PrEP-eligible behaviours and condom use among sexually active older adults in China: Findings from the sexual well-being (SWELL) study

Abstract

Objectives

Older adults remain sexually active and at risk of sexually transmitted infections (STIs). This study aimed to explore consistent condom use and pre-exposure prophylaxis (PrEP)-eligible behaviours and their correlates among sexually active older adults in China.

Study design

Cross-sectional study.

Methods

Data were collected from a multicentre cross-sectional survey in China between June 2020 and December 2022. Eligibility criteria were community-dwelling older adults aged ≥50 years who were sexually active (i.e. had oral, vaginal or anal sex in the past year). In-person questionnaire interviews included demographic characteristics, general health and sexual health information.

Results

In total, 1332 sexually active older adults were recruited in the study. Overall, 33.7 % (449/1332) of participants consistently used a condom in the past year and 7.9 % (105/1332) reported PrEP-eligible behaviours. Consistent condom use was significantly associated with the following characteristics: age (only for women aged 50–59 years [adjusted odds ratio (aOR) 0.60, 95 % confidence interval (CI): 0.36–0.98]; women aged 60–69 years [aOR 0.27, 95 % CI: 0.10–0.71]), living alone (men [aOR 0.40, 95 % CI: 0.20–0.79]; women [aOR 0.27, 95 % CI: 0.10–0.72]), body mass index (men [aOR 1.59, 95 % CI: 1.18–2.14]; women [aOR 1.76, 95 % CI: 1.13–2.73]), general health status (men reporting ‘fair’ health [aOR 0.62, 95 % CI: 0.39–0.97]; women reporting ‘very good’ health [aOR 0.39, 95 % CI: 0.16–0.96]), talking about sex (men [aOR 1.67, 95 % CI: 1.23–2.26]) and knowledge of condom use to prevent sexually transmitted infections (men [aOR 1.52, 95 % CI: 1.06–2.18]). PrEP-eligible behaviours were more likely in men (aOR 1.76, 95 % CI: 1.08–2.90) and in individuals who were not in a stable relationship (aOR 4.80, 95 % CI: 2.41–9.54) and who lived alone (aOR 2.02, 95 % CI: 1.07–3.82).

Conclusion

Consistent condom use was moderate among sexually active older adults in China. More than one-quarter of older adults who lived alone reported PrEP-eligible behaviours. Comprehensive intervention measures should consider the characteristics and health needs of community-dwelling older adults.