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HIV-1-infected MSM more often experience sexual dysfunctions than the general population. We assessed associations between HIV-1 status and decreased sexual functioning among MSM.We used cross-sectional data from 399 HIV-1-infected MSM mostly on combination antiretroviral therapy (cART) and 366 HIV-1-uninfected MSM aged at least 45 years participating in the AGEhIV Cohort Study. The study questionnaire included questions on erectile function, sexual satisfaction, and sexual desire. Multivariable logistic regression models were constructed to assess the association between HIV-1 status and these three sexual domains. We also explored HIV-1-related and ART-related parameters in multivariable models among HIV-1-infected participants.Decreased erectile function (13.0 vs. 3.4%, P < 0.001), decreased satisfaction (17.8 vs. 11.8%, P = 0.02), and decreased desire (7.0 vs. 3.6% P = 0.03) were each more prevalent in HIV-1-infected than in HIV-1-uninfected participants. In multivariable models adjusted for age, ethnicity, waist-to-hip ratio, age-associated comorbidities, depression, frailty, use of antihypertensive and antidepressant medication, we found HIV-1 status significantly associated with decreased erectile function [adjusted odds ratio (aOR) 2.53, 95% CI 1.23–5.20], but not with decreased satisfaction (aOR 1.34, 95% CI 0.83–2.16), or decreased desire (aOR 1.77, 95% CI 0.80–3.91). Among HIV-1-infected participants, current exposure (aOR 5.39, 95% CI 2.09–13.92) and cumulative duration of exposure (aOR per year 1.20, 95% CI 1.07–1.35) to lopinavir/ritonavir were significantly associated with decreased erectile function in multivariable analysis.Among MSM aged at least 45 years, HIV-1 status was independently associated with decreased erectile function. Exposure to lopinavir/ritonavir appeared to be an independent risk factor for decreased erectile function among MSM with HIV-1.