Are individual-level psychosocial resiliencies associated with the use of Combination HIV prevention strategies among HIV-seronegative middle-aged and aging men who have sex with men?

Abstract

Background: Men who have sex with men (MSM) over the age of 50 are at high risk of HIV infection. With the introduction of highly effective biomedical prevention strategies like pre-exposure prophylaxis (PrEP), MSM now have more options to prevent HIV than ever before. However, the selection of appropriate behavioral or biomedical prevention strategies can be challenging. There is limited information on the association between resilience and HIV prevention strategies in older MSM. Research on this topic could inform future strengths-based interventions to promote the use of CHP strategies in this population. Objectives: The goal of our study was to investigate the relationship between individual-level psychosocial resilience and the selection of CHP strategies among HIV-negative older MSM in the US. Methods: This cross-sectional study used data from the "Understanding Patterns of Healthy Aging in Men Who Have Sex with Men" sub-study of the Multicenter AIDS Cohort Study. Participants' self-reported use of HIV prevention strategies such as condom use, abstention from anal sex, pre-exposure prophylaxis use, post-exposure prophylaxis use, pulling out before cumming, and discussion viral load and HIV status before sex were used to develop latent classes of CHP strategies in a previous study by Meanley et al (2022). The three latent classes identified were high CHP overall, high anal sex abstention, and low prevention overall. Multivariate models adjusting for age, race/ethnicity, education, condomless anal sex, alcohol consumption, and recreational drug use were used to assess the association between individual-level psychosocial resilience as measured by the RS-14 scale and membership in latent classes of CHP strategies. Results: Our sample included 293 HIV-negative older MSM who were mostly white (82.6%) and college educated (94.9%), with a median age of 63. The low CHP overall class included 43.0% of the sample, low prevention overall included 42.0%, and high anal sex abstention included 15.0%. We found a statistically significant association between every 5-unit increase in RS-14 score and membership in the high CHP overall class when compared with the low CHP overall class (OR: 1.121 [95% CI: 1.014-1.241]). Conclusions: Our results aligned with emerging research that has found a positive association between resilience and HIV prevention strategies used by MSM. However, previous work has not focused on older populations of MSM or combination HIV prevention strategies, making our results a valuable contribution to the HIV prevention field. These findings can inform the development of resilience-based interventions in this population.