Characteristics, Safer Sex Practices, and Partner Communication in a Multi-Ethnic Sample of Older Men Who Have Sex with Men

OBJECTIVE: Transmission of HIV in older men who have sex with men (OMSM) is increasing, yet little is known about their safer sex practices. In a cross-sectional analysis, we investigated demographic characteristics, safer sex practices (including serosorting and sexual positioning practices), condom use, HIV testing behaviors, and drug and alcohol use in OMSM with or at-risk for HIV infection.

METHODS: Data were collected from a community-based sample of 802 MSM self-identified MSM ages 40 to 94 (M = 55.9; SD = 10.8). Participants completed a 121-item, self-administered anonymous questionnaire. The men were recruited from community venues (i.e., LGBT community centers, gay pride festivals, bars, sporting events, gyms, and social clubs) where OMSM congregate.

RESULTS: The majority of the 802 men (n=693; 86.4%) reported having sex with men in the last 6 months. In that time frame, more than one-third (n=304; 37.9%) had met a new sex partner. The average number of sex partners was 9 (SD = 27.6; range 0-500); one fifth (n=152; 19%) reported having 21 or more partners. The most frequent places where participants met their sexual partners were through the Internet and in bars. One third (n=249; 31%) of the men indicated that they practiced receptive anal sex (“bottoming”) without a condom, and nearly 40% (n=307; 38.3%) indicated that they practiced insertive anal sex (“topping”) without a condom. One-third (n=242; 30.3%) reported difficulty in maintaining condom use, and 12.8% (n=103) had not used a condom due to difficulty with erections before or during sex. Nearly 40% (n=314; 39.2%) of the men reported that they sometimes or always do not use condoms if their partner says he is HIV-negative. Of the men who had sex in the last 6 months, the majority (n = 405; 50.5) never or only sometimes discussed the topic of HIV with their partners and (n=369; 46%) never or only sometimes told their sex partners about their HIV status.

Of the 802 respondents, 722 had been tested for HIV and knew their status. Forty percent of the men (n=315) reported that they did not test regularly, but nearly one-third of the men who had tested reported a positive result (n=232; 28.9%). Nearly one-fourth (n=185; 23.1%) of the men reported that they had put themselves at risk for HIV. Many of the men reported having taken alcohol and or drugs (i.e., GHB, Ketamine, Ecstasy) right before or during sex. The majority of the sample was non-Hispanic white (n=661; 82.4%), 67 (8.4%) were Hispanic/Latino, 44 (5.5%) were Black, and 22 (2.7%) were Asian, Native American, or of mixed race.

CONCLUSION: Older MSM continue to be sexually active and engage in unsafe sex practices. More research is needed to understand the how sexuality, sex practices, and age convene to create HIV risk and protective factors in this understudied and vulnerable population.