Racial/ethnic and gender differences among older adults in nonmonogamous partnerships, time spent single, and human immunodeficiency virus testing

Factors Associated with Lower HIV Testing Rates in an Insured Urban Population

BACKGROUND

As of 2017 the Centers for Disease Control and Prevention (CDC) estimated that there were over one million individuals living with HIV/AIDS in the United States (CDC, 2017). Regionally the epicenter of HIV infection is in Washington DC with a prevalence rate of 1.9% (HAHSTA, 2018). Several wards including 5, 6, 7 and 8 are disproportionately impacted. Although the lack of insurance has been identified as a challenge for HIV detection and linkage to care, many insured individuals deny previous HIV testing. We implemented a routine HIV screening program in our institution since 2006. We present an analysis of our HIV testing data over a 42-month period to assess factors leading to lower HIV testing rates in an urban insured population.

METHODS

Rapid HIV screening was conducted using an opt-out methodology in the emergency department (ED) and an outpatient testing site (OTS) at Howard University Hospital (HUH). Data analysis was performed for clients aged 30-80 years.

RESULTS

Of the 20,008 adults tested the majority (92.4%) were African Americans (AA), and 52% were men. Overall 88 % had health insurance, most (74%) were covered by Medicaid. Out of those insured 9% (1637) reported no previous HIV testing. In this group (64%) were 50 years and older. Unprotected sex was the leading reported risk factor (19%).

CONCLUSION

1637 of those insured reported no previous HIV testing. Age greater than 50 and unprotected sex were significant risk factors. Health insurance status did not always correlate with previous testing. HIV prevention efforts should target this population with appropriate messaging and screening during routine evaluations.

Current Challenges and Solutions in Research and Clinical Care of Older Persons Living with HIV: Findings Presented at the 9th International Workshop on HIV and Aging

In the era of effective antiretroviral therapy, the number of older people with HIV (PWH) is increasing, and those aging with HIV are experiencing an increasing burden of age-associated comorbidities. Life expectancy among older PWH is approaching that of demographically comparable HIV-uninfected (HIV-) adults. With this changing demographic of PWH come new challenges for researchers and clinicians in how to identify, address, and manage the complex interplay of treated HIV infection and aging-associated factors. In response to these challenges, the annual International Workshop on HIV and Aging was initiated in 2009 as a multidisciplinary platform for scientific discourse on the research and clinical complications arising from the aging population of PWH. The multidisciplinary nature of the workshop has resulted in a wide range of topics addressed over the past 9 years, from basic mechanisms in aging and HIV pathogenesis, to epidemiology of aging within large cohorts, interventions, and implementation of clinical programs. Herein, we summarize the key topics discussed at the 9th Annual International Workshop on HIV and Aging 2018, including "inflammaging," mitochondrial dysfunction, exercise interventions, HIV-associated neurocognitive impairment, metabolic dysfunction, menopause, and polypharmacy. In addition to recent developments in research and clinical care, we discuss open questions and future research directions required to better understand the interaction of HIV and aging.

Self-reported testing and treatment histories among older Australian men and women who may be at risk of a sexually transmissible infection

BACKGROUND

Rates of sexually transmissible infections (STIs) are increasing among older adults in many countries. Little is known about the testing and treatment histories of these populations. Correlates of testing in the past 5 years among older adults who may be at risk of a STI were examined.

METHODS

A cross-sectional survey of 2137 Australians aged 60+ years that involved questions on STIs and STI testing was conducted in 2015. To help inform potential education campaigns, analyses focused on those who may have been at risk of a STI (n=805, 38%).

RESULTS

Less than one in three reported a STI test in the past 5 years (n=241, 30%) while 6% (n=51) reported a STI diagnosis. Those diagnosed typically received treatment from a family doctor or general practitioner. Among men, lower testing rates were associated with older age, identifying as heterosexual, lower educational attainment, not using online dating and reporting one partner in the past 5 years. For women, lower rates of testing were found among those who did not use a condom at their most recent sexual encounter and those with one partner in the past 5 years.

CONCLUSIONS

STI testing rates were low. This study indicates that consideration should be given to the way targeted education campaigns are formulated, such as emphasising the importance of STI testing to older people who are at risk, as well as encouraging healthcare professionals to discuss sexual health with their older patients.

