Understanding Unprotected Anal Intercourse Among Older Men Who Have Sex with Men in Mainland China, Hong Kong, and Taiwan: A Cross-Regional Study

Background: Unprotected anal intercourse (UAI) among older men who have sex with men (MSM) is a significant public health issue in mainland China, Hong Kong, and Taiwan. This study investigates the factors influencing UAI in this population across these regions, considering cultural, social, and healthcare-related differences.Study Setup (Methods):A total of 453 older MSM, aged 60 and above, were recruited from mainland China, Hong Kong, and Taiwan, with 151 participants from each region. Participants completed anonymous online questionnaires assessing demographic characteristics, sexual risk behaviors, and psychosocial factors such as everyday discrimination, perceived social acceptance, psychological distress, social capital, sense of control, and resilience. Logistic regression models were applied to identify predictors of UAI engagement.Results:Among the 453 participants, 46.8% reported engaging in UAI. Those who engaged in UAI were more likely to exhibit other sexual risk behaviors, including sexual risk-taking with uncommitted partners (80.7%), impulsive sexual behaviors (87.7%), and greater intent to engage in sexual risk behaviors (84.9%). Adjusted logistic regression models revealed that greater perceived social acceptance was associated with a 58% reduction in the odds of UAI (AOR = 0.42, 95% CI [0.26, 0.68], p < .001). Conversely, sexual risk-taking with uncommitted partners (AOR = 1.35, 95% CI [1.13, 1.61], p < .001) and intent to engage in sexual risk behaviors (AOR = 1.53, 95% CI [1.03, 2.29], p < .05) were significant predictors of increased odds of UAI.Discussion:These findings emphasize the importance of fostering supportive social environments to reduce sexual risk behaviors in older MSM.