The Pitt Men’s Study is one of the four sites of the Multicenter AIDS Cohort Study (MACS). We analyzed longitudinal data (n = 237) from the Pitt Men’s Study, an on-going cohort study of the natural history of HIV infection and progression among gay and bisexual men in Pittsburgh, PA. The secondary aim of the study is to investigate factors that may be associated with different trajectories. This study tested this hypothesis relative to the number of sex partners over time. We hypothesized that this group is not homogeneous and might be better characterized by subpopulations with specific attributes.
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This exploratory study aims to identify subsets of trajectories with respect to the number of sexual partners among older HIV-negative and -positive MSM. Understanding sexual risk behaviors over time among older MSM is important because it will help identify who is at the highest risk, whether or not there are unique subgroups of MSM who are at higher risk than the others, and the factors associated with risk behaviors among aging MSM. The studies were, however, cross-sectional and could not elucidate the change of risk behavior such as number of sexual partners over time. To our knowledge, only two published North American epidemiologic studies specifically investigated HIV risk behaviors among older MSM. Dolcini and colleagues found that among older MSM, the median number of sexual partners per year decreases by one with every ten years of age. One of the most important risk behaviors for HIV acquisition and transmission among MSM involve multiple sexual partners. It has become clear that older MSM are at risk for HIV acquisition and transmission, and the changes in patterns of risk behaviors in this population require further investigation. This risk factor may be of special importance in the older MSM population. Recent work has demonstrated an association between the use of Viagra, by itself, or with other stimulant drugs, and increased rates of high-risk sexual behavior and HIV transmission in MSM. In addition, the development of phosphodiesterase type 5 (PDE-5) inhibitors, exemplified by Viagra, has enabled many older men to restore or enhance their sexual function. Reduced concern due to highly active antiretroviral therapy and safer sex fatigue were also found to be associated with sexual risk-taking among HIV-positive MSM. Some HIV-positive MSM continue to engage in high-risk sexual behavior after their diagnosis, placing themselves at risk for contracting secondary infections as well as transmitting HIV to others. With the advent of more effective treatments for HIV, a significant proportion of MSM are now living and aging with HIV. Several historical issues must be considered when studying sexual behaviors in older MSM. Other qualitative studies identified additional factors driving risky sexual behaviors among older MSM such as drinking in conjunction with sex, stigma related to sexual orientation and HIV, the perceived low risk for contracting the HIV virus, the perceived loss of attractiveness accompanied with aging, marginalization within the gay community, loneliness, and a desire to have sexual intimacy.
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This HIV prevalence was even higher among African Americans, injection drug users, illicit drug users, and those who were more open about their sexual orientation. In a probability sample of older MSM living in four metropolitan cities, Dolcini and colleagues reported an HIV prevalence of 19% among respondents over the age of 50.
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The Centers for Disease Control and Prevention estimates that 10 percent of all newly acquired infections are in adults over the age of 50, suggesting that older MSM are engaging in risk behaviors associated with HIV. Contrary to the general belief that older MSM are not sexually active and are therefore not at risk for HIV, converging lines of research and data show otherwise. Due in part of ageism and homophobia, older MSM remain a marginal population in which HIV levels and sexual risk factors are less well known. HIV prevention efforts have traditionally focused on young MSM. Because men who have sex with men (MSM) are disproportionately affected by HIV, understanding how risky sexual behaviors change as MSM age is an important aspect of the epidemiology in this population.