Sexual Communication and Seroadaptation Practices in HIV-Negative Midlife and Older Men Who Have Sex With Men

Advances in treatments have increased the longevity of people with HIV. The high prevalence of HIV among men who have sex with men (MSM) creates a greater risk for exposure that increases with age. Seroadaptation, which includes serosorting (sexual behavior and condom use based on knowing the serostatus of self and partners) and strategic sexual positioning (choosing receptive versus insertive anal sex), is sometimes used as an HIV risk-reduction strategy. This study examined seroadaptation, sexual communication, and HIV-risk behaviors in 420 sexually active HIV-negative MSM aged 40–81 years in South Florida via anonymous pen-and-paper questionnaire. Recreational drug use and serosorting (i.e., not using condoms if the partner said he was HIV-negative) were associated with higher risk for unprotected receptive anal intercourse. Younger age, greater number of partners, and serosorting were associated with higher risk for unprotected insertive anal intercourse. Understanding these behaviors in this group might help guide HIV-prevention efforts. Future research may examine the role of HIV-prevention medication (PrEP) in influencing sexual behavior in midlife and older MSM.