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A National Longitudinal Cohort Study of HIV-positive and HIV-negative Australian Gay Men Aged 40+

Selected Findings

LifeTimes is a national longitudinal survey of the health and well-being of HIV-positive and HIV-negative Australian gay men aged 40 years and older.

LifeTimes was developed in response to the rapid ageing of Australia’s HIV population. The survey is conducted every year among the same national cohort of middle-aged and older Australian gay men. It examines changes in health and wellbeing over time to identify and understand health-related patterns linked to ageing and compares HIV-positive and HIV-negative gay men to identify challenges specifically related to living and ageing with HIV. By including both HIV-positive and HIV-negative gay men, LifeTimes also provides valuable information on experiences and challenges of growing older as a gay man generally, including changes to sexual and relationship patterns, and to other areas of life, that may have an impact on sexual health and other aspects of health.

LifeTimes was launched in 2010. The Wave 1 survey was completed in 2010-2011 by 1,179 men from all Australian states and territories, including cities and regional and rural areas. To identify changes in health and well-being, this same cohort was followed up 12 months later with a Wave 2 survey (2011-2012). A third follow-up wave was recently completed (2012-2013).

Below is a summary of findings from the first two waves of LifeTimes. For any enquiries about LifeTimes, you can contact Lead Investigator, Dr Anthony Lyons, a.lyons@latrobe.edu.au.

The LifeTimes Cohort

The LifeTimes cohort involves 1,179 gay men aged 40 years and older from all across Australia.

In this cohort, 97% reported their sexual identity as gay or homosexual, 2% as bisexual, and 1% as some other identity.

At the time of the Wave 1 survey in 2010-2011, 61% were aged in their 40s, 27% in their 50s, and 11% in their 60 years and older.

A total of 189 (17%) reported being HIV-positive.

On education, 37% had a university degree. On employment, 63% were working full-time, 13% part-time, and 24% were retired or otherwise not working. On income, 38% reported a pre-tax annual income of less than $50,000 and 62% reported an income of $50,000 or greater, with 17% earning $100,000+. There were 21% born overseas.

On sex and relationships, 52% were in a regular relationship and 81% reported having sex in the past 12 months. 18% said they had one sexual partner in the past 12 months, 26% said they had two to five partners, 13% six to ten partners, and 25% more than ten partners.

Of the men who completed the follow-up Wave 2 survey approximately 12 months later, we were able to match 372 of them to Wave 1. This group was slightly older on average than the total Wave 1 group but were similar on every other demographic.

Physical Health

In Wave 1, 40% reported receiving treatment for a major physical health condition, such as hypertension, cardiovascular disease, or asthma.

Not surprisingly, there were large differences by age, with treatment for a major physical health condition reported by 31% of men in their 40s, 52% of men in their 50s, and 61% of men aged 60 and older.

There were no differences by HIV status. Men who were HIV-positive were no more likely to report treatment for a major physical health condition than were HIV-negative men.

However, there were differences for a few specific conditions. Though percentages were small, 3% of HIV-positive men reported having hepatitis B and 2% hepatitis C. None of the HIV-negative men reported these conditions. But more HIV-negative men reported having hypertension than HIV-positive men: 14% vs. 8%.

An in-depth look at differences between HIV-positive and HIV-negative men on physical health conditions can be found in:

Lyons, A., Pitts, M., & Grierson, J. (2012). Exploring the psychological impact of HIV: Health comparisons of older Australian HIV-positive and HIV-negative gay men. AIDS and Behavior, 16(8), 2340-2349.

Mental Health

In Wave 1, 27% reported receiving treatment for a mental health problem, such as depression (22%) and anxiety (14%).

There were no age differences.

There were large differences according to HIV status. 37% of HIV-positive men reported receiving treatment for a mental health problem compared to 25% of HIV-negative men.

However, as we report in a Research Article on this topic, one explanation may be differences in living conditions. In LifeTimes, the HIV-positive men were generally poorer than the HIV-negative men. They were also less likely to be working, less likely to be employed full-time, and were a little less likely to have some forms of social support. It is possible that these challenges are at least partly behind differences in mental health.

An in-depth look at HIV status and mental health from LifeTimes can be found in:

Lyons, A., Pitts, M., & Grierson, J. (2012). Exploring the psychological impact of HIV: Health comparisons of older Australian HIV-positive and HIV-negative gay men. AIDS and Behavior, 16(8), 2340-2349.

Health Changes over 12 Months

Changes in health over 12 months were mapped among the men who completed both Waves 1 and 2.

