Sexual behavior among older HIV-positive adults: Psychosocial correlates of risk

Background: Adults over 50 comprise almost 30% of HIV-infected individuals in the U.S., but few resources have been devoted to understanding their prevention and treatment needs. This study examined the prevalence and patterns of sexual behavior among a sample of HIV+ older adults, focusing on psychosocial correlates of high-risk sexual behavior. Methods: Participants were 914 HIV+ adults (29% women; 87% persons of color) aged 50 and over, living in the New York City metropolitan area. Results: 367 participants (40%) reported anal or vaginal sex in the past 3 months; 41% of sexually active participants reported unprotected sex and 35% reported unprotected sex with serodiscordant partners. Physical health factors (e.g. AIDS diagnosis, CD4 count, physical functioning) were not significantly associated with sexual behavior patterns. Sexually active participants were significantly less lonely (p < .01) and less depressed (p < .05). Multivariate modeling revealed significantly different correlates of sexual risk by gender and sexual orientation, explaining between 9% and 25% of the variance. For straight men, unprotected sex was associated with greater loneliness, lower positive relations with others, and lower purpose in life (p =.01). For women, unprotected sex was associated with greater loneliness, higher public and personal stigma, lower purpose in life, and lower autonomy ( p < .05). Psychosocial factors did not significantly predict unprotected sex for gay/bisexual men. Conclusions: These findings underscore the importance of targeting prevention programs to HIV+ older adults, and suggest that psychosocial factors may play a critical role in predicting sexual risk in this population.