Abstract

This is a cross-sectional quantitative study carried out with 241 elderly diagnosed with HIV, assisted in the services of reference of Recife, Pernambuco State, Brazil. Knowledge and attitudes were evaluated through the Aging Sexual Knowledge and Attitudes Scale (ASKAS). Senior men, participants with higher educational level, those without depressive symptoms and individuals diagnosed with HIV for more than 12 years have a higher level of knowledge about sexuality in old age. Conservative attitudes toward sexuality in aging have been strongly associated with women, illiterate participants, practicing evangelical and Catholic religions, and elderly diagnosed with HIV with less than 12 years. Elderly with less knowledge had more conservative attitudes regarding sexuality in aging (r = 0.42; p < 0.0001). Thus, it is essential to carry out health actions with the aim of improving knowledge and attitudes regarding sexuality in the elderly, paying particular attention to those who are most vulnerable to HIV infection.

Key words
Knowledge; Sexuality; Elderly; HIV

Introduction

Few elderly were diagnosed during the first decade of the epidemic of acquired immunodeficiency syndrome (AIDS). However, this setting has been changing over the years¹1 Lazarus JV, Nielsen KK. HIV and people over 50 years old in Europe. HIV Med [Internet]. Agosto 2010 [acessado 2017 Dez 22];11(7):[cerca de 3 p.]. Disponível em: https://onlinelibrary.wiley.com/doi/epdf/10. 1111/j.1468-1293.2009.00810.x
https://onlinelibrary.wiley.com/doi/epdf... ^,22 Centers for Disease Control - CDC (USA). Persons aged 50 and older [Internet]. [acessado 2017 Dez 3]. Disponível em: http://www.cdc.gov/hiv/topics/over 50/index.htm
http://www.cdc.gov/hiv/topics/over 50/in... . Data from the Ministry of Health (MS) show that in Brazil, between the 1980s and 2000s, 4,761 cases of Human Immunodeficiency Virus (HIV) infection were reported in people aged 60 years or older, while between 2001 and 2016, this number hiked to 28,122 cases, which is a 700% increase³3 Brasil. Ministério da Saúde (MS). Boletim epidemiológico AIDS-ST. Brasília: MS; 2017..

It may be that increased life expectancy⁴4 Lisboa MES. A invisibilidade da população acima de 50 anos no contexto da epidemia HIV/AIDS. In: Anais do VII Congresso Virtual HIV/AIDS: O VIH/SIDA na Criança e no Idoso. 2007; Lisboa., use of hormonal therapies and the discovery of sexual potency-enhancing drugs are promoting a better quality of sexual life in the elderly population⁵5 Leite MT, Moura C, Berlize EM. Doenças Sexualmente Transmissíveis e HIV/AIDS na opinião de idosos que participam de grupos de terceira idade. Rev Bras Geriatr Gerontol [Internet]. 2007 [acessado 2017 Dez 23];10(3):[cerca de 15 p.]. Disponível em: http://www.unati.uerj.br/tse/.
http://www.unati.uerj.br/tse/... ^,66 Zornitta M. Os novos idosos com AIDS: sexualidade e desigualdade à luz da bioética [dissertação]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca; 2008.. On the other hand, these people were not alerted on the consequent vulnerability to Sexually Transmissible Infections (STIs) and HIV nor the importance of condoms⁶6 Zornitta M. Os novos idosos com AIDS: sexualidade e desigualdade à luz da bioética [dissertação]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca; 2008.^,77 Caldas JMP, Gessolo KM. AIDS depois dos 50: um novo desafio para as políticas de saúde pública. In: Anais do VII congresso virtual de HIV/AIDS. O VIH/SIDA na criança e no idoso. 2007; Lisboa. p. 127-131.. In contrast, the elderly’s sexuality has been neglected by the government⁸8 Santos AFM, Assis M. Vulnerabilidade das idosas ao HIV/AIDS: despertar das políticas públicas e profissionais de saúde no contexto da atenção integral: revisão de literatura. Rev Bras Geriatr Gerontol [Internet]. 2011 [acessado 2017 Nov 29];14(1):[cerca de 10 p.]. Disponível em: http://www.scielo.br/pdf/rbgg/v14n1/a15v14n1.pdf.
http://www.scielo.br/pdf/rbgg/v14n1/a15v... .

The senior population is not being included satisfactorily in national strategies aimed at the promotion of sexual health and the prevention of STI/HIV/AIDS. STI/HIV/AIDS prevention actions carried out by the National STD/AIDS Program (PN-DST/AIDS) prioritized those aged 50 years and over⁹9 Brasil. Ministério da Saúde (MS). Atenção à saúde da pessoa idosa e envelhecimento. Brasília: MS; 2010. only in 2008.

HIV prevalence in the population over 60 years of age grows as no other age group and is now a public health problem⁸8 Santos AFM, Assis M. Vulnerabilidade das idosas ao HIV/AIDS: despertar das políticas públicas e profissionais de saúde no contexto da atenção integral: revisão de literatura. Rev Bras Geriatr Gerontol [Internet]. 2011 [acessado 2017 Nov 29];14(1):[cerca de 10 p.]. Disponível em: http://www.scielo.br/pdf/rbgg/v14n1/a15v14n1.pdf.
http://www.scielo.br/pdf/rbgg/v14n1/a15v... . This increase is associated with the advance of HIV diagnosis and care technologies and widespread dissemination of antiretroviral therapy (ART)¹⁰10 Beck C. Análise de Sobrevida e perfil epidemiológico de casos de AIDS em Porto Alegre/RS: limitações e potencialidades da vigilância epidemiológica [dissertação]. Porto Alegre: Universidade Federal do Rio Grande do Sul; 2014.. Thus, as treatment access is improved, the survival of people with HIV increases, which causes many to reach old age¹¹11 Sankar A, Nevedal A, Neufeld S, Berry R, Luborsky M. What do we know about older adults and HIV? a review of social and behavioral literature. AIDS Care [Internet]. Outubro 2011 [acessado 2017 Nov 11];23(10):[cerca de 20 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199226/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,1212 The Joint United Nations Programme on HIV/AIDS (UNAIDS). Update: How Africa turned AIDS around. Geneva: UNAIDS/WHO; 2013..

