Factors Associated With Recent Decline in Anal Health Among Older Gay and Bisexual Men: A Cross-sectional Analysis

We investigated factors associated with “worse than usual” anal health among gay and bisexual men aged ≥35 years recruited to a longitudinal study of anal human papillomavirus infection/lesions from September 2010 to August 2015. Among 616 participants (median age 49 years; 36% HIV-positive), 42 (6.8%) reported worse than usual anal health in the last 4 weeks. Associated factors included spending less time with gay friends (odds ratio [OR] = 2.25, 95% CI = 1.06–4.77), most time “feeling down”(OR = 9.17, 95% CI = 2.94–28.59), reduced libido (OR = 2.90, 95% CI = 1.52–5.52), current anal symptoms (OR = 6.55, 95% CI = 2.54–16.90), recent anal wart diagnosis (OR = 4.33, 95% CI = 1.98–9.49), and fear of developing anal cancer (OR = 9.34, 95% CI = 4.52–19.28). Concerns regarding anal health should be routinely discussed by clinicians, and potentially associated psychosocial, physical, and sexual issues further explored.