Sexual Communication and Seroadaptation Practices Related to HIV/STD Risk and Protection in HIV-Negative Midlife and Older Men Who Have Sex with Men

Background: The advances in HIV treatments that have increased the longevity of people with HIV have also created a greater potential for HIV transmission. The high prevalence of HIV among men who have sex with men (MSM) creates a greater risk for exposure. The risk of exposure from each sexual encounter also increases with age. Previous studies and interventions have focused primarily on younger populations and may not be applicable to older MSM.

Objectives: To examine seroadaptation practices, sexual behaviors, HIV-related sexual communication, and perception of risk that might influence sexual risk/protection in this group.

Methods: Cross sectional data were collected from a community‐based sample of 802 self-identified MSM aged 40 and older in South Florida from community venues (e.g., bars, gyms) via an anonymous pen-and-paper questionnaire.

Results: Data from a subset of 420 HIV-negative MSM aged 40-81 years (M=55.5 years; SD=10.7) who reported >or=1 male sexual partner(s) in the past 6 months were analyzed. Logistic regression analyses showed that drug use (odds ratio [OR] = 2.5; 95% confidence interval [CI]: 1.5, 4.0) and serosorting (i.e., not using condoms if the partner said he was HIV-negative; OR=.60; 95% CI: 0.4, 0.8) were associated with higher risk for unprotected receptive anal sex.  Younger age (OR=.98; 95% CI: 0.9, 0.9), number of partners (OR=1.0; 95% CI: 1.1, 1.1), and serosorting (OR=0.53; 95% CI: 0.4, 0.7) were associated with higher risk for unprotected insertive anal sex.

Conclusions: Despite the emphasis in the literature on the risk factors for HIV acquisition in MSM and challenges they face, we found a combination of HIV/STD risk and protective behaviors to a substantial degree.

Implications for Programs, Policy, and Research: Understanding sexual risk and protection in older HIV-negative MSM can help guide future research and prevention efforts targeted to this group, which may influence the factors affecting their ability to engage in safer sex.