“I Don’t Know and I Don’t Want to Know”: A Qualitative Examination of Older African American Women’s Knowledge and Experiences With HIV

While older African American women (e.g., aged 50 years and older) comprise only 11% of the female population in the United States, they account for 50% of HIV diagnoses among women in this age group. Unique sociocultural factors, including a lack of HIV knowledge and stigma, contribute to HIV risk among older African American women. The goal of this qualitative study was to obtain a nuanced perspective from older African American women about HIV knowledge and experiences with HIV using the framework of intersectionality theory. Focus groups were conducted with 35 African American women who were 50 years and older, nonpartnered, and heterosexual. Women were asked what they knew about HIV and if they thought older women were at risk for HIV. A thematic analysis using NVivo 11 yielded two central themes and three subthemes: HIV knowledge, including experiential knowledge, superficial knowledge, and no knowledge, and stigma around HIV in the Black church. Implications for developing HIV prevention programs and testing messages are discussed.

Sexual Health Behavior and Mental Health Among Older African American Women: The Sistahs, Sexuality, and Mental Health Well-Being Project

BACKGROUND

In Los Angeles County, the rates of sexually transmitted infections and diseases among African Americans represent a significant public health disparity. Older African American women are at particular risk as they are more likely to engage in high-risk sexual behaviors and report social isolation and loneliness than their younger counterparts. However, the literature on the relationship between sexual health and mental health in this group is limited. The purpose of this study was to use a community-based participatory research (CBPR) approach to better understand sexual health behaviors and mental health among African American women over 50 years of age who reside in South Los Angeles.

MATERIALS AND METHODS

This project was divided into two phases. Phase I (January-March 2017) of the project consisted of four dialog/focus groups (N = 45) (ages: 50-80; M_age = 67). The purpose of Phase II (April 2017) was to present study results from Phase I to the community via a community-based conference, as well as gather feedback and generate discussion about the next steps for community prevention/intervention.

RESULTS

Women reported that they did not feel comfortable discussing sexual practices with their physician, partners, and friends. Most women identified depression, loneliness, and self-esteem issues as reasons for engaging in high-risk sexual behaviors. During Phase II, potential intervention avenues emerged to address issues such as lack of physician-patient communication, lack of community support, and dialogs about sex.

CONCLUSIONS

The use of CBPR greatly enhanced our knowledge of the core issues surrounding sexual health and mental health among older African American women.

Indicators of self-reported human immunodeficiency virus risk and differences in willingness to get tested by age and ethnicity: An observational study

There are many barriers that prevent people from receiving human immunodeficiency virus (HIV) testing; however, little is known about the impact of age and ethnicity on HIV testing. We explored differences in self-reported HIV risk and willingness to be tested in the 2014 Get Tested Coachella Valley Community Survey by age and ethnicity.Data were collected from 995 participants via survey methods (online, hard copy, and in person). Surveys asked about demographics, sexual history, HIV testing history, thoughts on who should get tested, and future preferences for HIV testing.Most participants were women (62.5%), Hispanic (55.8%), and older than 50 years (51%). Participants who did not receive testing said they did not do so because they did not perceive themselves as at risk of contracting HIV (51.8%). Many participants (24.1%) said they did not receive testing because their health care provider never offered them the HIV test. Participants were more likely to have been tested if they were between 25 and 49 years old, compared to participants aged 50 or older (70.2% vs 48.6%, respectively, P < .001). Participants who were not Hispanic or Latino were more likely to have had an HIV test compared to Hispanic or Latino participants (62.5% vs 51.1%, P < .001).Interventions are needed to reach older adults to address HIV testing and beliefs. These interventions must debunk beliefs among physicians that older adults are not sexually active and beliefs among older adults that only certain populations are at risk of HIV.

