Unprotected anal intercourse among HIV-positive and HIV-negative MSM aged 40 and older in serodiscordant and seroconcordant relationships

Published: July 21, 2010

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 rates of HIV in men who have sex with men (MSM) aged 40 and older in the U.S. have increased, yet little is known about their risk and protective behaviors. Evidence suggests many HIV transmissions among MSM are from main sexual partners. We examined the sexual practices among HIV-negative/unknown serostatus and HIV-positive MSM aged 40 and older with seroconcordant and serodiscordant partners.
Methods: We recruited a community-based sample of 802 MSM aged 40 and older in South Florida from community venues (i.e., bars, gyms) to complete an anonymous pen-and-paper questionnaire. Using data from the sample’s 636 participants (aged 40-83 years; M=54.5 years; SD=10.6) who reported (1) their HIV serostatus and (2) having a regular male sex partner with a different/similar serostatus, we used chi-square analyses to test for differences between men with HIV-negative/unknown serostatus and HIV-positive men in unprotected receptive and unprotected insertive anal intercourse (URAI; UIAI) by partner serostatus.
Results: Men with serodiscordant partners tended to be younger (p< .001) and HIV-positive (p< .01). Seventy-two percent of the participants reported unprotected sex in the past 6 months. HIV-positive men were more likely than men with HIV-negative/unknown serostatus to have URAI with both seroconcordant (p=.001; 56% vs. 28%) and serodiscordant partners (p=.001; 51% vs. 27%). HIV-positive men had more UIAI with seroconcordant partners (p=.01; 53% vs. 39%) than did men with negative/unknown serostatus. No difference was found in UIAI between HIV-positive men and men with HIV-negative/unknown serostatus who had serodiscordant partners (p=.307; 45% vs. 51%).
Conclusions: These findings show that MSM aged 40 and older are sexually active and engage in both protected and unprotected sex and in making decisions to take personal risk for HIV. Prevention efforts should not be limited to non-partnered MSM over 40 but should offer couples-based HIV interventions as well.

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