Aging, Sexuality, and HIV Issues among Older Gay Men

Murray, James, Adam, Barry D., The Canadian Journal of Human Sexuality

ABSTRACT: This study reports on one-on-one interviews with gay and bisexual men age forty and over, concerning their sexuality in the context of HIV. Respondents report a range of age-related issues that impact on safer sex decision-making including decreased attractiveness, widowerhood, loss of support networks from AIDS, and anticipated future quality of life, as well as strengths and satisfactions that decrease their risk. Respondents typically attributed unsafe sex in other men to popular discourses around (1) condom fatigue, (2) treatment optimism, and (3) inserter invulnerability, but deny that these ideas explain their own behaviour. They identify their own risk situations with: depression, impending mortality, "trading off" safe sex, and the effect of condoms in keeping erections. Community-building projects that begin to address risk situations have followed from this research with the AIDS Committee of Toronto.

Key words: Aging Gay men HIV risk

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A large majority of HIV/AIDS prevention efforts aimed at the gay community have emphasized younger gay men. Attention has been focused on the vulnerability of gay youth to HIV infection. HIV/ AIDS prevention materials and outreach prevention efforts have, thus, tended to reflect, and be oriented towards, the needs and social-cultural environment of younger gay men. However, gay men aged 40 and over represent a large segment of the population who have become HIV positive (HIV+). As of the end of 2000, men aged 40 and over made up 29% of the positive HIV test results reported among males in Canada and men having sex with men (MSM) is the largest exposure category in this age group (Health Canada, 2001). Similarly, in the United States, men aged 40 and over made up 26% of infection cases among males reported through June 2001 (CDC, 2002). Given these statistics, it is clear that older gay men, like people in other HIV risk categories, require HIV/AIDS risk reduction information and services that are directly pertinent to their group specific needs and circumstances. A fundamental principle that has emerged from the past decade and a half of HIV/AIDS prevention efforts is that in order to be effective, prevention programs cannot be generic but must be tailored to the demographic profile of the target audience and the socio-cultural environment in which they live. This may be particularly the case for adult gay men for whom a key part of their identity may be tied to the socio-sexual norms, beliefs, and practices of their environment (Kertzner, 2001).

The topic of older gay and bisexual men has received some attention in the social science literature (e.g., Berger, 1996; Grossman, D'Augelli & Hershberger, 2000; Lee, 1989; Vacha, 1985). However, research on aging and sexuality among older gay men with respect to how these issues relate to HIV risk and prevention is limited. Kooperman (1994), in a study of gay and bisexual men age 50 and over from the United States, Canada, and Australia found that nearly three quarters had been sexually active in the previous thirty days and most felt that the AIDS epidemic had had some degree of impact on their sexual behaviour. However, the study did not examine how contextual factors related to sexuality and aging might be related to HIV risk in these men. Kertzner (2001) interviewed 30 men, with an average age of 46, about their perceptions of the adult life course as it relates to homosexual identity. As a group, these men showed high levels of commitment to homosexual identity, self-esteem, and life satisfaction. However, some men expressed the view that gay life was "the province of the young and the beautiful" thus excluding or alienating older gay men. In the current study, we pursued a similar avenue of research but with a specific focus on how life course factors relate to HIV issues among older gay men.

The AIDS Committee of Toronto (ACT) initiated a series of interviews and focus groups among gay and bisexual men over forty to gain some insight into their HIV prevention needs and concerns. The central focus of the project was to explore the sexual health concerns of older men to see if it was possible to discern how aging and HIV risk may be linked in this population. The specific objectives of this research project were: 1) to identify prominent health and sexual health concerns of gay men over age 40; 2) to gain a sense of the relationship gay men over age 40 have with the gay community and the impact of the gay community on their lives and health; 3) to learn more about common social and sexual spaces for gay men over age 40; 4) to determine level of knowledge related to HIV transmission; 5) to identify risk-taking behaviours of gay men over age 40; 5) to identify possible reasons for risk-taking behaviours and; 6) to identify possible community organizational responses to the health and sexual health needs of gay men over age 40, including their HIV prevention needs.