Implicit attitudes to sexual partner concurrency vary by sexual orientation but not by gender-A cross sectional study of Belgian students

High rates of sexual partner concurrency have been shown to facilitate the spread of various sexually transmitted infections. Assessments of explicit attitudes to concurrency have however found little difference between populations. Implicit attitudes to concurrency may vary between populations and play a role in generating differences in the prevalence of concurrency. We developed a concurrency implicit associations test (C-IAT) to assess if implicit attitudes towards concurrency may vary between individuals and populations and what the correlates of these variations are. A sample of 869 Belgian students (mean age 23, SD 5.1) completed an online version of the C-IAT together with a questionnaire concerning sexual behavior and explicit attitudes to concurrency. The study participants C-IATs demonstrated a strong preference for monogamy (-0.78, SD = 0.41). 93.2% of participants had a pro-monogamy C-IAT. There was no difference in this implicit preference for monogamy between heterosexual men and women. Men who have sex with men and women who have sex with women were more likely to exhibit implicit but not explicit preferences for concurrency compared to heterosexual men and women. Correlates of the C-IAT varied between men and women.

Virologic failure and mortality in older ART initiators in a multisite Latin American and Caribbean Cohort

INTRODUCTION

The "greying" of the HIV epidemic necessitates a better understanding of the healthcare needs of older HIV-positive adults. As these individuals age, it is unclear whether comorbidities and their associated therapies or the ageing process itself alter the response to antiretroviral therapy (ART). In this study, HIV treatment outcomes and corresponding risk factors were compared between older ART initiators and those who were younger using data from the Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet).

METHODS

HIV-positive adults (≥18 years) initiating ART at nine sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Patients were classified as older (≥50 years) or younger (<50 years) based on age at ART initiation. ART effectiveness was measured using three outcomes: death, virologic failure and ART treatment modification. Cox regression models for each outcome compared risk between older and younger patients, adjusting for other covariates.

RESULTS

Among 26,311 patients initiating ART between 1996 and 2016, 3389 (13%) were ≥50 years. The majority of patients in both ≥50 and <50 age groups received a non-nucleoside reverse transcriptase inhibitor-based regimen (89% vs. 87%), did not have AIDS at baseline (63% vs. 62%), and were male (59% vs. 58%). Older patients had a higher risk of death (adjusted hazard ratio (aHR) 1.64; 95% confidence intervals (CI): 1.48 to 1.83) and a lower risk of virologic failure (aHR: 0.73; 95% CI: 0.63 to 0.84). There was no difference in risk of ART modification (aHR: 1.00; 95% CI: 0.94 to 1.06). Risk factors for death, virologic failure and treatment modification were similar for each group.

CONCLUSIONS

Older age at ART initiation was associated with increased mortality and decreased risk of virologic failure in our cohort of more than 26,000 ART initiators in Latin America and the Caribbean. To the best of our knowledge this is the first study from the region to evaluate ART outcomes in this growing and important population. Given the complexity of issues related to ageing with HIV, a greater understanding is needed in order to properly respond to this shifting epidemic.

Strategies for enhancing research in aging health disparities by mentoring diverse investigators

Introduction

The Resource Centers for Minority Aging Research (RCMAR) program was launched in 1997. Its goal is to build infrastructure to improve the well-being of older racial/ethnic minorities by identifying mechanisms to reduce health disparities.

Methods

Its primary objectives are to mentor faculty in research addressing the health of minority elders and to enhance the diversity of the workforce that conducts elder health research by prioritizing the mentorship of underrepresented diverse scholars.

Results

Through 2015, 12 centers received RCMAR awards and provided pilot research funding and mentorship to 361 scholars, 70% of whom were from underrepresented racial/ethnic groups. A large majority (85%) of RCMAR scholars from longstanding centers continue in academic research. Another 5% address aging and other health disparities through nonacademic research and leadership roles in public health agencies.

Conclusions

Longitudinal, team-based mentoring, cross-center scholar engagement, and community involvement in scholar development are important contributors to RCMAR’s success.

Recent HIV Testing Prevalence, Determinants, and Disparities Among U.S. Older Adult Respondents to the Behavioral Risk Factor Surveillance System

BACKGROUND

Although routine human immune deficiency virus (HIV) testing during health care visits is recommended for most adults, many older adults (i.e., ages 50-64 years) do not receive it. This study identified factors associated with HIV testing in the past 12 months (i.e., recent HIV testing) among US adults in the 3 categories of older adulthood (50-54, 55-59, and 60-64 years) for which routine HIV testing is recommended.

