Sexual risk behaviors and HIV risk among Americans aged 50 years or older: a review

Figures & data

Figure 1 Estimated diagnoses of HIV infection, by age, 2011, United States.

Note: Figure reproduced from Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. HIV among older Americans. Atlanta, GA: Centers for Disease Control and Prevention; 2013. Available from: http://www.cdc.gov/hiv/pdf/library_factsheet_HIV_%20AmongOlderAmericans.pdf. Accessed April 10, 2015.⁷

Table 1 Diagnoses of HIV infection among adults aged 50 years and older by age at diagnosis (years) and race ethnicity

Characteristic	2007			2008			2009			2010
	No	Estimated*		No	Estimated*		No	Estimated*		No	Estimated*
		No	Rate#		No	Rate#		No	Rate#		No	Rate#
Age at diagnosis, years
50–54	3,583	3,708	18.6	3,372	3,558	17.5	3,276	3,568	17.3	3,124	3,671	17.8
55–59	1,996	2,062	11.9	1,998	2,106	12.0	1,924	2,091	11.6	1,825	2,154	12.0
60–64	952	982	7.2	991	1,040	7.3	890	961	6.4	945	1,119	7.5
65–69	502	519	5.1	479	508	4.7	425	462	4.1	437	522	4.7
70–74	205	212	2.6	173	181	2.2	193	210	2.5	171	199	2.3
75–79	97	100	1.4	86	90	1.3	83	90	1.3	74	90	1.3
80–84	27	28	0.5	25	26	0.5	28	30	0.5	28	33	0.6
≥85	9	9	0.2	11	12	0.2	3	4	0.1	8	9	0.2
Race/ethnicity
American Indian/Alaska Native	30	31	5.8	34	35	6.4	24	25	4.4	30	34	5.9
Asian	79	82	2.8	71	74	2.4	72	80	2.5	70	85	2.6
Black/African American	3,426	3,542	43.6	3,503	3,696	44.0	3,244	3,519	40.6	3,056	3,605	41.6
Hispanic/Latino‡	1,154	1,200	17.0	989	1,052	14.1	1,036	1,141	14.5	1,008	1,212	15.4
Native Hawaiian/other Pacific Islander	11	11	18.8	6	6	9.6	9	9	13.8	2	2	3.1
White	2,547	2,625	3.9	2,418	2,536	3.7	2,333	2,526	3.6	2,361	2,762	3.9
Multiple races	124	129	22.0	114	123	20.0	104	115	18.0	85	98	15.3
Total¶	7,371	7,620	8.8	7,135	7,523	8.4	6,822	7,415	8.1	6,612	7,797	8.5

Notes:

* Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing risk factor information, but not for incomplete reporting;

# rates are per 100,000 population;

‡ Hispanics/Latinos can be of any race.

¶ Because column totals for estimated numbers were calculated independent of the values for the subpopulations, the values in each column may not sum to the column total. Adapted from Table 1a from the Centers for Disease Control and Prevention. Diagnoses of HIV infection among adults aged 50 years and older in the United States and dependent areas, 2007–2010. HIV Surveillance Supplemental Report 2013. Atlanta, GA: Centers for Disease Control and Prevention; 2013. Available from: http://www.cdc.gov/hiv/pdf/statistics_2010_HIV_Surveillance_Report_vol_18_no_3.pdf. Accessed October 27, 2014.⁸

Figure 2 Search strategy.

Notes: Search was performed using Ovid MEDLINE. *Choose “Focus” (rather than “Explode”) and choose “Include All Subheadings” (options available in Ovid MEDLINE). “Focus” refers to including most relevant references. “Explode” refers to including references that are only marginally relevant to the topic selected (in addition to those most relevant); ^#references to studies of non-US populations were excluded manually, leading to the exclusion of 53 references (129−53=76). Most of the excluded references referred to studies of samples in the People’s Republic of China, Brazil, and Western Europe.

Figure 3 Estimated diagnoses of HIV infection among adults aged 50 and older by sex and transmission category, 2010, 46 states.

