As many as four out of ten HIV positive African-American men could be putting their partners at risk by not using condoms, according to research in the latest UK-based Journal of Advanced Nursing.
A study of 130 middle-aged and older men in the USA found that many of the 40 to 65 year-olds were engaging in high-risk sexual practices.
38 per cent didn't use condoms during oral sex, with 25 per cent having unprotected vaginal sex and 22 per cent having unsafe anal sex. The research also showed that men who were single and displayed fewer HIV symptoms were least likely to use condoms during sex.
"Despite the worrying number of men not using condoms, 78 per cent of those who took part in the study were able to answer questions about HIV and AIDS correctly and 25 per cent claimed to be knowledgeable about the subject but still engaged in risky sex" says Dr Christopher Lance Coleman from the University of Pennsylvania School of Nursing in Philadelphia.
"These findings are of particular concern as HIV and AIDS rates among black (non-Hispanic men) in the USA and in people over 50 have risen considerably in recent years. In fact, AIDS prevalence statistics for minority men in the USA are staggering."
- In 2005, 127.6 per 100,000 cases of HIV/AIDS were African-American men compared to 18.5 for White men, according to data for 33 US states using confidential name-based reporting. The US Center for Disease Control suggests that this ethnic group is eight times as likely to develop AIDS as white males.
- Figures for 2005 also show that 44 per cent of all new cases of HIV were black (non-Hispanic) males, based on the latest data from 50 US states.
- AIDS rates are also rising in people over 50. In 2006, 27 per cent of adults living with AIDS in the USA were over 50.
77 per cent of the 130 African-American men who completed the questionnaire for this study, after responding to advertisements posted in two infectious disease clinics, were single. The average age of the participants was 46.
60 per cent were homosexual and 40 per cent were heterosexual. 32 per cent had received mental health treatment during the last year and the majority earned less than $10,000.
"While we think that our findings are compelling, it would be unwise to conclude that - as with any study - they are representative of all older African-American men who are HIV positive" stresses Dr Coleman.
"However, the findings of this study are worrying, particularly in view of rising HIV and AIDS rates in both ethnic communities and the over 50s. They definitely point to the need for further research into why older African-American men with HIV don't use condoms."
In 2006 UNAIDS - the joint United Nations programme on HIV and AIDS - estimated that there are now 39.5 million cases of HIV and AIDS worldwide. And they called for an international response to curb the stigma experienced by homosexual men who are HIV positive.
"We welcome this move as we believe it is essential to break down barriers to condom use among all people with AIDS and HIV" says Dr Coleman. "Some studies have even suggested that homosexual men have sex with women to hide their sexuality and HIV status."
The authors hope that their findings will add to the ongoing debate about safe sex and condom use and highlight the need for more tailored initiatives to be developed for older African-American men.
"Health promotion messages have traditionally been targeted at young people" says Dr Coleman. "But the increased prevalence of older ethnic males with HIV and AIDS makes it essential for health professionals to promote safe sex and increase condom use to this target audience."
Notes to editors
- Determinants of perceived barriers to condom use among HIV-infected middle-aged and older African-American men, Coleman et al. Journal of Advanced Nursing. 60.4, 368-376.
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