Older HIV-positive gay men as likely to have risky sex as younger gay men with HIV

Michael Carter
Published: 27 November 2008

A significant number of people living with HIV in London are aged over 50, researchers report in the December edition of Sexually Transmitted Infections. The study was conducted amongst patients attends NHS HIV clinics in north-east London. Overall, 10% of patients were aged over 50, and this increased to one-in-seven gay men, the primary focus of the research.

Another finding of the study was that the proportion of gay men aged 50-plus reporting unprotected sex with men who were HIV-negative or whose HIV status they did not know, was similar to that reported by younger gay men.

The number of people living with HIV in the UK has doubled since effective HIV treatment became available. There are two reasons for this: patients are living significantly longer thanks to antiretroviral therapy, and there are new HIV diagnoses.

A “greying” of the HIV epidemic in the US has been reported, but there has hitherto been little research on the ageing of the HIV-positive population in the UK.

Researchers therefore designed a study looking at the age of diagnosis, sexual behaviour and some social characteristics of people living with HIV who were aged over 50, focusing their attention on gay men. (Previous results from this study were presented at the British HIV Association conference in April 2008)

Most HIV-positive patients in the UK receive their HIV care free of charge at NHS clinics. All people attending six NHS HIV out-patient clinics in north-east London were eligible for inclusion in the investigators’ research, which was conducted between summer 2004 and summer 2005.

A total of 1687 patients were included in the study. Overall 11% (184) patients were aged over 50, most of whom (140) were aged between 50-59.

The researchers found that 14% of gay men were aged over 50 compared to 9% of black African heterosexual men and 7% of black African heterosexual women.

A significant proportion (40%) of patients received their HIV diagnosis when they were aged 50 or above, including a third of gay men and approximately 50% black African heterosexual men and women. The researchers also found that 45% of patients were in their 40s at the time fo their diagnosis, and a further 14% were in their 30s.

The rest of the research findings focused on gay men.

The researchers found that gay men over 50 had significantly lower CD4 cell counts at the time of their HIV diagnosis (median, 159 cells/mm3), than men diagnosed in their 40s (250 cells/mm3), 30s (311 cells/mm3) and 20s (400 cells/mm3). They speculate that this may be because of late diagnosis.

However, the proportion of gay men taking HIV treatment increased with age, with 50% of those in their 20s taking antiretroviral therapy, compared to 64% of men in their 30s, 80% of those in their 40s and 83% of gay men in their 50s and above.

There were no significant differences in sexual behaviour between older and younger gay men. The researchers found gay men in their 50s just as likely as gay men in other age groups to report unprotected anal sex with a gay men who was HIV-negative or of unknown HIV status.

Furthermore, gay men in their 50s reported that they had had unprotected anal sex with an average of four men who were HIV-negative or of unknown HIV status in the previous three months. This was no different to the number reported by gay men in other age groups.

The investigators think that these findings show the importance of targeting HIV prevention messages at older as well as younger HIV-positive gay men.

Older gay men were, however, less likely to report “serosorting” (the selection of other HIV-positive partners) than gay men aged under 50.

Next the investigators enquired about social circumstances. They found that gay men aged over 50 were less likely to report being in a relationship (47%) than gay men in all other age groups (40s, 50%; 30s, 54%, 20s, 60%).

Gay men aged over 50 were also the age group least likely to be in employment (35% vs. 55% of men in 40s, 63% of men in their 30s and 61% of men in their 20s).

Similar proportions of men in their 30s (61%), 40s (59%) and the over 50s (57%) reported depression in the previous three months, with men in their 20s being the group most likely to report depression (71%).

Not having enough money to live on was rarer in the over 50s (7%) than any other age group (most common amongst men in their 20s, 22%).

“Our study highlights the diversity of older people living with HIV”, write the investigators, “the over 50s with HIV do not simply comprise an ageing cohort of people diagnosed in their 30s and 40s, but also people diagnosed with HIV over the age of 50 years.”

They conclude, “this diversity will present a continuing challenge for HIV treatment and prevention among older people living with HIV in the UK. Positive prevention programmes should target HIV-positive gay men of all ages because older gay men with HIV were just as likely to report high-risk sexual behaviour as younger gay men.”

Reference

Elford, J. et al. Over 50 and living with HIV in London. Sex Transm Infect 84: 468-72, 2008.