METHOD

This was a cross-sectional analysis of data from US older adult respondents to the 2010 Behavioral Risk Factor Surveillance System. We calculated prevalence (proportions) of HIV testing by age category and race/ethnicity. Using multiple logistic regression, we identified predisposing, enabling, and need factors associated with recent HIV testing within and across age categories, by race/ethnicity and controlling for covariates.

RESULTS

HIV testing prevalence was low (<5%), varied by race/ethnicity, and decreased with age. Within and across age categories, the odds of testing were highest among blacks (odds ratio [OR], 3.47; 95% confidence interval [CI], 2.82-4.25) and higher among Latinos (OR, 2.06; 95% CI, 1.50-2.84) and the oldest and youngest categories of American Indians/Alaska Natives (OR, 2.48; 95% CI, 1.11-5.55; OR, 2.98; 95% CI, 1.49-5.95) than among whites. Those reporting a recent doctor visit (OR, 2.32; 95% CI, 1.92-2.74) or HIV risk behaviors (OR, 3.50; 95% CI, 2.67-4.59) had higher odds of HIV testing.

CONCLUSION

Regardless of risk, the oldest older adults, whites, and older women may forego HIV testing. Doctor visits may facilitate HIV testing. Additional research is needed to understand why eligible older adults seen by providers may not be screened for HIV infection.

Trends in HIV Testing Among U.S. Older Adults Prior to and Since Release of CDC's Routine HIV Testing Recommendations: National Findings from the BRFSS

OBJECTIVE

This study examined temporal trends in HIV testing among U.S. older adults (50-64 years of age) before and after the release of CDC's routine HIV testing recommendations in 2006.

METHODS

The sample (n=872,797; 51.4% female) comprised 2003-2010 Behavioral Risk Factor Surveillance System respondents in the oldest categories to which the recommendations apply: 50-54 years (34.5%, n=301,519), 55-59 years (34.1%, n=297,865), and 60-64 years (31.3%, n=273,413). We calculated (1) four-year pooled prevalences of past-year HIV testing before and after 2006, when the recommendations were released; and (2) annual prevalences of HIV testing overall and by age category from 2003-2010. Using weighted, multivariable logistic regression analyses, we examined binary (pre- vs. post-recommendations) and annual changes in testing, controlling for covariates. We stratified the data by recent doctor visits, examined racial/ethnic differences, and tested for linear and quadratic temporal trends.

RESULTS

Overall and within age categories, the pooled prevalence of past-year HIV testing decreased following release of the recommendations (p<0.001). The annual prevalence decreased monotonically from 2003 (5.5%) to 2006 (3.6%) (b=-0.16, p<0.001) and then increased immediately after release of the recommendations, but decreased to 3.7% after 2009 (b=0.01, p<0.001). By race/ethnicity, testing increased over time among non-Hispanic black people only. Annual prevalence also increased among respondents with recent doctor visits.

CONCLUSION

CDC's HIV testing recommendations were associated with a reversal in the downward trend in past-year HIV testing among older adults; however, the gains were neither universal nor sustained over time.

HIV Awareness and Knowledge among Viewers of a Documentary Film about HIV among Racial- or Ethnic-Minority Older Adults

A documentary film on HIV was developed based on social cognitive theory and entertainment educational methods in an effort to increase awareness and encourage protective behavior change related to HIV among older adults. The documentary includes perspectives from racial- or ethnic-minority older adults who are living with HIV and those of health care providers, and was screened in several venues. Authors of this article conducted thematic content analysis of anonymous, written, open-ended responses from 341 film viewers (clinicians and laypeople) who described what they learned about HIV after viewing the film. Four key themes emerged from the analysis: (1) increased awareness about the epidemiology of HIV among older, minority groups and about sexuality among older people; (2) improved general HIV knowledge, including risk reduction strategies and details about HIV testing; (3) awareness of lack of sexual health education among health care providers, and that a call to action is needed; and (4) awareness that HIV reinfection can occur in certain circumstances with people who are already infected. Findings suggest that an educational documentary can be used to effectively increase awareness and knowledge about the impact of HIV among minority older adults, and may also encourage HIV prevention action steps by providers.

