The Paradox of Ageing: Sexual Risk Behaviors and Psychosocial Determinants Among Older Men Who Have Sex with Men in Hong Kong and Taiwan

Objectives: This study investigated regional variations in sexual risk behaviors among older men who have sex with men (MSM) in Hong Kong and Taiwan, with a focus on exploring the interplay of everyday discrimination, social acceptance, psychological distress, and sociodemographic factors. Methods: This comparative, cross-sectional investigation recruited a sample of 302 older MSM aged 60 years or older (151 from each region) through collaborations with community organizations utilizing non-random sampling methods. Data analysis was conducted using general linear models to identify key predictors of sexual risk behaviors. Results: Participants from Hong Kong exhibited significantly higher sexual risk behaviors than their Taiwanese counterparts across all measured dimensions (p < .05), except for risky sexual acts. (a) Age consistently emerged as a protective factor, whereas (b) economic activity was associated with an increased likelihood of engaging in sexual risk behaviors. Moreover, (c) non-disclosure of sexual orientation to friends and lower income levels were correlated with heightened risk across several behavioral domains. Discussion: The findings highlight the complex relationship between sociodemographic and psychosocial factors in influencing sexual risk behaviors among older MSM. The results point to the need for targeted interventions that address both the protective and risk-enhancing effects of social factors, with a particular focus on younger and economically active older MSM. Strategies that are tailored to specific regions and consider differences in risk behaviors especially across various sexual practices are key to improving sexual health outcomes for this aging group.