Factors associated with risk for unprotected receptive and insertive anal intercourse in men aged 40 and older who have sex with men

Abstract

The frequency of HIV infection is increasing in men who have sex with men (MSM) aged 40 and older yet little is known about factors that influence their risky sexual behavior, such as sexual positioning. The goal of this study was to examine multi-level factors associated with unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI) in MSM aged 40 and older. A community-based sample of 802 self-identified MSM aged 40-94 years was recruited through targeted outreach from community venues (e.g., bars, social events) in South Florida and completed an anonymous pen-and-paper questionnaire. Logistic regression showed that younger age (i.e., aged 40-59; odds ratio [OR]=0.6; 95% confidence interval [CI]: 0.4, 0.9), HIV-positive status (OR=2.8; 95% CI: 1.9, 4.0), drug use (OR=2.6; 95% CI: 1.7, 3.7), a larger number of male sexual partners (OR=1.7; 95% CI: 1.3, 2.3), and lower scores on internalized homonegativity (OR=0.9; 95% CI: 1.0, 1.0) were associated with higher risk for URAI. Younger age (OR=0.4; 95% CI: 0.3, 0.6), HIV-positive status (OR=1.5; 95% CI: 1.0, 2.1), drug use (OR=1.6; 95% CI: 1.1, 22.3), Viagra use (OR=1.7; 95% CI: 1.2, 2.4), larger number of sexual partners (OR=2.1; 95% CI: 1.6, 2.9), and holding views more characterized by high optimism concerning the future (OR=1.1; 95% CI: 1.0, 1.1) were associated with higher risk for UIAI. These results provide useful information that may guide the development of tailored prevention interventions to reduce the growing rates of HIV among MSM aged 40 and older.

Moving Toward a Holistic Conceptual Framework for Understanding Healthy Aging Among Gay Men

“…Finally, despite three decades of extant research on sexual behaviors associated with the acquisition of HIV and other sexually transmitted infections (STIs) among gay men (Halkitis, 2010), there is limited knowledge regarding the general sexual health of older gay men in the United States (e.g., Jacobs, Fernandez, Ownby, Bowen, Hardigan, & Kane, 2010), and what is known is often related to the sexual health of those who are seropositive . While the bulk of this research has focused on understanding risk behaviors associated with HIV/STI acquisition and transmission, sexual health encompasses partnership, activity, behavior, attitudes, and function that may be more relevant to the lives of aging gay men.…”

Condom Use, Disclosure, and Risk for Unprotected Sex in HIV-Negative Midlife and Older Men Who Have Sex With Men

“…Validated psychosocial scales were also included in the questionnaire but are not included in this analysis as they were not required for the focus of this study. Information on the scales used in this study can be found in our previous publications (Jacobs et al, 2010;Jacobs & Kane, 2012).…”

“…Previous studies (Darrow et al, 2005;Lyons, Chandra, Goldstein, & Ostrow, 2010;Ostrow et al, 2009;Semple, Strathdee, Zians, & Patterson, 2010;Wells, Golub, & Parsons, 2011) have linked drug use in MSM men to risky sexual behaviors and to higher rates of HIV infection, but most of these studies have focused primarily on specific time points and on younger MSM. A few studies have written about or investigated drug use as risk for HIV in older MSM populations (Heath, Lanoye, & Maisto, 2011;Jacobs et al, 2010;Ostrow et al, 2009), but they were not specific to HIV-negative older MSM. More data are needed to understand how drug use affects risky sexual behaviours among MSM with negative serostatus in mid-and later life.…”

“…Although some studies have included older MSM in their samples, only a few studies have investigated sexual risk and HIV issues specifically in midlife and older MSM (Dolcini, Catania, Stall, & Pollack, 2003;Jacobs et al, 2010;Lelutiu-Weinberger et al, 2011;Lim et al, 2011;Murray & Adam, 2001;Ober, Shoptaw, Wang, Gorbach, & Weiss, 2009;Pope, Wierzalis, Barret, & Rankins, 2007). Rates of HIV infection among older urban MSM in the United States are very high, particularly among those in their 50s.…”

“…Many midlife and older MSM do not recognize the risk of unprotected sex and believe HIV is no longer a serious health threat. (Jacobs et al, 2010;Jimenez, 2003;MacKellar et al, 2007). Not all MSM get tested, and those who do may do so infrequently while continuing to have unprotected sex with nonmonogamous partners.…”