Older Male Clients of Female Sex Workers in the United States

Recent research has provided increased information about the clients of sex workers; however, little is known about the population of older male customers who contract for heterosexual services online. 

Clients (N = 208) between 60 and 84 years of age were obtained through sex work review sites and online discussion forums. Participants completed a 129-item questionnaire focusing on physical health, sexual and non-sexual behaviors with sex providers, and the qualities sought in the same. 

More than half reported having visited sex providers between 13 and 24 times or more during the past 12 months. Participants' advancing age was positively associated with frequency of paid sex. Most frequent sexual activities with providers were fellatio without a condom, followed by penile-vaginal sex with a condom. Analyses also examine the relationship between aging and buying sex. 

Those with higher incomes and without spouses or partners were more likely to report non-sexual activities with providers, and many participants sought a "GFE" or girlfriend experience, in which paid sexual exchanges are part of a relationship that mirrors conventional non-remunerative relationships.

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By:  Milrod C1, Monto M2.

• 1, 519 N. La Cienega Blvd, #209, Los Angeles, CA, 90048, USA. christinemilrod@gmail.com.
• 2Department of Sociology and Social Work, University of Portland, Portland, OR, USA. 
• Arch Sex Behav. 2016 Apr 5.

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Prevalence of High Risk Behaviors in HIV Infected Persons Aged ≥50 Years in Selected Counties of Yunnan Province

OBJECTIVE:

To understand the prevalence of high risk behaviors and influencing factors among HIV infected persons aged ≥50 years.

METHODS:

Face to face questionnaire interview was conducted among the HIV infected persons selected in Jianshui, Gejiu and Mengzi counties in Yunnan province through random sampling in June 2015. The sample size was 450.

RESULTS:

Among the HIV infected persons surveyed, 41.2% (122/296) had sexual behaviors with their spouses during past year, and the consistent condom use rate was 66.4% (81/122). Among the HIV infected males, 8.9%(28/313) had commercial sexual behaviors during past year, and the consistent condom use rate was 17.9% (5/28). Among the HIV infected females, 0.7% were still engaged in commercial sex service during past year. Among the 450 HIV infected persons, 32(7.1%) reported having casual sex behaviors during past years, and the consistent condom use rate was 18.7% (6/32). The rate of commercial sexual behavior in urban residents (13.4%, 19/115) was higher than that in rural residents(4.5%, 9/198), the difference was statistically significant (χ(2)=11.715,P=0.001). The risk factors for commercial sex behaviors included lack of family and social support, aged 50-59 years, living in urban area, higher income and being male. The risk factors for using no condom included living in rural area, lower education level, lack of family and social support and higher income.

CONCLUSIONS:

Risk sex behaviors are still prevalent in HIV infected people aged >50 years, which exacerbated HIV transmission. Further efforts should be focused on the education about AIDS prevention and control and promoting protected sexual behaviors. Additional effort should be done to improve the family and social support for HIV infected people aged >50 years. Moreover, comprehensive intervention for low-paid female sex workers also needs to be strengthened.

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By:  Zhai J1, Niu J2, Song LJ2, Mei JY2, Xiao MY2, Luo HB2, Ma YL2, Zhang JM3, Li WH4, Yang QW5, Jia MH2.

• 1Kunming Medical University, Kunming 650000, China.
• 2AIDS/STD Department, Yunnan Provincial Center for Disease Control and Prevention, Kunming 650022, China.
• 3Jianshui County Center for Disease Control and Prevention, Jianshui 654300, China.
• 4Gejiu County Center for Disease Control and Prevention, Gejiu 661000, China.
• 5Mengzi County Center for Disease Control and Prevention, Mengzi 661100, China. 
• Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Mar 10;37(3):371-4. doi: 10.3760/cma.j.issn.0254-6450.2016.03.016.

