Predictors of condom use with main and casual partners among HIV-positive men over 50.

objectiveSexual health among the growing population of older adults living with HIV has garnered increased research attention. Previous studies have identified alcohol and drug use as factors increasing rates of sexual activity and sex risk behavior in this population. However, the influence of partner type (whether main or casual) on the links between substance use and sexual behavior in older men living with HIV remains understudied and was the focus of the current study.

methodData were collected from telephone interviews with 378 men, aged 50 years or older, living with HIV and residing in the New York City area. The sample included 224 (59%) men who identified as gay or bisexual and 154 (41%) who identified as heterosexual. The majority of the sample identified as Black (66%), and the average age was 55 years. Participants reported on recent sexual behavior, substance use, and viral load/detectability status.

resultsResults of multinomial logistic regression analyses found that substance use was associated with increased rates of condomless sex with casual partners but not with main partners, whereas self-reported viral load (perceptions of immunological health) was a factor associated with condomless sex with main partners but not with casual partners.

conclusionsThe findings indicate that different factors are involved in instances of condomless sex depending on whether the partner is a main or casual partner. Research and intervention efforts aimed at reducing risk factors for older men living with HIV and their partners need to take into account the relational context of sexual behavior.