Trajectories of risky sexual behavior, depressive symptoms, and substance use in a cohort of middle-aged and older adults in the Pitt Men's Study

There is a general misperception that sexuality and sexual orientation are not important in the lives of older adults. Older gay and bisexual men remain an invisible population in which health behaviors and health status are less well-known. While an enormous body of research has documented the disparities of substance use, depression, and HIV prevalence among Men who have Sex with Men (MSM) compared to heterosexual men, less is known about how patterns of substance use, depression, and risky sexual behavior evolve as MSM age.;Using a semi-parametric, group-based approach, this study investigated the effect of aging on risky sexual behavior, depression, and illicit drug use in a cohort of middle-aged and older MSM in the Pitt Men's Study.;In the three presented manuscripts, results indicate that the majority of participants did not have unprotected anal intercourse partners or use illicit drugs, and reported very low depressive symptoms across the age range of the study. At the same time, the analysis identified trajectory groups with respect to midlife exposure to risky sexual behavior, chronic depressive symptoms, and multiple illicit drug use. Several correlates such as socio-demographic variables, health behaviors (smoking and binge drinking), and psychological variables (HIV-related attitudes) were differentially associated with the trajectory groups.;The results of the study refuted the negative stereotypes of older gay and bisexual men as "sad, undesirable, and depressed", yet the study managed to provide a more realistic picture of the development of mental health and HIV risk behaviors of this cohort from middle to early old age. This confirms the diversity and heterogeneity of this population noted by previous researchers.;Public health significance. Using this epidemiologic approach, future researchers can identify subgroups of men who are at most risk for depression, substance abuse, and risky sexual behaviors over an extended period of time. As a result, public health resources such as prevention and intervention programs can be allocated to these men in a cost-effective way. In addition, investigations of the risk factors associated to each trajectory group may give clues to different etiologies of group characteristics among a cohort of aging sexual minorities.