Prevalence and correlates of risky anal sex acts among older men who have sex with men in Mainland China, Hong Kong, and Taiwan

Risky anal sex acts remain an important public health concern among older men who have sex with men (OMSM) in Mainland China, Hong Kong, and Taiwan. This study examined the prevalence of any risky anal sex act and its demographic, behavioural, and psychosocial correlates across these three settings. A total of 453 OMSM aged 60 years or above were recruited, with 151 participants from each region. Participants completed anonymous online questionnaires assessing demographic characteristics, sexual risk behaviours, and psychosocial factors. Logistic regression analyses were conducted to identify associated factors. Overall, 46.8% of participants reported any risky anal sex act. In the adjusted model, greater perceived social acceptance was associated with lower odds of any risky anal sex act (AOR = 0.42, 95% CI [0.26, 0.68], p < .001). By contrast, sexual risk-taking with uncommitted partners (AOR = 1.35, 95% CI [1.13, 1.61], p < .001) and intention to engage in sexual risk behaviours (AOR = 1.53, 95% CI [1.03, 2.29], p < .05) were associated with higher odds. Prevention strategies should address both psychosocial and behavioural factors.