In 2013, the Joint United Nations Program on HIV/AIDS (UNAIDS) recognized the growing population of older adults with HIV, as well as the fact that this population group is at risk of infection by the virus¹²12 The Joint United Nations Programme on HIV/AIDS (UNAIDS). Update: How Africa turned AIDS around. Geneva: UNAIDS/WHO; 2013.. When speaking about aging and AIDS, the first issue that must be addressed is the sexuality of the elderly¹³13 Brasil. Ministério da Saúde (MS). Envelhecimento e saúde da pessoa idosa. Brasília: MS; 2006..

Sexuality is an essential aspect of the human being and represents the interaction of various elements, including gender, identities and gender roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. People experience and express sexuality differently, through thoughts, attitudes, behaviors and relationships¹⁴14 World Health Organization (WHO). Care of girls and women living with female genital mutilation: a clinical handbook. Geneva: WHO; 2018..

Deconstructing the myth of an asexual old age¹¹11 Sankar A, Nevedal A, Neufeld S, Berry R, Luborsky M. What do we know about older adults and HIV? a review of social and behavioral literature. AIDS Care [Internet]. Outubro 2011 [acessado 2017 Nov 11];23(10):[cerca de 20 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199226/
https://www.ncbi.nlm.nih.gov/pmc/article... , several studies describe the elderly as sexually active persons¹⁵15 Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A, Suhr JA, Garske J P, Johnson CJ. Patterns and Correlates of Sexual Activity and Condom Use Behavior in Persons 50-Plus Years of Age Living with HIV/AIDS. AIDS Behav [Internet]. Novembro 2008 [acessado 2017 Nov 27];12(6):[cerca de 20 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575000/
https://www.ncbi.nlm.nih.gov/pmc/article...

16 Sormanti M, Shibusawa T. Predictors of Condom Use and HIV Testing Among Midlife and Older Women Seeking Medical Services. J Aging Health 2007; 19(4):705-719.

17 Huang AJ, Subak LL, Thom DH, Van Den Eeden SK, Ragins AI, Kuppermann M, Shen H, Brown JS. Sexual function and aging in racially and ethnically diverse women. J Am Geriatr Soc [Internet]. Agosto 2009 [citado em 8 de novembro de 2017];57(8): [cerca de 6 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749599/
https://www.ncbi.nlm.nih.gov/pmc/article... ^-1818 Laumann EO, Glasser DB, Neves RCS, Moreira ED. A population-based survey of sexual activity, sexual problems and associated help-seeking behaviour patterns in mature adults in the United States of America. Int J Impot Res [Internet]. 2009 Mai-Jun [acessado 2017 Dez 10];21(3):[cerca de 7 p.]. Disponível em: https://www.arca.fiocruz.br/bitstream/icict/9054/2/Laumann%20EO%20A%20population%20based....pdf
https://www.arca.fiocruz.br/bitstream/ic... . Interest and sexual activity continue to play an essential role in people’s lives as they age¹⁹19 Lindau ST, Schumm LP, Laumann EO, Levinson W, O'Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med [Internet]. Agosto 2007 [acessado 2017 Dez 19];357(8):[cerca de 12 p.]. Disponível em: https://www.nejm.org/doi/pdf/10.1056/NEJMoa067423
https://www.nejm.org/doi/pdf/10.1056/NEJ...

20 Serra A, Sardinha AHL, Lima SCVS, Pereira ANS. Perfil comportamental de idosos com HIV/AIDS atendidos em um centro de referência. Rev enferm UFPE on line [Internet]. Fevereiro 2013 [acessado 2017 Dez 15];7(2):[cerca de 5 p.]. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/10249/10861
https://periodicos.ufpe.br/revistas/revi...

21 Bertoncini BZ, Moraes KS, Kulkamp IC. Comportamento sexual em adultos maiores de 50 anos infectados pelo HIV. DST - J Bras Doenças Sex Transm [Internet]. 2007 [acessado 2017 Nov 20];19(2):[cerca de 4 p.]. Disponível em: http://www.dst.uff.br/revista19-2-2007/3.pdf.
http://www.dst.uff.br/revista19-2-2007/3... ^-2222 Golub SA, Tomassilli CJ, Pantalone DW, Brennan M, Karpiak SE, Parsons JT. Prevalence and Correlates of Sexual Behavior and Risk Management Among HIV-Positive Adults Over 50. Sex Transm Dis [Internet]. Outubro 2010 [acessado 2017 nov 29];37(10):[cerca de 6 p.]. Disponível em: http://www.natap.org/2010/HIV/CorrelatesSexual.pdf
http://www.natap.org/2010/HIV/Correlates... . According to the literature, a considerable proportion of older adults are involved in one or more sexual relationships²³23 Cooperman NA, Arnsten JH, Klein RS. Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS Educ [Internet]. Agosto 2007 [acessado 2017 nov 29];19(4):[cerca de 12 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505189/
https://www.ncbi.nlm.nih.gov/pmc/article...

24 Lima TC, Freitas MIP. Comportamentos em saúde de uma população portadora do HIV/AIDS. Rev Bras Enferm [Internet]. 2012 Jan-fev [acessado 2017 Nov 20];65(1):[cerca de 6 p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672012000100016.
http://www.scielo.br/scielo.php?script=s... ^-2525 Illa L, Brickman A, Saint-Jean G, Echenique M, Metsch L, Eisdorfer C, Bustamante-Avellaneda V, Sanchez-Martinez M. Sexual Risk Behaviors in Late Middle Age and Older HIV Seropositive Adults. AIDS Behav [Internet]. Novembro 2008 [acessado 2017 Nov 25];12(6):[cerca de 7 p.]. Disponível em: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.548.6331&rep=rep1&type=pdf
http://citeseerx.ist.psu.edu/viewdoc/dow... . Provided that there are no severe health problems, nothing prevents this group from having sexual activity at this life stage¹⁹19 Lindau ST, Schumm LP, Laumann EO, Levinson W, O'Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med [Internet]. Agosto 2007 [acessado 2017 Dez 19];357(8):[cerca de 12 p.]. Disponível em: https://www.nejm.org/doi/pdf/10.1056/NEJMoa067423
https://www.nejm.org/doi/pdf/10.1056/NEJ... .

