Reduced concern due to highly active antiretroviral therapy and safer sex fatigue were also found to be associated with sexual risk-taking among HIV-positive MSM. Some HIV-positive MSM continue to engage in high-risk sexual behavior after their diagnosis, placing themselves at risk for contracting secondary infections as well as transmitting HIV to others. With the advent of more effective treatments for HIV, a significant proportion of MSM are now living and aging with HIV. Several historical issues must be considered when studying sexual behaviors in older MSM. Other qualitative studies identified additional factors driving risky sexual behaviors among older MSM such as drinking in conjunction with sex, stigma related to sexual orientation and HIV, the perceived low risk for contracting the HIV virus, the perceived loss of attractiveness accompanied with aging, marginalization within the gay community, loneliness, and a desire to have sexual intimacy. This HIV prevalence was even higher among African Americans, injection drug users, illicit drug users, and those who were more open about their sexual orientation. In a probability sample of older MSM living in four metropolitan cities, Dolcini and colleagues reported an HIV prevalence of 19% among respondents over the age of 50. The Centers for Disease Control and Prevention estimates that 10 percent of all newly acquired infections are in adults over the age of 50, suggesting that older MSM are engaging in risk behaviors associated with HIV.
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Contrary to the general belief that older MSM are not sexually active and are therefore not at risk for HIV, converging lines of research and data show otherwise. Due in part of ageism and homophobia, older MSM remain a marginal population in which HIV levels and sexual risk factors are less well known. HIV prevention efforts have traditionally focused on young MSM. Because men who have sex with men (MSM) are disproportionately affected by HIV, understanding how risky sexual behaviors change as MSM age is an important aspect of the epidemiology in this population.