title: Older partner selection, sexual risk behaviour and unrecognised HIV infection among black and Latino men who have sex with men.
abstract: OBJECTIVE
  The authors examine whether young black and Latino men who have sex with men (MSM) who have older sex partners are more likely than those who do not have older sex partners to have unrecognised HIV infection. The authors examine whether the association stems from (1) increased sexual risk behaviour with male partners of any age, (2) heightened risk of being exposed to HIV infection by older partners or (3) a combination of these two factors.
  
  
  METHODS
  The analytical sample consisted of 723 black and Latino MSM, aged 18-35&emsp14;years, who were HIV negative or of unknown serostatus at study entry. Participants completed a self-administered questionnaire and were tested for HIV infection. Men who reported having a male sex partner who was at least 4 years older than themselves were compared with those who did not. Outcomes included unprotected receptive anal intercourse (URAI) with male partners of any age (past 3&emsp14;months) and having unrecognised HIV infection.
  
  
  RESULTS
  Men with older partners reported a higher prevalence of URAI (AOR = 1.50, 95% CI 1.02 to 2.21). A second model found that men with older partners had increased odds of having unrecognised HIV infection (AOR = 2.51, 95% CI 1.18 to 5.34) after controlling for the number of URAI partners of any age, which remained an independent predictor.
  
  
  CONCLUSIONS
  Young black and Latino MSM who had older male sex partners were at increased risk of having unrecognised HIV infection. This heightened risk was associated with sexual risk behaviour with partners of any age as well as possible increased exposure to HIV infection from older partners.
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-37, Atlanta, GA 30333, USA. hjoseph1@cdc.gov
authors.forename: Heather A
authors.initials: HA
authors.lastname: Joseph
authors.forename: Gary
authors.initials: G
authors.lastname: Marks
authors.forename: Lisa
authors.initials: L
authors.lastname: Belcher
authors.forename: Gregorio A
authors.initials: GA
authors.lastname: Millett
authors.forename: Ann
authors.initials: A
authors.lastname: Stueve
authors.forename: Trista A
authors.initials: TA
authors.lastname: Bingham
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lauby
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000367:Age Factors; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology* / Q000635:transmission; D006630:Hispanic or Latino / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008393:Marriage; D009519:New York City / Q000453:epidemiology; D015143:Philadelphia / Q000453:epidemiology; D012747:Sexual Partners; D047568:Unsafe Sex / Q000523:psychology*; D055815:Young Adult