Patients with HIV are living longer, but the incidence of HIV is increasing among those over age 50. And prevention campaigns have not reached this older population, nor have they effectively reached black men: in 2004 blacks represented 50% of new HIV cases.

Researchers surveyed 130 HIV-positive black men receiving care at infectious-disease clinics. Ages ranged from 40 to 65 years; most had low incomes, and 77% were single. About 40% (51 men) identified themselves as heterosexual and about 60% (79 men) as men who have sex with men. Although 101 men demonstrated good knowledge about HIV, 40 said that this knowledge did not prevent them from engaging in risky sexual behavior. For example, more than one-third reported not using condoms during oral sex, about one-fourth didn't use them for vaginal sex, and about one-fourth had unprotected anal sex. Single men and men with fewer HIV symptoms were more likely to engage in unprotected sex.

These findings indicate that knowledge alone does not lead to the use of preventive practices in older, HIV-positive black men and that interventions should perhaps target single men and those with fewer disease-related symptoms. "We hope that these findings start an important conversation, which did not occur some 25 years ago, concerning the importance of targeting HIV prevention messages to older adults," study author Christopher Coleman told AJN.