The elderly have many of the risk behaviors found among younger people. However, with less knowledge about HIV contamination²⁶26 Weaver SP, Passmore C. Older adults' knowledge concerning risk factors for HIV transmission. Texas Academy of Family Physicians [Internet]. 2008 [citado em 7 de novembro de 2017]; 9 (1): [cerca de 5 p.]. Disponível em: https://www.tafp.org/news/tfp/summer-2008/research
https://www.tafp.org/news/tfp/summer-200... ^,2727 Negin J, Nemser B, Cumming R, Lelerai E, Amor YB, Pronyk P. HIV attitudes, wareness and testing among older adults in Africa. AIDS and Behav [Internet]. Janeiro 2012 [citado em 7 de novembro de 2017]; 16 (1): [cerca de 6 p.]. Disponível em: http://www.millenniumvillages.org/uploads/ReportPaper/HIV-Attitudes.pdf
http://www.millenniumvillages.org/upload... and relevance of condoms²³23 Cooperman NA, Arnsten JH, Klein RS. Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS Educ [Internet]. Agosto 2007 [acessado 2017 nov 29];19(4):[cerca de 12 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505189/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,2828 Nguyen N, Holodniy M. HIV infection in the elderly. Clin Interv Aging [Internet]. Setembro 2008 [acessado 2017 Nov 20];3(3):[cerca de 20 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC 2682378/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,2929 Neundorfer MM, Harris PB, Britton PJ, Lynch DA. HIV-risk factors for midlife and older women. Gerontologist [Internet]. Outubro 2005 [acessado 2017 Nov 12];45(5):[cerca de 20 p.]. Disponível em: https: //academic.oup.com/gerontologist/article/45/5/617 /652580
https: //academic.oup.com/gerontologist/... . Studies investigating sexual activity in older adults with HIV are scarce, even in the face of a higher number of seniors infected with the virus³3 Brasil. Ministério da Saúde (MS). Boletim epidemiológico AIDS-ST. Brasília: MS; 2017.^,1212 The Joint United Nations Programme on HIV/AIDS (UNAIDS). Update: How Africa turned AIDS around. Geneva: UNAIDS/WHO; 2013. and evidence that they engage in unprotected sex¹⁵15 Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A, Suhr JA, Garske J P, Johnson CJ. Patterns and Correlates of Sexual Activity and Condom Use Behavior in Persons 50-Plus Years of Age Living with HIV/AIDS. AIDS Behav [Internet]. Novembro 2008 [acessado 2017 Nov 27];12(6):[cerca de 20 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575000/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,2323 Cooperman NA, Arnsten JH, Klein RS. Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS Educ [Internet]. Agosto 2007 [acessado 2017 nov 29];19(4):[cerca de 12 p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505189/
https://www.ncbi.nlm.nih.gov/pmc/article... .

We note that elderly sexuality is still a subject sidelined by scholars, and most of the studies on this subject are directed to the adverse physiological aspects of sexuality in old age³⁰30 Vieira KFL, Coutinho MPL, Saraiva ERA. A Sexualidade Na Velhice: Representações sociais de idosos frequentadores de um grupo de convivência. Psicol Cienc Prof [Internet]. Jan-Mar 2016 [acessado 2017 Nov 24]; 36 (1): [cerca de 14 p.]. Disponível em: http://www.scielo.br/pdf/pcp/v36n1/1982-3703-pcp-36-1-0196.pdf
http://www.scielo.br/pdf/pcp/v36n1/1982-... . As a consequence, the lack of knowledge about sexuality favors the development of prejudiced behaviors and conservative attitudes about sexual interest in older adults, which makes these people even more vulnerable to STIs, among them HIV³¹31 Delamater J. Sexual expression in later life: a review and synthesis. J Sex Res [Internet]. Março 2012 [acessado 2017 Nov 20];49(2-3):[cerca de 17 p.]. Disponível em: http://www.ssc.wisc.edu/~delamate/pdfs/Sex ExpressARSR.pdf
http://www.ssc.wisc.edu/~delamate/pdfs/S... .

Therefore, it is vital to engage in further research on this topic to contribute to a better understanding of elderly sexuality and to promote the development of public policies focused on sexual health and prevention of STI/HIV/AIDS, ensuring improved care for the most vulnerable elderly.

This study aims to evaluate knowledge and attitudes about the sexuality of elderly with HIV, as well as to characterize the sample by socioeconomic and demographic variables, diagnosis time, depressive symptoms, presence or absence of comorbidities and functional capacity.

Methods

This is a descriptive, quantitative, cross-sectional study carried out from October 2016 to May 2017 in the services of reference for the care to HIV-infected patients in Recife (PE). The study sample consisted of 241 older adults with HIV of both genders enrolled as of 2009.

The inclusion criteria were to be enrolled in the services of reference in the period established for the research (as of 2009); having used ART for at least 04 weeks; with a minimum age ≥ 60 years – a condition that defines the elderly person as per Law No. 8842/94, which addresses the National Policy of the Elderly, and participating in the study on a voluntary basis by signing the informed consent form. Elderly with cognitive impairment assessed through the Mini-Mental State Examination (MMSE) were excluded. This instrument has six categories that evaluate, time and place orientation, immediate memory, attention, calculation, recall of words, language and visual construction.

A questionnaire was applied with questions regarding socioeconomic and demographic characteristics (age, ethnicity/skin color, marital status, gender, schooling, income and religion), comorbidities and time of diagnosis mentioned in the medical record. Depressive symptoms, functional capacity, knowledge and attitudes about sexuality in aging were also evaluated.

The comorbidities recorded in the medical records were systemic arterial hypertension (SAH), diabetes mellitus (DM), cardiovascular diseases (CVD), osteoporosis, osteoarthrosis, neurological diseases, respiratory diseases, neoplasms, depression, smoking and renal dysfunction.

