3 - (OP24) The Impact of Aging-related Syndemics and Resilience on Older Men Who Have Sex with Men's Sexual Health in Florida

Introduction: The U.S. HIV epidemic is “greying” with most people with HIV over the age of 50 years. Men who have sex with men (MSM) make up the greatest proportion of new and existing HIV cases, in part due to syndemic conditions that both perpetuate and exacerbate negative HIV prevention and treatment outcomes. Understanding the impact of aging-specific factors on sexual and HIV prevention outcomes among older MSM (OMSM) is essential for contextualizing the “greying of the epidemic;” yet, research is lacking. To address this gap, this study examined the differential impacts of two additive syndemic indices – one aging-related and the other based on traditional conditions - and their interaction with resilience among OMSM in Florida.

Methods: HIV-negative OMSM in Florida completed a one-time assessment of age-related (i.e., internalized ageism, social isolation, aging-related anxiety, sexual minority specific aging concerns, explicit ageism, perceived cognitive impairment, economic marginalization) and traditional (i.e., depression, PTSD symptoms, substance use, intimate partner violence, childhood sexual abuse) syndemic conditions along with measures of resilience, sexual health, and PrEP engagement. Traditional logistic and zero-inflated binomial regression models examined the impact of traditional syndemics, age-related syndemics, resilience, and their interactions on sexual health and PrEP engagement outcomes among the study population.

Results: Participants (N = 291) experienced on average 3.24 age-related (SD = 1.85, range = 0-7) and 1.54 traditional (SD = 1.32, range = 0-5) syndemic conditions. OMSM’s reported sexual activity, PrEP use, and past 6-month STI diagnosis was low. Total condomless sex acts (B = 0.51, p = .02), number of sex acts (B = 0.21, p = .03), and number of sexual partners (B = 0.14, p = .04) were impacted by the aging-related syndemic index while past 6-months STI diagnosis (B = 0.81, p < .01), current PrEP use (B = 0.58, p < .01), total number of sexual partners (B = 0.30, p < .01), and total number of condomless sex acts (B = -0.58, p < .01) were significantly associated with the traditional syndemic index. Resilience (B = 0.41, p < .01) and the interaction between resilience and age-related syndemic index (B = 0.14, p = .09) were positively associated with total number of sex partners such that resilience buffered the association between the age-related syndemic index and total number of sex partners.

Discussion: This is the first study to empirically examine how aging-related syndemic conditions may negatively impact sexual health outcomes among OMSM. Participants experienced a significant number of unique aging-related and traditional syndemic conditions that are associated with several sexual health outcomes, but not PrEP engagement. Cognitive-behavioral approaches that address both traditional and age-related syndemic factors through techniques like cognitive restructuring, behavioral activation, and problem solving may bolster OMSM’s resilience, and in turn, improve general sexual health, and further health equity for this group. Future research should assess these relationships longitudinally to better understand how aging may contribute to persistent sexual health disparities among OMSM.