Risk and Resilience Related to Unprotected Anal Intercourse in HIV-Positive and HIV-Negative Older Men Who Have Sex with Men

BACKGROUND AND PURPOSE. Men who have sex with men (MSM) continue to be the U.S. population most heavily impacted by the HIV epidemic. In 2007, MSM comprised 52% of HIV/AIDS

cases among older adults in Florida. Middle-aged and older MSM (OMSM) continue to engage in risky behavior thus placing themselves at risk for HIV infection/reinfection. While the rates of HIV in OMSM have increased, little is known about their sexual practices and risk behaviors. The goal of this study was to investigate the sexual practices and identify risks for unprotected anal intercourse (UAI) in MSM aged 40 and older.

METHODS: A multi‐ethnic sample of 802 self-identified MSM aged 40 years and older was recruited in South Florida from community venues (i.e., bars, sporting events, churches, gyms, LGBT community centers). The men were approached by the researcher and trained peer research assistants to complete an anonymous, self administered questionnaire using the paper‐and‐pencil survey format. The study used a cross‐sectional research design to determine the influence of selected psychosocial variables, drug use, and demographic variables (e.g., HIV serostatus, employment) that place OMSM at risk for unprotected anal intercourse (UAI). Data collected over a 5‐month period (December 2007 –May 2008)were analyzed for this poster.

RESULTS: In ordinal logistic regression analysis to predict UAI using two models, one for insertive anal intercourse (‘top' position) and one for receptive anal intercourse (‘bottom' position) that adjusted for demographic and other variables, drug use, HIV serostatus, and not being employed were associated with increased odds of UAI in OMSM. For OMSM who bottom, the risk for UAI was associated with drug use (ketamine, GHB), not being employed, and serostatus (p = <0.0001, likelihood ratio test; Wald test, p<0.05). For OMSM who top, the risk for UAI was associated with stimulant drug use (p=0.0097,likelihood ratio test; Wald test, p<0.05). OMSM who top and use stimulants are 48% (odds ratio= 1.48, 95% CI= 1.09, 1.99) more likely to be at risk for UAI. OMSM who ‘bottom' and use ketamine or GHB are almost 3 times more likely to be at risk for UAI (odds ratio = 2.55, 95% CI = 1.50, 4.33). OMSM who bottom and who are HIV‐positive are 2 times more likely to be at risk for UAI (odds ratio = 1.93, 95% CI = 1.31, 2.85). OMSM who bottom and are employed full‐time are 35% less likely to be at risk for UAI than OMSM who bottom and are not employed (odds ratio = 0.65, 95% CI = 0.46, 0.93). Having a full‐time job creates a protective effect against risk for UAI in OMSM who bottom.

CONCLUSIONS AND IMPLICATIONS: MSM aged 40 and older continue to be at increased risk for HIV infection. Findings suggest that age, HIV serostatus, drug use, and employment may be risk factors for unprotected anal intercourse in OMSM. The results provide impetus to influence practice and future research related to the development of age-appropriate risk reduction efforts to decrease the rates of HIV infection among this at-risk understudied population.