Abstract / Summary
With expanded antiretroviral therapy (ART) access and population aging, the number of older people living with HIV (PLWH) in China is rising, yet little is known about how sexual behavior, condom use, and HIV status concealment intersect with access to support and continuity of care in later life. A qualitative study was conducted from January to May 2023. Purposive sampling was used to recruit 24 PLWH (18 males, 6 females) aged ≥ 60 from designated infectious disease hospitals in seven cities across five geographic regions of China. Data collection continued until thematic saturation. Semi-structured interviews were analyzed using inductive thematic analysis. Reliability was ensured through double-coding. A total of 24 older PLWH completed the interviews. Their mean age was 65.9 years (SD 5.4), the median age was 64 years (range: 60–78), and 75.0% were male. HIV status concealment linked sexual decision-making with later-life care vulnerability. Some participants abstained because of transmission concerns, while sexual desire persisted among many men, often through masturbation. Condom use was facilitated by partner protection, health education, and health awareness but constrained by commercial-sex contexts, partner serostatus, erectile dysfunction, condom access, and limited awareness of oral sex-related risks. Disclosure supported partner protection, emotional support, and ART adherence, whereas anticipated stigma, relationship disruption, and perceived low risk sustained concealment. Participants who had not disclosed were particularly concerned that declining mobility would impede future ART collection and family assistance. Importantly, One participant reported that some peers had intentionally skipped doses to conserve medication because they feared future access difficulties; concealment also complicated access to non-HIV healthcare. Concealment may reduce immediate stigma but intensify later-life care vulnerability. Age-responsive services integrating sexual health, privacy protection, flexible ART delivery, and HIV and non-HIV care are needed.