Why women engage in anal intercourse: results from a qualitative study

This study used qualitative methods to assess why women engage in heterosexual anal (receptive) intercourse (AI) with a male partner. Four focus groups which comprised women from diverse ethnicities were conducted. All groups were digitally recorded for transcription; transcripts were analyzed using the methods of grounded theory to determine themes. Women's reasons for engaging in anal intercourse with a male partner can be described in broad categories including that the women wanted to have anal intercourse, either because of their own desire, to please a male partner, or they were responding to a quid pro quo situation. The riskiness of AI was assessed within relationship contexts. Past experience with AI including emotional and physical reactions was identified. Among the negative physical experiences of AI were pain and disliking the sensation, and uncomfortable side effects, such as bleeding of the rectum. Negative emotional experiences of AI included feelings of shame, disgust, and being offended by something her male partner did, such as spitting on his penis for lubrication. Positive physical experiences included liking the sensation. Many of the women also endorsed positive emotional experiences of AI, including that it was more intimate than vaginal sex, and that it was something they reserved only for special partners. The majority of AI episodes were unplanned and not discussed prior to initiation. Pain during AI was mitigated by the use of lubricants or illicit drugs. Even those women who found pleasure in AI expressed a preference for vaginal intercourse.

HIV and STI testing in older adults: an integrative review

AIMS AND OBJECTIVES

To examine the frequency of human immunodeficiency virus testing and sexually transmitted infection testing among older adults (50 years and older), present factors related to human immunodeficiency virus and sexually transmitted infection testing among older adults, and summarise the perspectives and practices of older adults and health care providers related to sexual health communication.

BACKGROUND

Reported cases of sexually transmitted infections and human immunodeficiency virus among older adults have increased, therefore refuting the stereotype of the sexually inactive older adult.

DESIGN

Integrative review.

METHODS

Database searches in PubMed, EMBASE, CINAHL, and Web of Science; manual reference list searches; and database searches for articles that cited previously identified articles.

RESULTS

There is limited research on this topic and considerable diversity in the populations studied and outcomes measured. The search process yielded 20 articles meeting the eligibility criteria. Human immunodeficiency virus and sexually transmitted infection testing of older adults are infrequent. Human immunodeficiency virus testing among older adults is associated with perceived risk of contracting human immunodeficiency virus and influenced by encouragement from health care providers. Sexually transmitted infection testing due to genital symptoms is more likely than asymptomatic screening. Few providers collect routine sexual histories from older adult patients, although older adults are receptive to sexual history taking.

CONCLUSIONS

There are missed opportunities to identify sexually transmitted infections and human immunodeficiency virus in older adults. Stereotypes and assumptions have hindered providers from identifying and testing older adults at risk for human immunodeficiency virus and sexually transmitted infections.

RELEVANCE TO CLINICAL PRACTICE

Sexual health assessment is essential to comprehensive health care. A sexual history provides information that may indicate human immunodeficiency virus and sexually transmitted infection testing. Detection and treatment of human immunodeficiency virus and sexually transmitted infections will break the chain of infection and improve quality of life.

HIV testing among clients in high HIV prevalence venues: disparities between older and younger adults

The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus (HIV) testing of every client presenting for services in venues where HIV prevalence is high. Because older adults (aged ≥50 years) have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent (past 12 months) and ever HIV testing in a probability sample of at-risk adults (N = 1238) seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category (<50 years vs. ≥50 years) and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.40-0.90) or ever (OR = 0.6; 95% CI = 0.40-0.90). Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis.

Social Capital and Sexual Risk-Taking Behaviors Among Older Adults in the United States

Using the General Social Survey (GSS) 2012, a national household-based probability sample of non-institutionalized U.S. adults, this study examined the association of social capital and sexual risk behaviors among older adults aged 55 years and older. Of the 547 respondents, 87% reported not using condoms during their last intercourse, and nearly 15% reported engaging in sexual risk behaviors, such as casual sex, paid sex, male to male sex, and drug use. Binary logistic regression results showed that age, gender, marital status, education, race, sexual orientation, and sexual frequencies were significant predictors of older adults' unprotected sex. Social capital was not a predictor of unprotected sex but was positively associated with other human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk behaviors such as sex with strangers, having multiple sex partners, injecting drugs, and having male to male sex. Findings of this study highlight the importance of HIV/STD prevention programs for older adults.

