Sexual positioning, serosorting, and disclosure behaviors associated with risk for unprotected anal intercourse in HIV-positive MSM aged 40 and older

Published: August 30, 2010

Sexual positioning, serosorting, and disclosure behaviors associated with risk for unprotected anal intercourse in HIV-positive MSM aged 40 and older
R.J. Jacobs1, M.I. Fernandez2, R.L. Ownby3, G.S. Bowen2

1Nova Southeastern University, Preventive Medicine & Psychiatry and Behavioral Medicine, Ft. Lauderdale, United States, 2Nova Southeastern University, Preventive Medicine & Public Health, Ft. Lauderdale, United States, 3Nova Southeastern University, Psychiatry and Behavioral Medicine, Ft. Lauderdale, United States

Background: The number of MSM aged 40 and older in the United States living with HIV is increasing yet little is known about factors that influence their sexual behaviors, such as serosorting and sexual positioning. The goal of this analysis was to examine factors associated with unprotected insertive and receptive anal intercourse (UIAI; URAI) in HIV-positive MSM aged 40 and older.
Methods: Between December 2007-May 2008 we recruited a community-based sample of 802 self-identified MSM over 40 in South Florida, U.S. from community venues (e.g., bars, gyms, social clubs) to complete an anonymous, paper-and-pencil questionnaire. Using data from a subset of 233 self-reported HIV-positive MSM aged 40 to 82 years (M=51 years; SD=8.7), we employed regression analysis to determine the influence of age, income, drug use, HIV-disclosure, and serosorting on unprotected sex among this group.
Results: Analyses showed that younger age (odds ratio [OR] = 0.94; 95% confidence interval [CI]: 0.9, 1.1), higher income (OR=1.73; 95% CI: 1.1, 2.7), not discussing HIV status with partners (OR=2.1; 95% CI: 1.1, 4.1), and practicing safe sex with outside partners but not with primary partners (OR=1.9; 95% CI: 1.1, 3.4) were associated with UIAI. Younger age (OR=0.91; 95% CI: 0.9, .95), use of drugs before/during sex; OR=2.3; 95% CI: 1.1, 4.7), and not using condoms with HIV-negative partners (OR=0.5; 95% CI: 0.3, 0.8) were associated with higher risk for URAI.
Conclusions: Midlife MSM who are HIV-positive continue to be sexually active and engage in high-risk behaviors for HIV transmission/reinfection. Drug use reduction and skill-building strategies for HIV-disclosure should be woven into HIV risk-reduction interventions for this underserved and at-risk group.

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