Notes: ^‡Other transmission risk factors include hemophilia, blood transfusion, and risk factors not reported or identified; *heterosexual contact with a person known to have or be at high risk for, HIV infection. Due to rounding, percentages may not add up to 100%. Figure reproduced from Centers for Disease Control and Prevention. HIV Among Older Americans. Atlanta, GA: Centers for Disease Control and Prevention; 2013. Available from: http://www.cdc.gov/hiv/risk/age/olderamericans/. Accessed: October 15, 2014.⁷³
Abbreviation: IDU, injection drug use.

Table 2 Sexual risk behaviors among older Americans

Author	Population	Data source	Main findings
Cooperman et al, (2007)^Citation22	Men aged 49–80 years, N=624	Cross-sectional survey	In the preceding 6 months, 75% of men (N=624, including 268 HIV-negative and 356 HIV-positive men) reported sexual activity with one or more partners. Overall, more than half of respondents reported risky sexual behaviors (multiple partners, inconsistent condom use, and trading sex for money or drugs). Risky sexual behaviors were more common among HIV-negative compared with HIV-positive men; for example, 57% of HIV-positive vs 18.1% of HIV-negative men “always” used condoms (P<0.01), although about 25% of both groups had multiple sexual partners in the preceding 6 months.
Illa et al, (2008)^Citation66	Sexually active HIV-positive adults aged 45 years and older, N=210	Cross-sectional survey	Subjects were receiving HIV-related clinical care in Miami, Florida. “Sexually active” was defined as having engaged in vaginal or anal intercourse in the last 12 months. Of the 210 individuals surveyed, 125 were men and 85 were women, respectively. The sample was largely heterosexual. Almost 21% of participants reported not using condoms consistently, and 33% had multiple sexual partners during the preceding 6 months. Negative mood and perceived HIV stigma were associated with inconsistent condom use.
Lovejoy et al, (2008)^Citation67	HIV-positive depressed adults aged 50+ years, N=290	Cross-sectional survey, three metropolitan areas	Of the 290 individuals surveyed, 62% were abstinent (no sexual episodes in the preceding 3 months). Although most men who have sex with men (64%) and heterosexual women (79%) were abstinent, only 28% of heterosexual men were abstinent. Among those not abstinent, 53% of heterosexual men reported regular condom use compared with 23% and 13% among men who have sex with men and heterosexual women, respectively.
Onen et al, (2010)^Citation68	HIV-positive adults receiving HIV-related clinical care, N=541	Cross-sectional survey	Although reports of any recent sexual activity decreased with age, from 56.4% among those aged 18–35 years (N=165) to 27.3% among older individuals (≥50 years; N=128) (P<0.001), condom use practices did not differ significantly by age, with 88.0% and 82.4% of those aged 18–35 years and older individuals (≥50 years), respectively, reporting condom use at the last sexual episode.
Schick et al, (2010)^Citation1	US men and women aged 50+ years, N=1,973	National Survey of Sexual Health and Behavior, conducted in 2009	1. About 20%–30% of both men and women remained sexually active well into their 80s. 2. Condom use rates among those who are single and sexually active, having more than one sexual partner in the last year, were low across age groups and decreased with age: 24.3% of those aged 50–59 years and 17.1% of those aged 60–69 years reported using a condom at the most recent sexual event in the past year; lower proportions were reported by those aged 70 years and older.
Jacobs et al, (2013)^Citation38	Community-based sample of HIV-negative men who have sex with men, aged 40–81 years, N=420	Cross-sectional survey	About a third of the men who reported recent receptive anal intercourse, and about 40% of those who reported engaging in insertive anal intercourse, did not use a condom in the last 6 months. The majority had multiple partners, and one-third had met a new partner in the past 6 months. Two noteworthy findings: men aged 40–59 years were more likely to engage in unprotected insertive anal intercourse than their older counterparts (aged 60 years and older), and men who discussed their HIV serostatus with partners were more likely to use condoms than those who did not.

Centers for Disease Control and PreventionHIV among older Americans. Atlanta, GA: Centers for Disease Control and Prevention2013 Available from: http://www.cdc.gov/hiv/pdf/library_factsheet_HIV_%20AmongOlderAmericans.pdfAccessed April 10, 2015

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