Depressive symptoms were evaluated by the Geriatric Depression Scale (GDS). The scale used in this study (15-item GDS) was elaborated by Sheikh and Yesavage from the elements of the original scale that most strongly correlated with the diagnosis of depression³²32 Almeida OP, Almeida SA. Confiabilidade da versão brasileira da escala de depressão em geriatria (GDS) versão reduzida. Arq Neuro-Psiquiatr [Internet]. Junho 1999 [citado em 22 de novembro de 2017];57(2B):[cerca de 7 p.]. Disponível em: http://www.scielo.br/pdf/anp/v57n2B/1446.pdf
http://www.scielo.br/pdf/anp/v57n2B/1446... . Functional capacity was assessed through the Functional Assessment Scale (Barthel Index), which identifies the level of independence of the subject to perform ten basic activities of daily living: eating, personal hygiene, toilet use, bathing, dressing and undressing, sphincter control, walking, moving from chair to bed, climbing and going down the stairs³³33 Araújo F, Ribeiro JLP, Oliveira A, Pinto C. Validação do Índice de Barthel numa amostra de idosos não institucionalizados. Rev Port Saúde Pública [Internet]. 2007 [acessado 2017 Nov 20];25(2):[cerca de 8 p.]. Disponível em: https://repositorio-aberto.up.pt/bitstream/10216/15740/2/86323.pdf
https://repositorio-aberto.up.pt/bitstre... .

The level of knowledge and attitudes about sexuality was evaluated through the Aging Sexual Knowledge and Attitudes Scale (ASKAS), adapted and validated for Brazil in 2008 by Viana³⁴34 Viana HB. Adaptação e validação da ASKAS - Aging Sexual Knowledge and Attitudes Scale em idosos brasileiros [dissertação]. São Paulo: Universidade Estadual de Campinas; 2008.. It consists of questions related to sexuality changes in old age, such as sexual activity, masturbation, menopause, impotence, and sexual desire. It contains twenty questions (false/true) that measure knowledge and eight (disagree/agree) that assess attitudes. The lower the respondent’s score, the higher the knowledge about sexuality in old age and a positive attitude concerning the elderly’s interest in sex³⁴34 Viana HB. Adaptação e validação da ASKAS - Aging Sexual Knowledge and Attitudes Scale em idosos brasileiros [dissertação]. São Paulo: Universidade Estadual de Campinas; 2008..

The data were tabulated using the Excel program, and the resulting data from the socioeconomic and demographic questionnaire were analyzed and Wald’s test was applied to compare proportions. Frequency tables and charts were used to describe and summarize the results.

The relationship between attitude and knowledge about sexuality in aging was analyzed using Spearman’s correlation because the data did not show a normal distribution. Knowledge and attitude were compared by socioeconomic and demographic factors, presence or absence of comorbidities, time of diagnosis, depressive symptoms and functional capacity, using non-parametric techniques due to the lack of normality of the studied variables.

The variables with two categories were submitted to the Mann-Whitney’s U test, and those with more than two categories, to the Kruskal-Wallis test. The significance level of p < 0.05 was adopted. InfoStat’s statistical program was used to perform the analyses.

The study was submitted to and approved by the Research Ethics Committee of the Federal University of Pernambuco, as per Resolution 466/12 of the MS, regarding the development of scientific human research.

Results

Among the participants, the prevalent age range ranged from 60 to 82 years, with a mean age of 64.98 (+4.32) years, as observed in Figure 1. Socioeconomic and demographic characteristics showed a significantly higher distribution for males (62.7%) against females (37.3%). As for the variable marital status, the highest percentage was among the single (34.4%), followed by the married / with a partner (30.7%), with no significant differences between them (Table 1).

Regarding schooling, most of the individuals had between 1-4 years (28.6%), 5-8 years (24.5%) and 9-11 years (23.2%) of study, between these categories. The analysis of the ethnicity/skin color variable showed that the elderly who self-declared as browns (60.1%) were predominant. As for religion, the highest percentage was among Catholics (51.9%).

The elderly who participated in this research mostly lived with at least one relative (68.9%). There were more elderly pensioners (64.7%) and more than half of the respondents (55.6%) had an income of 1-2 minimum wages, and 56.9% of participants reported a full contribution to the household income. Table 2 shows that most of the elderly had between 11 and 20 years of HIV infection diagnosis (51.9%) and at least one comorbidity (78.8%). Regarding the elderly’s functional capacity, we found that most were independent (84.2%). Concerning depressive symptoms, the older adults identified without depressive symptoms prevailed (67.22%).

In the research about knowledge and attitudes concerning sexuality, participants had a good level of knowledge (mean of 29.77) and a very positive attitude (mean of 14.85) vis-à-vis sexuality in aging. Table 3 shows that there was a significant association between the level of knowledge about sexuality and the variables gender (p < 0.002), schooling (p < 0.001), religion (p < 0.025), depressive symptoms (p < 0.014) and HIV diagnosis time (p < 0.043).

Knowledge scores were significantly higher for male participants, for those attending school, participants without depressive symptoms, individuals diagnosed with HIV for more than 12 years, and for non-religious and other faiths elderly (Spiritist, Umbanda). The level of knowledge of the elderly concerning sexuality had no significant association with the variables marital status (p = 0.342), income (p = 0.153), ethnicity (p = 0.687), functional capacity (p = 0.175), age (p = 0.299) and comorbidity (p = 0.101).

The more conservative attitudes towards sexuality in aging were strongly associated with the variables gender (p < 0.007), schooling (p < 0.001), income (p < 0.0022), religion (p < 0.0207) and HIV diagnosis time (p < 0.009). Older women, illiterate participants, evangelicals and Catholics, and individuals with less than 12 years of HIV diagnosis time tend to have more conservative attitudes. Attitude scores did not show a significant association with factors age (p = 0.513), marital status (p = 0.869), ethnicity/skin color (p = 0.391), functional capacity (p = 0.869), depressive symptoms (p = 0.117) and comorbidities (p = 0.218) (Table 3).

A positive correlation (r = 0.42; p < 0.0001) was observed between the scores of knowledge and those of the attitude, indicating that those with a lower level of knowledge have a more conservative attitude towards the elderly sexuality (Figure 2).