METHODS

DATA COLLECTION

Using qualitative research methods, this study employed purposeful sampling techniques (Patton, 1990) to recruit gay men aged 40 and over from the Toronto area to identify important and major themes in their lives related to sexuality and HIV. A flyer advertising a "focus group for gay men aged 40 & over" to "talk about their experiences being 40 & over in Toronto's gay community" was distributed in Toronto gay bars, bathhouses, and other community venues. An advertisement was placed in Xtra! (a gay community newspaper), a fax was sent to more than twenty AIDS-related service organizations in Toronto, and direct requests for participants were made to front-line HIV prevention staff at a selection of ethno-specific AIDS service organizations. Recruitment material indicated a $20 payment for participation in the study. Interested men were asked to contact the first author at ACT.

Potential participants were included in the study if they identified as men, were aged 40 or over, and had sex with other men. Participants were given the option of selecting a focus group or a one-on-one interview, in order to allow those who may be uncomfortable participating in a group context to participate in the study. Focus groups had a pre-set time and location; the one-on-one interviews occurred at mutually satisfactory times for interviewer and participants. The parameters for participation were kept open (men who have sex with men, rather than gay or bisexual identified men), and ethno-specific AIDS service organizations were contacted directly, in an effort to obtain the insights of men from various ethno-cultural communities in Toronto. Participants were asked read a "Consent Form" to clarify their rights and ACT's responsibilities in the collection of information. Participants were then asked to fill out a "Demographic Survey" before being asked to respond to the facilitator's questions.

Two focus groups were conducted--September 27th, 2000 (n=9) and October 4th, 2000 (n=10). An additional twenty-seven (n=27) men chose to participate in the study through one-on-one interviews. The on-on-one interviews took place in October through December 2000. Both focus groups, and all one-on-one interviews, were conducted at ACT, and were facilitated by the first author. The one-on-one interviews allowed for more in-depth responses, and this paper will thus focus on these interviews and the themes identified therein.

DATA ANALYSIS

The semi-structured one-on-one interviews were tape recorded and transcribed by the first author. Data coding was conducted by the second author and the data were interpreted by both authors. Transcribed interviews were analysed by an iterative process of constant comparison to identify both recurring themes and the range of variation and nuance in respondents' narratives (Strauss & Corbin, 1990). A set of 21 questions was developed by the authors to guide the interview process. These questions are listed in Table 1.

RESULTS

In the written portion of the interview, the 27 men provided demographic information (Table 2). Most of the men were in their 40s and more than half had an annual income of $35,000 or more. About two thirds of the men described themselves as "single" with two of these men identifying themselves as widowed and another stating that he had recently ended a long-term relationship. The sample was relatively well educated with over half having attended university. Over three fourths of the sample described their ethnicity as European, Canadian, or mixed. Thus, we were not successful in recruiting a significant sample of men from diverse ethno-cultural communities. Men from different ethno-cultural communities may share some of the concerns or issues identified in this sample; however, further research specifically targeted at a diverse range of communities is needed to ascertain where the needs of men from different ethno-cultural communities are similar and where their needs are unique. About one third of the sample reported that they were HIV+. This is important to consider as HIV serostatus may have impacted on how the men in our study responded to the interview questions.

KEY THEMES

Analysis of the transcribed tapes of the semi-structured interviews with the participants in this study revealed 12 recurring themes within two broad categories (Table 3). Below, we describe and discuss these themes and provide illustrative quotes from …

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Publication information: Article title: Aging, Sexuality, and HIV Issues among Older Gay Men. Contributors: Murray, James - Author, Adam, Barry D. - Author. Journal title: The Canadian Journal of Human Sexuality. Publication date: Fall-Winter 2001. Page number: 75+. © 1999 SIECCAN, The Sex Information and Education Council of Canada. COPYRIGHT 2001 Gale Group.

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