Behavior, knowledge and perception of risks about sexually transmitted diseases in a group of people over 50 years old

The goal was to analyze the behavior, knowledge and risk perception about sexually transmitted diseases / AIDS (STD/AIDS) in people over 50 years old. 165 public servants at a State Secretary in Mato Grosso, Brazil were interviewed. The chi-square test and logistic regression tests were used for the analysis of risk perception and the behavior and knowledge variables about STD/AIDS. Most of the respondents were female (60.6%), 63.2 had a fixed partner, 72.4% had sexual relations in the past six months, and only 13.3% always wore condoms, with 21.5% being male and 8% female. Perception of risk was associated with non-use of condoms in their last sexual relation (p<0.001) and answering that anyone may acquire a STD/AIDS (p=0.039). The challenge of public policies is to increase actions, directing them to promote the health of the adult and elderly populations, especially regarding sexuality and vulnerability to STD/AIDS.


INTRODUCTION
Sexually transmitted diseases (STD) are considered one of the most common healthcare problems in the world and one of the five main factors that make people look for healthcare services (1) . In Brazil, there are 12 million cases of STD every year and, since notification is not compulsory and about 70% of people with some STD seek treatment in drugstores, the real number of cases is well below the estimates, nearly 200 thousand cases a year (2) .
Contrary to common belief, STDs may have serious consequences. A person with a STD has a higher chance of being contaminated by the human immunodeficiency virus (HIV) and the consequent development of Acquired Immunodeficiency Syndrome (AIDS) (2) .
In Brazil, the behavior of the AIDS epidemic, since its onset in the 1980s, has presented important changes, allowing for the identification of distinct movements. The first, characterized by the predominant infection of male homosexuals and bisexuals; the second, by a significant increase of drug addicts in the young heterosexual population; and finally, the marked advance in the transmission among low-income groups and women, and also the current moment of the epidemic, which consists in increasing cases of the disease in people over 50 years old (3) . high as the amount of women of the same age (4) .
The Ministry of Health has notified increasing numbers of AIDS cases in the population over 40 years old. Of the total cases notified in 1992, 15.6% were for men between 40 and 49 years old, increasing to 24.4% in 2003. For the 50-59 age group, it increased from 4.5% to 8.7%, and for 60 years old and over, it increased from 1.8% to 2.7% in the same period (5) . In the United States, 10% of the AIDS cases in women occurred in the 50 and older age range, and 32% of these women were older than 60 years old when diagnosed, suggesting that the infections occurred after their menopause (6) .
Despite an increasing amount of HIV-infection and AIDS cases in people over 50, it is not common for this population to consider itself at risk of contracting STD/AIDS. Even though they may become involved in risky behaviors, such as unprotected sex, they still do not see themselves as vulnerable to STDs (7) .   In the logistic regression analysis, the association between the perception of risk and condom use in the last sexual relation (p<0.001) remained, with a chance ratio of 23.43 times as high perception of risk for those who did not wear condoms (Table 3).   (12) . On the other hand, the sexual activity of participants in this study was higher than in a research executed by the National DST/AIDS Program, which verified that 67.1% of people between 50 and 59 years old and 39.2% of people older than 60 were sexually active (4) . Another important result from this study, related to behavior, was the practice of protected sex.
The interviewees know the importance of using condoms to prevent STD/AIDS; however, it was observed that 78.5% of the men and 86.5% of the women did not use condoms in the last sexual relation.
Studies reveal that, despite knowledge about the forms of STD/AIDS transmission, there are few elderly adults reporting condom use in all of their sexual relations (1,3,6,13) . Since AIDS is a recent disease, discovered in the 1980s, older adults may face some difficulty to become aware of the use of condoms, because this practice is not part of their culturehence, the importance of developing specific orientation for this part of the population.
The use of condoms by women as a method of prevention instead of contraception has not yet been internalized. Like younger women, the women over 50 years old in this study revealed a low perception of risk. Slightly over half the women (54.6%) considered the possibility of contracting STD/ AIDS. It is interesting to notice that, even when a low percentage is considered, it was still higher than levels found in other studies for the same age range (6) and about the self-perception of STD in women (9) . The low risk perception seen for women may be related to programs (14) . Vulnerability still depends on a more active and autonomous attitude of the subjects, besides the role of public policies in contributing to the reduction of collective vulnerability (15) .
Women are known to use healthcare services more frequently. A higher percentage of women (62.3%) than men (46.7%) seeks healthcare services in Brazil (16) . Many times, this may be justified by the fact that women is responsible for the health of the family, and other times because they are the main caregivers of some dependent family member.
Therefore, they demand a larger number of procedures, including laboratory exams. Aspects of women's more frequent use of healthcare services can also be noticed in this research, since 52% of women and only 33.8% of men had been tested for HIV (Table 1).
Once more, the behavior-related results Somehow, there seems to be a consensus that the elderly person is an asexual being, which does not think about sex (17) , incapable of sexually arousing other people, which puts this population in a situation of higher vulnerability to STD/AIDS (18) . Updating these Rev As for the concept of risk, particularly for AIDS, there have been changes during the history of the epidemic.
The term "risk group" was gradually replaced by "risk behavior" (9) . However, the idea of "risk group" still persists in the comprehension and perception of people in relation to the transmission of and vulnerability to STD/AIDS. This perception was seen in this study when 32.3% of men answered that some specific groups of people would be more exposed to STD/ AIDS. It is important to highlight that the interviewed population, in this study, is somehow differentiated, because it consists of people who, besides being active in the job market, hold a college degree or a highschool education in 80% of cases; 55.5% stated having a family income higher than six times the minimum wage, and 66.7% have private healthcare insurances.
Another factor that should be observed is the variability of the magnitude of behavior, knowledge and perception of the risk of contracting a STD/AIDS among the results found in other studies (7) . The