Discussion

The study population consisted of seniors with HIV of both genders, with a predominance of males, corroborating data from the MS and the State Health Secretariat of Pernambuco (SES-PE), where men are still the most affected by this infection, including those aged 60 years or more³3 Brasil. Ministério da Saúde (MS). Boletim epidemiológico AIDS-ST. Brasília: MS; 2017.^,3535 Pernambuco. Secretaria Executiva de Vigilância em Saúde - SEVS. Situação Epidemiológica da Infecção pelo HIV em Pernambuco. Boletim HIV/AIDS. Recife: SEVS; 2017.. These findings were also compared with those of other studies, which showed similar results²¹21 Bertoncini BZ, Moraes KS, Kulkamp IC. Comportamento sexual em adultos maiores de 50 anos infectados pelo HIV. DST - J Bras Doenças Sex Transm [Internet]. 2007 [acessado 2017 Nov 20];19(2):[cerca de 4 p.]. Disponível em: http://www.dst.uff.br/revista19-2-2007/3.pdf.
http://www.dst.uff.br/revista19-2-2007/3... ^,2222 Golub SA, Tomassilli CJ, Pantalone DW, Brennan M, Karpiak SE, Parsons JT. Prevalence and Correlates of Sexual Behavior and Risk Management Among HIV-Positive Adults Over 50. Sex Transm Dis [Internet]. Outubro 2010 [acessado 2017 nov 29];37(10):[cerca de 6 p.]. Disponível em: http://www.natap.org/2010/HIV/CorrelatesSexual.pdf
http://www.natap.org/2010/HIV/Correlates... ^,3636 Okuno MFP, Fram DS, Batista REA, Barbosa DA, Belasco AGS. Conhecimento e atitudes sobre sexualidade em idosos portadores de HIV/AIDS. Acta Paulista de Enfer [Internet]. 2012 [acessado 2017 Nov 24];25(1):[cerca de 8 p.]. Disponível em: http://www.scielo.br/pdf/ape/v25nspe1/pt_18.pdf
http://www.scielo.br/pdf/ape/v25nspe1/pt... .

However, the number of HIV cases among females has increased considerably over the years in the country across all age groups. This growth reveals female vulnerability, determined by biological aspects and by social, economic and cultural factors, with an emphasis on gender roles, unbalanced power relations and the naturalization of violence against women³⁷37 The Joint United Nations Programme on HIV/AIDS (UNAIDS). Agenda for accelerated country action for women, girls, gender equality and HIV: operational plan for the UNAIDS action framework: addressing women, girls, gender equality and HIV. Geneva: UNAIDS; 2010..

Considering that a little more than half of the elderly had between 11 and 20 years of HIV diagnosis and that the prevalent age group corresponded to 60-69 years, it may be that some of this public became infected in adulthood, but due to the increased survival, caused by the use of ART, these people managed to reach old age. This is even a well-documented aspect in the literature, where it is observed that many older adults were less than 50 years old when they contracted HIV³⁸38 Affeldt AB, Silveira MF, Barcelos RS. Perfil de pessoas idosas vivendo com HIV/AIDS em Pelotas, sul do Brasil, 1998 a 2013. Epidemiol Serv Saúde [Internet]. 2015 Jan-Mar [acessado 2017 Dez 27];24(1):[cerca de 8 p.]. Disponível em: http://www.scielo.br/pdf/ress/v24n1/2237-9622-ress-24-01-00079.pdf.
http://www.scielo.br/pdf/ress/v24n1/2237... .

Most of the participants in this study belong to the lower social class, with fewer resources and lower access to good social and health conditions and, consequently, more vulnerable, agreeing with MS data³3 Brasil. Ministério da Saúde (MS). Boletim epidemiológico AIDS-ST. Brasília: MS; 2017.. The increased HIV incidence is correlated with unfavorable socioeconomic indicators. Individuals with few years of schooling, low income and residing in geographical areas with poor infrastructure have been the most affected by the virus³⁹39 Porto TSAR, Silva CM, Vargens OMC. Caring for women with HIV/AIDS: an interactionist analysis from the perspective of female healthcare professionals. Rev Gaúcha Enferm [Internet]. 2014 [acessado 2017 Dez 17];35(2):[cerca de 7 p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472014000200040
http://www.scielo.br/scielo.php?script=s... . Thus, the lack of financial resources negatively influences the quality of life, compromising the individual’s health⁴⁰40 Okuno MFP, Gomes AC, Meazzini L, Scherrer Júnior G, Belasco Junior D, Belasco AGS. Qualidade de vida de pacientes idosos vivendo com HIV/AIDS. Cad Saude Publica [Internet]. Julho 2014 [acessado 2017 Dez 27];30(7):[cerca de 9 p.]. Disponível em: http://www.scielo.br/pdf/csp/v30n7/0102-311X-csp-30-7-1551.pdf
http://www.scielo.br/pdf/csp/v30n7/0102-... .

In this research, as in others developed in the South and Southeast regions of the country³⁶36 Okuno MFP, Fram DS, Batista REA, Barbosa DA, Belasco AGS. Conhecimento e atitudes sobre sexualidade em idosos portadores de HIV/AIDS. Acta Paulista de Enfer [Internet]. 2012 [acessado 2017 Nov 24];25(1):[cerca de 8 p.]. Disponível em: http://www.scielo.br/pdf/ape/v25nspe1/pt_18.pdf
http://www.scielo.br/pdf/ape/v25nspe1/pt... ^,3838 Affeldt AB, Silveira MF, Barcelos RS. Perfil de pessoas idosas vivendo com HIV/AIDS em Pelotas, sul do Brasil, 1998 a 2013. Epidemiol Serv Saúde [Internet]. 2015 Jan-Mar [acessado 2017 Dez 27];24(1):[cerca de 8 p.]. Disponível em: http://www.scielo.br/pdf/ress/v24n1/2237-9622-ress-24-01-00079.pdf.
http://www.scielo.br/pdf/ress/v24n1/2237... ^,4040 Okuno MFP, Gomes AC, Meazzini L, Scherrer Júnior G, Belasco Junior D, Belasco AGS. Qualidade de vida de pacientes idosos vivendo com HIV/AIDS. Cad Saude Publica [Internet]. Julho 2014 [acessado 2017 Dez 27];30(7):[cerca de 9 p.]. Disponível em: http://www.scielo.br/pdf/csp/v30n7/0102-311X-csp-30-7-1551.pdf
http://www.scielo.br/pdf/csp/v30n7/0102-... ^,4141 Righetto RC, Reis RK, Reinato LAF, Gir E. Comorbidades e coinfecções em pessoas vivendo com HIV/Aids. Rev. Rene [Internet]. 2014 Nov-Dez [acessado 2017 Dez 27].;15(6):[cerca de 7 p.]. Disponível em: http://www.revistarene.ufc.br/revista/index.php/revista/article/viewFile/1761/pdf
http://www.revistarene.ufc.br/revista/in... , most of the elderly had a type of comorbidity. A poorly treated chronic disease can lead to elderly isolation or withdrawal from social life, dependence, and functional disability⁴²42 Veras, R. Fórum. Envelhecimento populacional e as informações de saúde do PNAD: demandas e desafios contemporâneos. Introdução. Cad Saude Publica [Internet]. Outubro 2007 [acessado 2017 Dez 11];23(10):[cerca de 4 p.]. Disponível em: http://www.scielo.br/pdf/csp/v23n10/20.pdf
http://www.scielo.br/pdf/csp/v23n10/20.p... .

