Condom Use, Sexual Risk, and Self-Reported STI in a Sample of Older Male Clients of Heterosexual Prostitution in the United States

While there is evidence of increasing rates of sexually transmitted infections (STIs) among older men in the United States, there has been little research on older male clients of female sex providers. The purpose of the current study was to understand the sexual risk behaviors and psychosocial correlates among older men hiring sex providers through provider review websites and discussion boards. A convenience sample of 208 male clients ages 60 to 84 completed online surveys about their sexual behavior and psychosocial factors. Participants indicated the most common sexual activities with providers in the past 12 months were receiving condomless fellatio (33.7%) and having penile-vaginal intercourse with a condom (31.7%). Although condomless penile-vaginal sex with a provider in the past 12 months was only reported by 2.9%, about half (51%) of the respondents indicated that they had experienced this at least once during their lifetime. This was associated with a preference for providers who do not require condoms, having been previously diagnosed with an STI, and perceiving one's HIV risk to be higher, as well as advancing age and having more emotional relationships with providers. Findings demonstrate the need for general and sexual health care practitioners to openly discuss protective measures and strategies for avoiding STIs among their older-to-elderly male patients.