Condom Use and Serosorting Behaviors Among Older Men Who Have Sex With Men at Risk For or Living With HIV

BACKGROUND AND PURPOSE: This research explored the sexual practices of a multi-ethnic sample of 802 older men who have sex with men (OMSM) who may be at risk for HIV transmission/infection. The rates of HIV in OMSM have increased, yet little is known about the sexual decision making processes that place them at risk. The multiplicity of underlying factors and root causes of HIV infection helps account for the intensity of the epidemic among OMSM and their subpopulations. There are multiple HIV/AIDS epidemics, indicating that HIV prevention interventions, care, and treatment need to be tailored to risk behavior and population variations, including age differences in prevailing behavioral norms.

METHODS: We present the findings of the qualitative component of a community-based self-administered questionnaire (N = 802) of OMSM aged 40-94 (M = 55.9 years, SD = 10.8) and participatory inquiry with an audio-taped focus group of 10 OMSM (aged 43-75). Participants were recruited from community venues (i.e., LGBT centers, gay pride festivals, bars, sporting events, gyms, social clubs, and religious organizations) where OMSM congregate. Two open-ended qualitative questions (i.e., “Thinking about when you have sex in general, what makes it easier to use condoms/protection with your partners?” and “Thinking about when you have sex in general, what are some of the reasons you haven't used condoms/protection?”) were added to the 119 quantitative items. These questions were also asked of focus group participants to help elucidate some of the nuances that influence OMSM's safer sex and condom use decision-making processes. Using a grounded theory approach (Glaser & Strauss, 1967), data was divided by emergent themes and coded.

RESULTS: The study participants were sexually active, practiced high-risk behaviors, used serosorting and sexual positioning practices (receptive and/or penetrative anal sex), and testing as forms of HIV prevention. Emergent themes included (1) safer sex decision making with monogamous partners regarding sex outside the primary relationship, (2) trust issues regarding who is considered “safe” (i.e., HIV-negative), (3) condom use negotiation (i.e., who decides if a condom is used and under which circumstances), and (4) drug use as a factor for high-risk sexual behaviors, and (5) problems with condom use and maintaining erections. The findings elucidate about men's layers of decision-making for using condoms, defining safer sex practices from an older gay man's perspective, the intersections of age with the desire for partnership, optimism for the future, and internalized homophobia in their life experiences as it applies to their ability and desire to engage in both safer sex and in making decisions to take personal risk for HIV.

CONCLUSIONS AND IMPLICATIONS: Age, life optimism, internalized homophobia, and serostatus may play a role in attitudes toward safer sex practices and high-risk behaviors in older MSM. Understanding how older MSM differ or are viewed differently from their younger counterparts may be most beneficial in developing efficacious interventions to reduce HIV transmission in older MSM. The presentation concludes with realistic recommendations to inform for social work practice and prevention strategies to reduce the spread of HIV among older MSM populations.