Several evidence confirms the influence of chronic-degenerative diseases on the elderly’s functionality⁴³43 Alves LC, Leimann BCQ, Vasconcelos MEL, Carvalho MS, Vasconcelos AGG, Fonseca TCO, Lebrão ML, Laurenti R. A influência das doenças crônicas na capacidade funcional dos idosos do Município de São Paulo, Brasil. Cad Saude Publica [Internet]. Agosto 2007 [acessado 2017 Dez 22];23(8):[cerca de 7 p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2007000800019.
http://www.scielo.br/scielo.php?script=s... ^,4444 Dantas CMHL, Bello FA, Barreto KL, Lima LS. Capacidade funcional de idosos com doenças crônicas residentes em instituições de Longa Permanência. Rev Bras Enferm [Internet]. 2013 Nov-Dez [acessado 2017 Dez 14];66(6):[cerca de 7 p.]. Disponível em: http://oaji.net/articles/2014/672-1401982249.pdf
http://oaji.net/articles/2014/672-140198... . However, when evaluating the functional capacity of the participants of this study, a low prevalence of dependents was observed. This result is in agreement with another study that evaluated the functional capacity of the elderly with HIV and AIDS⁴⁵45 Cruz GECP, Ramos LR. Limitações funcionais e incapacidades de idosos com síndrome de imunodeficiência adquirida. Acta Paul Enferm [Internet]. 2015 Set-Out [acessado 2017 Dez 10];28(5):[cerca de 6 p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002015000500488#B16
http://www.scielo.br/scielo.php?script=s... .

The low prevalence of depressive symptoms among participants in this research may have been influenced by the several years of HIV infection diagnosis since most had been living with HIV for more than 10 years. According to Leite⁴⁶46 Leite MA. Depressão, qualidade de vida e adesão ao tratamento antirretroviral em idosos portadores de HIV/Aids [dissertação]. São Paulo: Secretaria de Estado da Saúde de São Paulo; 2016., depression in the seniors with HIV is more related to the recent discovery of infection, the onset of physical symptoms, disease progression, limitations imposed by illness and issues of psychosocial aspects involved.

Regarding the knowledge of the elderly, this research identified that the sample studied has a good knowledge about sexuality in aging. In the same direction, other studies found that older adults with HIV had a good level of knowledge about sexuality³⁶36 Okuno MFP, Fram DS, Batista REA, Barbosa DA, Belasco AGS. Conhecimento e atitudes sobre sexualidade em idosos portadores de HIV/AIDS. Acta Paulista de Enfer [Internet]. 2012 [acessado 2017 Nov 24];25(1):[cerca de 8 p.]. Disponível em: http://www.scielo.br/pdf/ape/v25nspe1/pt_18.pdf
http://www.scielo.br/pdf/ape/v25nspe1/pt... ^,4747 Okuno MFP, Gosuen GC, Campanharo CRV, Fram DS, Batista REA, Belasco AGS. Qualidade de vida, perfil socioeconômico, conhecimento e atitude sobre sexualidade de "pessoas que vivem" com o Vírus da Imunodeficiência Humana. Rev. Latino-Am Enfermagem 2015; 23(2):192-199.. However, Alam and Fadila⁴⁸48 Alam RR, Fadila DSF. Knowledge, attitude and practice of elders about sexuality. Journal of Nursing Education and Practice [Internet]. 2016 [acessado 2017 Dez 25];6(12):[cerca de 10 p.]. Disponível em: http://www.sciedu.ca/journal/index.php/jnep/article/viewFile/9471/6037.
http://www.sciedu.ca/journal/index.php/j... revealed that more than half of this group had moderate knowledge about sexuality in old age.

Regarding the realm of attitudes, the individuals in this study showed a very positive attitude towards the elderly’s sexuality. This result is in agreement with the findings by Okuno et al.³⁶36 Okuno MFP, Fram DS, Batista REA, Barbosa DA, Belasco AGS. Conhecimento e atitudes sobre sexualidade em idosos portadores de HIV/AIDS. Acta Paulista de Enfer [Internet]. 2012 [acessado 2017 Nov 24];25(1):[cerca de 8 p.]. Disponível em: http://www.scielo.br/pdf/ape/v25nspe1/pt_18.pdf
http://www.scielo.br/pdf/ape/v25nspe1/pt... , who also used the ASKAS and identified among the seniors with HIV a liberal attitude towards sexuality.

A positive correlation was found between levels of the elderly’s knowledge and attitudes regarding sexuality. Thus, individuals with higher levels of knowledge have more permissive attitudes towards older adults’ sexuality. This finding is similar to the results of the study by Lee Kyung-Ja et al.⁴⁹49 Lee Kyung-Ja, Kwon Myoung-Sook, Kim MJ, Moon SM. A Study on Knowledge and Attitudes Regarding Sexuality of Elderly People in Korea. J Journal of Korean Academy of Nursing [Internet]. 2007 [acessado 2017 Dez 23];37(2):[cerca de 10 p.]. Disponível em: http://www.kan.or.kr/new/kor/sub3/filedata/2007 02/179.pdf
http://www.kan.or.kr/new/kor/sub3/fileda... , Mahieu et al.⁵⁰50 Mahieu L, Casterle BDC, Acke J, Vandermarliere H, Elssen KV, Fieuws S, Gastmans C. Nurses' knowledge and attitudes toward aged sexuality in Flemish nursing homes. Nurs Ethics 2016; 23(6):605-623. and Senra⁵¹51 Senra AMM. Sexualidade na Terceira Idade Conhecimentos e Atitudes de Cuidadores Formais de Pessoas Idosas [dissertação]. Castelo Branco: Instituto Politécnico de Castelo Branco; 2013., but different from the findings of Alam and Fadila⁴⁸48 Alam RR, Fadila DSF. Knowledge, attitude and practice of elders about sexuality. Journal of Nursing Education and Practice [Internet]. 2016 [acessado 2017 Dez 25];6(12):[cerca de 10 p.]. Disponível em: http://www.sciedu.ca/journal/index.php/jnep/article/viewFile/9471/6037.
http://www.sciedu.ca/journal/index.php/j... , who did not find a significant correlation between the scores of knowledge and attitudes.

