Men who have sex with men are increasingly playing an important role in the HIV epidemic in China. Previous studies have disproportionately focused on the younger MSM population. However, limited studies in western nations have indicated that older MSM may still be sexually active in their late life, and at risk of HIV/STIs infection. We investigated sexual practices, HIV knowledge, HIV stigma, self-perceived HIV/STIs risk and accessibility of HIV prevention services and testing of middle aged and older MSM in Shenzhen, China.
Both qualitative and quantitative methods were employed in our study. We conducted anonymous in-depth interviews with a diverse sample of 20 MSM aged 45 and above. In addition, we conducted an anonymous community-based cross-sectional survey with a conventional sample of middle aged and older MSM in Shenzhen to explore HIV/STIs risk and accessibility of HIV/STIs prevention services and testing.
In the qualitative study, casual sex partners were more often reported than regular partners. The frequency of heterosexual behaviors was low and condom use in heterosexual behaviors was absent. Middle-aged and older MSM have limited access to HIV/STIs prevention services, which might be due to their low self-rated HIV risk. In the cross-sectional study, approximately one third of participants (n = 94, 31.1%) reported unprotected anal intercourse with male partners in the past 6 months. Correlates significantly associated with unprotected anal intercourse with male partners included self-perceived HIV risk score (OR=1.02; 95% CI: 1.01-1.04), HIV knowledge (OR=1.25; 95%CI: 1.07-1.45), used stimulant drug (OR=2.92; 95% CI: 1.22-6.99) and engaging in group sex in the past 6 months (OR=45.90; 95% CI: 10.01- 210.57). A total of 109 participants (36.1%) indicated they had accessed at least one HIV/STIs prevention service in Shenzhen, and 174 participants (57.6%) reported that they had been tested for HIV infection in Shenzhen. Correlates significantly associated with never accessing HIV/STIs prevention services included age (OR=1.07; 95% CI: 1.02-1.13), monthly income above 8,000 Yuan ($1250) (OR=0.39; 95% CI: 0.18-0.83), anticipated HIV stigma (OR=1.09; 95% CI: 1.01-1.17), and the number of sexual partners (2-5:OR=0.23; 95% CI: 0.10-0.50; 6 and above: OR=0.27; 95% CI: 0.12-0.63)). Never having HIV testing was associated with age (OR=1.06; 95% CI: 1.01-1.10), anticipated HIV stigma (OR=1.08; 95% CI: 1.00-1.16), and the number of same-sex partners (2~5 partners: OR=0.27; 95% CI: 0.12-0.62; >5 partners: OR=0.31; 95% CI: 0.13-0.73).
Our study indicates that a significant proportion of middle aged and older MSM engaged in different types of HIV-related risk behaviors. These data suggest the presence of HIV/STI risk within the aged group that needs adequate attention from both policy makers and researchers. Middle aged and older MSM also have limited access to HIV prevention services and testing. The findings call for the tailoring of current HIV prevention and testing efforts to meet the needs of middle aged and older MSM.