Objective   To analyze the characteristics and influencing factors of high-risk sexual behaviors before infection confirmation among middle-aged and elderly people living with human immunodeficiency virus (PLHIV) transmitted via different routes.

  Methods   We recruited 449 PLHIV in Wuhan city of Hubei province and aged 50 years and older at the diagnosis during the period from 2017 to June 30, 2019. A face-to-face anonymous survey was conducted among the PLHIV using a self-designed questionnaire to collect information on high-risk sexual behaviors and HIV-related knowledge before the confirmation of HIV infection. Chi-square test and multivariate analysis were used to explore influencing factors for high-risk sexual behaviors.

  Results   Complete information were collected from 419 participants (353 males and 66 females with a mean age of 59.67 ± 7.48 years). The reported HIV transmission routes included extramarital heterosexual behaviors for 215 (51.3%) of the participants, heterosexual behaviors between HIV-discordant couples for 40 (9.5%) of the participants and homosexual behaviors for 164 (39.1%) of the participants. Multivariate analysis showed that for the participants being infected via extramarital heterosexual behaviors, ever working in places other than hometown (odds ratio OR = 4.55), being capable of making annual balance between income and expenditure (OR = 4.22), and history of commercial heterosexual behavior (OR = 11.20) were risk factors for multiple sexual partners before HIV infection confirmation; while for the participants being infected via homosexual behaviors, ever working in places other than hometown (odds ratio OR = 10.04), being capable of making annual balance between income and expenditure (OR = 26.29), and history of non-commercial temporary homosexual behavior (OR = 35.37) were risk factors for multiple sexual partners before HIV infection confirmation, but with a common knowledge/without knowledge about AIDS prevention (OR = 0.04/0.07) was a protective factor against multiple sexual partner.

  Conclusion   Ever working in places other than hometown and being capable of making annual balance between income and expenditure are risk factors for multiple sexual partners before infection confirmation among middle-aged and elderly people living with human immunodeficiency virus.