It should be emphasized that greater knowledge and more permissive attitudes about the sexuality of the elderly does not necessarily indicate a better understanding of the transmissibility, preventive behavior, diagnosis and treatment of STI/HIV/AIDS. However, a lack of knowledge can make the older adults more vulnerable to STI/HIV/AIDS.

In the studies by Okuno et al.³⁶36 Okuno MFP, Fram DS, Batista REA, Barbosa DA, Belasco AGS. Conhecimento e atitudes sobre sexualidade em idosos portadores de HIV/AIDS. Acta Paulista de Enfer [Internet]. 2012 [acessado 2017 Nov 24];25(1):[cerca de 8 p.]. Disponível em: http://www.scielo.br/pdf/ape/v25nspe1/pt_18.pdf
http://www.scielo.br/pdf/ape/v25nspe1/pt... ^,4747 Okuno MFP, Gosuen GC, Campanharo CRV, Fram DS, Batista REA, Belasco AGS. Qualidade de vida, perfil socioeconômico, conhecimento e atitude sobre sexualidade de "pessoas que vivem" com o Vírus da Imunodeficiência Humana. Rev. Latino-Am Enfermagem 2015; 23(2):192-199., women showed higher levels of knowledge about sexuality in old age. However, in this study, male participants evidenced greater knowledge. Santos and Assis⁵²52 Santos AFM, Assis M. Vulnerabilidade das idosas ao HIV/AIDS: despertar das políticas públicas de saúde no contexto da atenção integral: revisão de literatura. Rev Bras Geriat Gerontol [Internet]. 2011 [acessado 2017 Dez 25];14(1):[cerca de 11 p.]. Disponível em: http://revista.unati.uerj.br/scielo.php
http://revista.unati.uerj.br/scielo.php... state that the lack of information on sexuality in aging is a consequence of prejudice constructed from a model of normative and repressive education, directed, especially, to females. Thus, older women face more significant challenges in acquiring knowledge about sexuality and achieving a healthy sexual life⁵³53 Alencar DL, Marques APO, Leal MCC, Vieira JCM. Fatores que interferem na sexualidade de idosos: uma revisão integrativa. Cien Saude Colet [Internet]. 2014 [citado em 20 de dezembro de 2017];19(8):[cerca de 11 p.]. Disponível em: http://www.scielo.br/pdf/csc/v19n8/1413-8123-csc-19-08-03533.pdf.
http://www.scielo.br/pdf/csc/v19n8/1413-... .

Data from this study showed that people with more advanced education have a high level of knowledge about sexuality, as reported by Alam and Fadila⁴⁸48 Alam RR, Fadila DSF. Knowledge, attitude and practice of elders about sexuality. Journal of Nursing Education and Practice [Internet]. 2016 [acessado 2017 Dez 25];6(12):[cerca de 10 p.]. Disponível em: http://www.sciedu.ca/journal/index.php/jnep/article/viewFile/9471/6037.
http://www.sciedu.ca/journal/index.php/j... . Individuals with many years of schooling have greater access to primary care services and, consequently, more significant contact with sexuality-related information, besides better assimilating guidance by professionals⁵⁴54 Silva HR, Marreiros MDOC, Figueiredo TS, Figueiredo MLF. Características clínico-epidemiológicas de pacientes idosos com aids em hospital de referência, Teresina-PI, 1996 a 2009. Epidemiol Serv Saúde [Internet]. 2011 [acessado 2017 Dez 23];20(4):[cerca de 8 p.]. Disponível em: http://scielo.iec.gov.br/scielo.php?script=sci_arttext&pid=S1679-49742011000400009.
http://scielo.iec.gov.br/scielo.php?scri... .

From the data analyzed, we observed that the elderly with no depressive symptoms had higher knowledge about sexuality in aging. Depressive seniors may lack interest in developing activities that were previously enjoyable, lack of energy, difficulty concentrating, memory loss and cognitive deficits; which may make it difficult to obtain information⁵⁵55 Pinho MX, Custódio O, Makdisse M. Incidência de depressão e fatores associados em idosos residentes na comunidade: revisão de literatura. Rev Bras Geriatr Gerontol [Internet]. 2009 [acessado 2017 Dez 23];12(1):[cerca de 18 p.]. Disponível em: http://www.scielo.br/pdf/rbgg/v12n1/1981-2256-rbgg-12-01-00123.pdf.
http://www.scielo.br/pdf/rbgg/v12n1/1981... .

Studies conducted with people living with HIV and over 50 years of age have shown that aging with the virus has led to self-acceptance, wisdom and a positive attitude toward life⁴³43 Alves LC, Leimann BCQ, Vasconcelos MEL, Carvalho MS, Vasconcelos AGG, Fonseca TCO, Lebrão ML, Laurenti R. A influência das doenças crônicas na capacidade funcional dos idosos do Município de São Paulo, Brasil. Cad Saude Publica [Internet]. Agosto 2007 [acessado 2017 Dez 22];23(8):[cerca de 7 p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2007000800019.
http://www.scielo.br/scielo.php?script=s... ^,5656 Saldanha AAW, Araújo LF, Sousa VC. Envelhecer com aids: representações, crenças e atitudes de idosos soropositivos para o HIV. Interam J Psychol [Internet]. 2009 [acessado 2017 Dez 26];43(2):[cerca de 10 p.]. Disponível em: http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S0034-96902009000200013
http://pepsic.bvsalud.org/scielo.php?scr... . This research showed that the population diagnosed with HIV for more than 12 years knew about sexuality.

