“We will die having sex” – gender, health and cultural influences on sexual practices among older people in South Africa

As the global population aging accelerates, especially in low-middle-income countries, an increase in age-related and sexual health challenges can be expected. However, for various reasons including a focus on reproductive ages, ageist stereotypes, taboos and stigma and limited resources, sexuality as broadly defined by the World Health Organization (WHO) in older adults is often neglected. This study used qualitative methods to explore the attitudes and perceptions of sexuality and sexual behaviour among older adults aged 50 years and above. Focus group discussions with 37 South African men and women (aged 50-78) were thematically analysed using an ethnographic and phenomenological naturalistic paradigm. Four major themes emerged from the analysis: the importance of sexuality and frequency of sexual activity, gendered perspectives on sexual activity, health state as a barrier to sexual activity, and cultural influences on sexuality and behaviour. Study highlights the significant role cultural norms and beliefs can play in old-age sexuality, with distinct gender differences in sexual practices. Health conditions, including chronic illnesses, disabilities, frailty and HIV status can act as barriers to sexual activities among older adults. Understanding these barriers and facilitators of sexuality in older adults is crucial in addressing sexual health concerns and challenges faced by older adults. Overall, the study contributes valuable insight into the often-neglected topic of sexuality in older adults, and the complexity of factors influencing sexual behaviours in ageing populations. There is a need for a holistic approach and further research to bring this subject matter to the attention of policy and programme makers. The scarcity of data and evidence on sexuality and sexual health needs of older adults in low-and-middle-income countries hinders the development of policies and targeted interventions to address the specific sexual health needs of older adults.