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Residential Patterns in Older Homeless Adults: Results of a Cluster Analysis

Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. They may have different life trajectories and reside in different environments than do younger homeless adults. Although the environmental risks associated with homelessness are substantial, the environments in which older homeless individuals live have not been well characterized. 

We classified living environments and identified associated factors in a sample of older homeless adults. From July 2013 to June 2014, we recruited a community-based sample of 350 homeless men and women aged fifty and older in Oakland, California. We administered structured interviews including assessments of health, history of homelessness, social support, and life course. Participants used a recall procedure to describe where they stayed in the prior six months. We performed cluster analysis to classify residential venues and used multinomial logistic regression to identify individual factors prior to the onset of homelessness as well as the duration of unstable housing associated with living in them. 

We generated four residential groups describing those who were unsheltered, cohabited unstably with friends and family, resided in multiple institutional settings (shelters, jails, transitional housing), or lived primarily in rental housing (recently homeless). 

Compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Cohabiters and renters were significantly more likely to be women and have experienced a shorter duration of homelessness. Cohabiters were significantly more likely than unsheltered participants to have experienced abuse prior to losing stable housing. 

Pre-homeless social support appears to protect against street homelessness while low levels of social support may increase the risk for becoming homeless immediately after losing rental housing. 

Our findings may enable targeted interventions for those with different manifestations of homelessness.

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By:  Lee CT1, Guzman D2, Ponath C2, Tieu L2, Riley E3, Kushel M4.

• 1Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA. Electronic address: christopher_lee@post.harvard.edu.
• 2Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
• 3Division of HIV/AIDS, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, USA.
• 4Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA. 
• Soc Sci Med. 2016 Feb 10;153:131-140. doi: 10.1016/j.socscimed.2016.02.004.

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A Comparison of Actual and Perceived Sexual Risk among Older Adults

Sexual risk among older adults (OAs) is prevalent, though little is known about the accuracy of sexual risk perceptions. Thus, the aim was to determine the accuracy of sexual risk perceptions among OAs by examining concordance between self-reported sexual risk behaviors and perceived risk. Data on OAs aged 50 to 92 were collected via Amazon.com's Mechanical Turk. 

Frequency of sexual risk behaviors (past six months) were reported along with perceived risk, namely, sexually transmitted infection (STI) susceptibility. Accuracy categories (accurate, underestimated, overestimated) were established based on dis/concordance between risk levels (low, moderate, high) and perceived risk (not susceptible, somewhat susceptible, very susceptible). Approximately half of the sample reported engaging in vaginal (49%) and/or oral sex (43%) without a condom in the past six months. However, approximately two-thirds of the sample indicated they were "not susceptible" to STIs. 

No relationship was found between risk behaviors and risk perceptions, and approximately half (48.1%) of OAs in the sample underestimated their risk. Accuracy was found to decrease as sexual risk level increased, with 93.1% of high-risk OAs underestimating their risk. Several sexual risk behaviors are prevalent among OAs, particularly men. However, perception of risk is often inaccurate and warrants attention.

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By:  Syme ML1, Cohn TJ2, Barnack-Tavlaris J3.

• 1 Center on Aging , Kansas State University.
• 2 Department of Psychology , Radford University.
• 3 Department of Psychology , The College of New Jersey. 

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Substance Misuse and Older Adults - Slides

More information at and via: http://goo.gl/2nSg1Q 

Links from presentation:  
www.psattc.org
www.uclaisap.org

http://www.hivguidelines.org/clinical-guidelines/hiv-and-aging/hiv-in-older-adults-a-quick-reference-guide-for-hiv-primary-care-clinicians/

http://www.hivguidelines.org/clinical-guidelines/quick-reference-cards/mental-health-screening-a-quick-reference-guide-for-hiv-primary-care-clinicians/

http://www.hivguidelines.org/clinical-guidelines/quick-reference-cards/substance-use-screening-a-quick-reference-guide-for-hiv-primary-care-clinicians/