In this research, older women, illiterate participants, evangelical and Catholic religion practitioners, and those with less than 12 years of HIV diagnosis had more conservative attitudes regarding the elderly’s sexuality. This finding is in agreement with that of Lee Kyung-Ja et al.⁴⁹49 Lee Kyung-Ja, Kwon Myoung-Sook, Kim MJ, Moon SM. A Study on Knowledge and Attitudes Regarding Sexuality of Elderly People in Korea. J Journal of Korean Academy of Nursing [Internet]. 2007 [acessado 2017 Dez 23];37(2):[cerca de 10 p.]. Disponível em: http://www.kan.or.kr/new/kor/sub3/filedata/2007 02/179.pdf
http://www.kan.or.kr/new/kor/sub3/fileda... , who reported that older women were more conservative about sexuality than older men. On the other hand, studies showed that there was no significant difference in attitude between men and women regarding the sexuality of older adults³⁶36 Okuno MFP, Fram DS, Batista REA, Barbosa DA, Belasco AGS. Conhecimento e atitudes sobre sexualidade em idosos portadores de HIV/AIDS. Acta Paulista de Enfer [Internet]. 2012 [acessado 2017 Nov 24];25(1):[cerca de 8 p.]. Disponível em: http://www.scielo.br/pdf/ape/v25nspe1/pt_18.pdf
http://www.scielo.br/pdf/ape/v25nspe1/pt... ^,4848 Alam RR, Fadila DSF. Knowledge, attitude and practice of elders about sexuality. Journal of Nursing Education and Practice [Internet]. 2016 [acessado 2017 Dez 25];6(12):[cerca de 10 p.]. Disponível em: http://www.sciedu.ca/journal/index.php/jnep/article/viewFile/9471/6037.
http://www.sciedu.ca/journal/index.php/j... .

The set of beliefs and moral values found in culture, society and religion imposed on females a position of inferiority compared to males, and of submission to sexual practices. The conservative attitudes evidenced by women in this study are reflections of oppressive sexual patterns, full of prejudice, created by a society that limits and silences female sexuality. Talking about sexuality still causes discomfort, fear and modesty, especially among older women who avoid exposing their sexual experiences and develop a reserved posture and negative attitudes on this topic.

The level of schooling may influence attitudes toward sexuality in aging. People with more advanced education tend to have a more favorable attitude about sexuality in aging³⁶36 Okuno MFP, Fram DS, Batista REA, Barbosa DA, Belasco AGS. Conhecimento e atitudes sobre sexualidade em idosos portadores de HIV/AIDS. Acta Paulista de Enfer [Internet]. 2012 [acessado 2017 Nov 24];25(1):[cerca de 8 p.]. Disponível em: http://www.scielo.br/pdf/ape/v25nspe1/pt_18.pdf
http://www.scielo.br/pdf/ape/v25nspe1/pt... ^,4949 Lee Kyung-Ja, Kwon Myoung-Sook, Kim MJ, Moon SM. A Study on Knowledge and Attitudes Regarding Sexuality of Elderly People in Korea. J Journal of Korean Academy of Nursing [Internet]. 2007 [acessado 2017 Dez 23];37(2):[cerca de 10 p.]. Disponível em: http://www.kan.or.kr/new/kor/sub3/filedata/2007 02/179.pdf
http://www.kan.or.kr/new/kor/sub3/fileda... ^,5151 Senra AMM. Sexualidade na Terceira Idade Conhecimentos e Atitudes de Cuidadores Formais de Pessoas Idosas [dissertação]. Castelo Branco: Instituto Politécnico de Castelo Branco; 2013.. Corroborating the literature, the elderly participants of this study with higher levels of education showed more permissive attitudes.

Religious aspects also contribute to a limited view of sexuality by relating sexual experiences to something sinful⁵⁷57 Vieira KFL. Sexualidade e qualidade de vida do Idoso: desafios contemporâneos e repercussões sociais [dissertação]. João Pessoa: Universidade Federal da Paraíba; 2012.. Thus, older practitioners of the Catholic and Evangelical religions showed more conservative sexual attitudes. This result is similar to that reported by Lee Kyung-Ja et al.⁴⁹49 Lee Kyung-Ja, Kwon Myoung-Sook, Kim MJ, Moon SM. A Study on Knowledge and Attitudes Regarding Sexuality of Elderly People in Korea. J Journal of Korean Academy of Nursing [Internet]. 2007 [acessado 2017 Dez 23];37(2):[cerca de 10 p.]. Disponível em: http://www.kan.or.kr/new/kor/sub3/filedata/2007 02/179.pdf
http://www.kan.or.kr/new/kor/sub3/fileda... . The idea that sex is naturally associated with pleasure is rejected by religious morality by restricting its exercise to those who, supported by religious values, wish to form a family. Through its rules and doctrines, religion works as an instrument for regulating sexual behavior and practices⁵⁸58 Parreira FLD. Diálogos sobre sexualidade: aproximações e distanciamentos nos discursos de licenciados/as de ciências biológicas bolsistas do PIBID/UFU [dissertação]. Uberlândia: Universidade Federal de Uberlândia; 2014..

This study has limitations inherent to its cross-sectional design, which does not allow establishing a cause and effect relationship, limiting itself to discuss the association between the studied variables. Also, since the sample was non-probabilistic and of convenience, the results obtained cannot be extrapolated to the entire population of seniors with HIV and are restricted to the public in question only. The associations found indicate the need for longitudinal studies to identify the influence of these variables on the knowledge and attitudes about the sexuality of the elderly population living with HIV.

Conclusion

The results of this research led us to conclude that older women, illiterate participants, practicing evangelical and Catholic religion, and the seniors with less than 12 years of HIV diagnosis had fewer knowledge and more conservative attitudes about elderly sexuality. The lack of knowledge favors the development of negative attitudes toward sexuality in aging, which may contribute to increasing the susceptibility of the elderly to HIV.

There is a clear need to promote among the elderly, especially those in situations of greater vulnerability, preventive and health education actions that favor reflection, behavior change, reduced vulnerability and stigma in the face of HIV/AIDS and other ISTs.

References

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