RACIAL DISPARITIES IN SEXUAL RISK BEHAVIORS: DISCUSSION
The present findings suggest a substantial minority of older HIV-infected white and African-American men may continue to engage in risk behaviors following diagnosis. Indeed, a disturbingly high proportion of men in each of the three groups reported some kind of unprotected sex since their diagnosis that could potentially transmit HIV infection to others, result coinfection with another sexually transmissible disease, or reinfection with another strain of HIV Although the percentages of men still reporting unsafe sex in the past six months were lower, a third or more in each group still acknowledged at least one unsafe contact. Although their current partner status may not be the same as at the time of their unsafe behavior, the large majority of African-American gay/bisexual men and white gay/bisexual men (83% and 78% respectively) had no steady partner, suggesting that their unsafe sex may be taking place outside the context of a monogamous relationship.
The findings that older African-American gay/bisexual men were significantly more likely to report unprotected vaginal/anal sex and a history of IV drug use than older white gay/bisexual men but did not differ from older heterosexual African-American suggest that gay/bisexual African-American men were more similar in their sexual behavior and drug use to heterosexual African-American men than to white gay/bisexual men. These findings suggest that race or its correlates may exert a greater influence on their risk behaviors than sexual orientation. However, future research with a larger sample should further examine the potential sexual orientation differences among African-American men, which may not have reached statistical significance due to the small sample available here.
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Several between-group differences that might possibly be factors in the greater prevalence of reported unsafe vaginal/anal sex among African-American gay/bisexual men than white gay/bisexual men were identified. For example, the former were more likely to report a history of IV drug use, which might explain the association between race and unsafe sexual behavior. Unfortunately, due to the high overlap between ethnicity and drug use, we were unable to examine this possibility. Another difference between these two groups that might be associated with differences in risky sexual behavior is the more socioeconomically disadvantaged status of the African-American men. It is possible that race is merely a surrogate for SES, since African-American participants of both sexual orientations tended to report lower incomes and less education than the white gay/bisexual men. However, in our exploration of this alternative hypothesis, no differences were found in reported sexual risk behaviors by income or education, suggesting that SES does not account for the differences in reported unprotected vaginal/anal sex between white and African-American gay/bisexual men. There were, however, differences in reported drug use by income and education. Thus, SES may account for the differences in IV drug use history and marijuana use between white gay/bisexual men and both groups of African-American men. Other possible explanations for why these racial disparities in sexual risk behaviors exist in this sample (e.g., self-disclosure, felt stigma, and HIV knowledge) are also possible, and should be examined as possible mechanisms by which race is associated with risk behaviors in future research. online pharmacy prescription drugs
Several limitations of the study must be acknowledged. First because sexual behaviors were not the original focus of the study, our measures of sexual risk behavior did not provide a detailed sexual behavior profile (e.g., how frequently these acts occurred, whether or not they took place with a steady partner, whether they acted as the insertive or receptive partner, or the serostatus of their partners). Second, because of the purposive sampling methods employed, the sample may not be representative of the population of older men with HIV/AIDS in New York City. The study may also be limited by the inherent problems of self-reported sexual behaviors and drug use. Furthermore, although we had a sufficient sample of this rare population to detect some significant between-group differences, others may have gone undetected due to the relatively small sample size. Conversely, there is the possibility that the differences noted in this small sample may not replicate with larger samples; therefore, we encourage future research to replicate this study with a larger, more representative sample. My CanadianOrder Net
The fact that a substantial proportion of men in all three groups continued to report sexual risk and drug use behavior following their diagnosis suggests the need for greater prevention efforts which include or specifically target late-middle-age and older adults. Older gay/bisexual African-American men reported the highest prevalence of risky sexual behavior in comparison to white gay/bisexual men. Clearly, the prevention messages and interventions had not reached or had not yet been as effective with older African-American gay/bisexual men. Traditionally, prevention efforts have tended to target individuals based on risk behavior categories (e.g., MSM), however, these data question the appropriateness of targeting African-American gay/bisexual men solely on the basis of sexual orientation, and suggest that their race/ethnicity must also be considered. Further, the fact that the sexual risk behaviors reported here took place after diagnosis with HIV/AIDS suggests the need for improved risk-reduction interventions for HIV-infected individuals, particularly at the time of testing and immediately following diagnosis. viagra uk online