Physical Health

A large majority of those who reported receiving treatment for a major physical health condition at Wave 1 again reported treatment for a major physical health condition at Wave 2. Only 6% said they were no longer being treated for a physical health condition.

Of those who did not report a major physical health condition at Wave 1, 4% reported receiving treatment for a major condition by Wave 2 while 96% continued to be well.

The likelihood of men reporting recovery from a physical health condition by Wave 2 was no different by age or by HIV status.

Mental Health

A large majority of those who reported receiving treatment for a mental health problem at Wave 1 again reported treatment for a mental health problem at Wave 2. Only 13% said they were no longer receiving treatment.

Of those who did not report a mental health problem at Wave 1, 6% reported receiving treatment for a mental health problem at Wave 2.

The likelihood of men reporting recovery from a mental health problem by Wave 2 was no different by age or by HIV status. In other words, despite more HIV-positive men reporting treatment for a mental health problem, they were just as likely as HIV-negative men to have recovered at Wave 2.

Growing Old as a Gay Man

The men who participated in LifeTimes gave plenty of detailed information on many aspects of their lives, including relationships, friendships, social support, experiences of discrimination, and health and wellbeing. Little is known about the experiences of growing older as a gay man, including any challenges. We looked at men aged in their 40s, 50s, and 60s and over.

Overall, those who were aged 60 and over had lower incomes. They were also more likely to be living alone, but were just as likely as men in their 40s and 50s to be in a regular ongoing relationship (54% were in a relationship), to be sexually active (65% had sex in the past 4 weeks), and to be satisfied with their sex life (40% said they were very satisfied).

Further, those aged 60 and over drew much greater support from friendships than did younger men (91% said they had 3 or more close friends). They also felt more connected with the gay community (67% said they felt some or a lot of connection with the gay community).

In general, the older men were less optimistic about the future, but they had higher self-esteem. We also examined factors for greater wellbeing. The most important factors for men in LifeTimes were having a satisfying sex life, receiving some or a lot of social support, and having good or excellent health.

In all, men aged 60 years and older faced some challenges, such as greater age-related discrimination, but appeared to be doing well in most areas of their lives.

An in-depth look at findings from LifeTimes on Growing Old as a Gay Man can be found in:

Lyons, A., Pitts, M., & Grierson, J. (2013). Growing old as a gay man: Psychosocial well-being of a sexual minority. Research on Aging, 35(3), 275-295.

Also see the following article on Factors for Positive Mental Health among Older Gay Men, also from the LifeTimes study:

Lyons, A., Pitts, M., & Grierson, J. (2013). Factors related to positive mental health in a stigmatized minority: An investigation of older gay men. Journal of Aging and Health, 25(7), 1159-1181.

Versatile Sex Roles

Having detailed information on sexual behaviour patterns is essential to accurately predicting epidemics of HIV and sexually transmitted infections. With anal sex, HIV is more often transmitted from the insertive to the receptive partner and less often from the receptive to the insertive partner. So it is important to have detailed information on patterns of insertive and receptive anal sex. It is commonly assumed that gay men stick to either an insertive or receptive role so that they are either Tops (insertive) or Bottoms (receptive). But how many are Versatile, that is, switch between insertive and receptive roles? We aimed to find out in LifeTimes.

The men in Wave 1 reported on their sexual behaviour over the past year. In all, 66% reported having anal sex at some time in the past year. Of these men, 24% were Tops. These men reported only ever taking an insertive role in the past year. Only 14% were Bottoms. These men reported only ever taking a receptive role in the past year. The rest (62%) were Versatile, that is, practiced both insertive and receptive roles.

Of the Versatile men, 20% were categorised as highly versatile. These men tended to have just as many insertive as receptive partners.

There were some age differences. Among men aged 60 years and older, 58% were Versatile compared with 67% of men in their 40s.

An in-depth look at findings on Versatility from LifeTimes can be found in:

Lyons, A., Pitts, M., & Grierson, J. (2013). Versatility and HIV vulnerability: Patterns of insertive and receptive anal sex in a national sample of older Australia gay men. AIDS and Behavior, 17(4), 1370-1377

Thankyou

We wish to extend a very big Thank You to all of the men who have been participating in LifeTimes since it began in 2010. Many have completed the survey each year, providing up to date information on numerous aspects of their lives. A project of this scale would not have been possible without the ongoing generosity and enthusiasm from all of those who have participated.

There are many more findings to come and we will continue to update this page with new information as LifeTimes continues.

In the meantime, any enquiries about LifeTimes can be directed to Dr Anthony Lyons, a.lyons@latrobe.edu.au.