Afterhood and Wellbeing Among Older Gay Men: A Mixed-Methods Study
1
Medicine, univeristy of california san francisco, San Francisco, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Older gay men are a growing yet understudied population whose later lives are shaped by the aftermath of social marginalization, AIDS epidemic, and structural inequality. While research has examined HIV outcomes and aging separately, less is known about how older gay men live or how well-being differs by HIV status. This study integrates the concept of Afterhood—the period of life that unfolds after major collective biographical disruptions—to examine aging, health, and inequities among older gay men.
METHODS:
We used a mixed-methods design drawing from the ongoing Openly Gray Study in San Francisco. Quantitative analyses were conducted on interim data collected 2023-2026 (N=410) among gay men aged 50+ to examine differences by HIV status. In parallel, we conducted in-depth interviews with a subsample of men (N=30) across ethnic and HIV status. Qualitative data were analyzed using thematic and constant comparative methods, guided by queer theory and life-course perspectives.
RESULTS:
Findings revealed significant disparities by HIV status. Compared to HIV-negative men, those living with HIV report greater financial insecurity (in childhood and in the prior 12 months), higher loneliness, lower likelihood of having a primary partner, and poorer health (e.g., elevated inflammation, depression, anxiety, drug use). Suicidal ideation was alarmingly common across groups (≈20%). Qualitative interviews contextualized these inequities, showing how men describe afterhood as a stage of continuity and reorientation rather than decline. Participants emphasize sustaining a “queer essence”—authenticity, creativity—through spirituality, community engagement, and chosen family, while navigating aging, illness, and loss.
CONCLUSIONS:
Afterhood is a critical period where aging, HIV, and inequity intersect. Addressing the well-being of older gay men—particularly those living with HIV—requires interventions extending beyond biomedical care to address loneliness, financial insecurity, mental health, and meaning-making. Centering afterhood offers a new framework for equity-driven global HIV and aging strategies.
Older gay men are a growing yet understudied population whose later lives are shaped by the aftermath of social marginalization, AIDS epidemic, and structural inequality. While research has examined HIV outcomes and aging separately, less is known about how older gay men live or how well-being differs by HIV status. This study integrates the concept of Afterhood—the period of life that unfolds after major collective biographical disruptions—to examine aging, health, and inequities among older gay men.
METHODS:
We used a mixed-methods design drawing from the ongoing Openly Gray Study in San Francisco. Quantitative analyses were conducted on interim data collected 2023-2026 (N=410) among gay men aged 50+ to examine differences by HIV status. In parallel, we conducted in-depth interviews with a subsample of men (N=30) across ethnic and HIV status. Qualitative data were analyzed using thematic and constant comparative methods, guided by queer theory and life-course perspectives.
RESULTS:
Findings revealed significant disparities by HIV status. Compared to HIV-negative men, those living with HIV report greater financial insecurity (in childhood and in the prior 12 months), higher loneliness, lower likelihood of having a primary partner, and poorer health (e.g., elevated inflammation, depression, anxiety, drug use). Suicidal ideation was alarmingly common across groups (≈20%). Qualitative interviews contextualized these inequities, showing how men describe afterhood as a stage of continuity and reorientation rather than decline. Participants emphasize sustaining a “queer essence”—authenticity, creativity—through spirituality, community engagement, and chosen family, while navigating aging, illness, and loss.
CONCLUSIONS:
Afterhood is a critical period where aging, HIV, and inequity intersect. Addressing the well-being of older gay men—particularly those living with HIV—requires interventions extending beyond biomedical care to address loneliness, financial insecurity, mental health, and meaning-making. Centering afterhood offers a new framework for equity-driven global HIV and aging strategies.
| eISSN: | 2654-1459 |
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