggering factors of sexual decrease. Hypertension was the main illness remembered. Cardiovascular diseases, most of the time, act as a complicating factor interfering in sexual activities, whether by psychological implications that such diagnoses cause, either by the use of drugs that trigger erectile dysfunction and/or loss of libido15.

The pressure rises [...] then you take medicine [...]. (A3)

The drugs affect us. To me, attacked me before because of disease, because I suffered stroke twice.(B5)

Some medications affect sexual performance, antihypertensives and diuretics are the most commonly cited15. The main factor is the reduction of blood flow to the penile region.

A study comparing men with and without sexual dysfunction, showed that those with dysfuncion had less information about sex during childhood, more difficulty at the beginning of sexual life, complained more of less sexual desire, reported often rapid ejaculation, considered the quality of sexual life unsatisfactory, have less stable links with their partners and more extramarital relations16.

The use of drugs that treat sexual dysfunction was not quoted by the subjects of this research, or they do not use it, even complaining that the problem exists, or do not accept its use.

Prevention is not required for married men and faithful

The notion of protection during the sexual act refers to a matter of debauchery and promiscuity, since one who requires protection does not have a fixed partner, a stable relationship.

If you go out [from home] you are taking a great risk, you have to use a condom. (B4)

This for those who are starting now, it is very necessary [...]. (A4)


Condom [...] for the person who is at that age, [the elder] only if it does not have its own partner [...]. (B5)

The elderly is unaware of the danger, because for him, married men are protected from acquiring any STD, unless he resolves to leave the marriage. This idea allows to infer that the extramarital relationships, relate directly to sexually transmitted diseases, which supports another study8.

It should be noted that, historically, the use of condoms has always been associated with the practice of promiscuity, prostitution and extramarital behavior, causing incredulity and loss of respect17.

Old way of identifying risk groups (homosexual);

The elderly of this study cite homosexuals as the main actors when it comes to AIDS transmission.

 [...]the first time we had news [...]was the famous fashion designer [...] he died with AIDS, he was homosexual.(A4)

Gays looks more for men. And still transmitting the disease.(B2)

Some impressions persist since the emergence of the epidemic, others gained new meanings with the advent of treatment, but AIDS still appears, according to common sense, as the illness of others, of those who adopt deviant sexual behavior, such as homosexuals, injection drug users and prostitutes18.

The concept of risk groups is exceeded, the media convey the idea of risk behavior and vulnerability19. It is understood that people spend to have behaviors that make them vulnerable to HIV and there is, therefore, selected groups that tend to a greater risk than the other.

This preconceived idea of the elderly, that homosexuals are responsible for the accelerated spread of AIDS, reflects the downgrading as increasing indices of disease among heterosexuals and women. The homosexual or bisexual male cases in the period from 1980 to 1988, corresponded to 5,083 (63.6%) of the total number of cases, while women accounted for 839 (10%), in the period of 2001 to 2004 women accounted (38.7%), 37,976 heterosexuals 23,366 (33.3%) and male gay and bisexual 17,303 (18.3%) of AIDS cases20.

Ignorance about AIDS and association with death.

Study participants bring the idea that there are no alternatives to the person who contracted AIDS, being that after their diagnosis only remains await moments of suffer, sorrow, pain and the arrival of death.

I am not aware [...].(A5)

AIDS is a disease that has no cure, as cancer is not curable, also never was found the remedy to combat the cancer. And AIDS the same way [...].(B2)

Oh the feeling is the death [...]the person when gets sick and starts suffering [...]suffering [...]then it goes on to ask the death [...].(A1)

It is curious, therefore, to note that while the disease spreads among the elderly, it is still unknown, is ignored and its meaning is permeated by myths and beliefs most often erroneous, fed by themselves and not discussed with health professionals.

When comparing, for example, the number of cases of AIDS identified in Minas Gerais, in the age group that corresponds to individuals between 50 to 80 years or more, in 1990 (20 cases) and 2010 (467 cases), a growth of approximately twenty times more cases apperaed, over a period of 10 years21.

AIDS was constantly associated to death among the participants of the group, this may be understandable since in the late 1980 to the mid-1990, it was responsible for a considerable number of deaths, especially in individuals from 15 to 49 years of age, in several countries. This close relationship with crash mortality decreased after the introduction of anti-retroviral drugs in Brazil, from 199622.

In a study23 performed with elderly patients with AIDS, it was observed that the shortcomings related to the knowledge of the syndrome is confirmed and is consensus among them that their information, before acquiring such illness, was scarce/insufficient.

CONCLUSION

As regards the perception of the old man there is an unequal relationship. The elderly brings with it a sexist vision about sexuality and their different possibilities for men and women in old age. They are able to recognize certain diseases and medicines as limiting of their sex life. The male condom is resistance on the part of this portion of the population, related to the inexperience/ignorance as to its use and not realize how susceptible individuals to the risks of an STD and AIDS. With regard to AIDS, they do not see therapeutic possibilities and its strong association with death.

As limitations of this study, one cannot make generalizations of its results, due to the low number of participants.

The need for health education is necessary to the old man. Effective actions can help reduce infection rates, the lack of knowledge are minimized, and prejudices are overcome by a differentiated look about the woman.

 

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