Binge drinking, stimulant use and HIV risk in a sample of illicit drug using heterosexual Black men

BACKGROUND

Relatively little research has examined the effects of binge drinking and HIV risk in heterosexual Black men. Even less research has explored this relationship in illicit drug using heterosexual Black men who are at an elevated risk of contracting and transmitting HIV through various vectors, including risky sexual behavior, in the Black community.

PURPOSE

The purpose of the current study is to examine the associations between binge drinking, drug use and HIV status in a community-based sample of 127 self-identified heterosexual Black men.

RESULTS

Overall, 17% reported binge drinking in the past month. Both stimulant use (AOR 7.29; 95%; CIs, 2.07, 25.70), and binge drinking (AOR=5.28; 95% CIs, 1.34, 20.91) were associated with HIV status.

CONCLUSION

These findings will inform prevention interventions to reduce the HIV risk among Black heterosexual men.

HIV/AIDS in older women: unique challenges, unmet needs

As persons living with HIV/AIDS live longer, both the prevalence and incidence of HIV infection in older women is expected to increase, and this review presents a model and review of the extant literature on older women with HIV/AIDS in the United States. Older women are rarely addressed in the discourse about HIV risk and prevention, and their concerns are often missed by risk-reduction programs that typically target men and younger adults. Societal biases around aging can compound factors such as stigma and disclosure for older women. Primary care providers are often not recommending routine HIV testing to older women, or addressing the impact of age-related physiological changes on risk and sexual health. Many older women may be starting new relationships, so it is important that providers understand the relational variables specific to this group of women. Empirical research focused on the needs of older women, and recognition of the diverse composition and needs of this group, are needed to inform prevention, intervention, and best practices with this population of women.

Point-of-Care HIV Testing and Linkage in an Urban Cohort in the Southern US

The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US.

Association between intimate partner violence and preventive screening among women

BACKGROUND

Intimate partner violence (IPV) is defined as physical, sexual, or psychological harm that can be perpetrated by a former/current spouse. IPV has been linked to adverse health outcomes and risky behaviors, and victims of IPV tend to need more healthcare overall than nonvictims of IPV. The purpose of this study was to determine the association between IPV and preventive screening among women.

METHODS

The study used data from eight states/territories, which collected IPV information in the 2006 and 2007 Behavioral Risk Factor Surveillance System (n=30,182). IPV and preventive screening for HIV, cervical cancer, colorectal cancer, cholesterol, and breast cancer were determined by self-report. Multivariable logistic regression models provided adjusted estimates of odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS

Approximately one in four women reported a history of lifetime IPV. Relative to those who did not report a history of IPV, IPV victims were twice as likely to have had an HIV test (aOR: 2.34; 95% CI: 2.06 to 2.66) or a breast exam (aOR: 1.76; 95% CI: 1.37 to 2.27). IPV victims are vigilant about certain screening practices related to sexual health (HIV testing) and passive screening (breast exam) compared to active screening.

CONCLUSION

The strongest association between IPV and preventive screening was seen for HIV testing, which likely reflects the women's perceived risk for HIV infection. That these women are in contact with the healthcare system provides support for recommendations for widespread adoption of IPV screening and counseling.

Belief in AIDS-related conspiracy theories and mistrust in the government: relationship with HIV testing among at-risk older adults

PURPOSE

One in 4 persons living with HIV/AIDS is an older adult (age 50 or older); unfortunately, older adults are disproportionately diagnosed in late stages of HIV disease. Psychological barriers, including belief in AIDS-related conspiracy theories (e.g., HIV was created to eliminate certain groups) and mistrust in the government, may influence whether adults undergo HIV testing. We examined relationships between these factors and recent HIV testing among at-risk, older adults.

DESIGN AND METHODS

This was a cross-sectional study among older adults enrolled in a large venue-based study. None had a previous diagnosis of HIV/AIDS; all were seeking care at venues with high HIV prevalence. We used multiple logistic regression to estimate the associations between self-reported belief in AIDS-related conspiracy theories, mistrust in the government, and HIV testing performed within the past 12 months.

RESULTS

Among the 226 participants, 30% reported belief in AIDS conspiracy theories, 72% reported government mistrust, and 45% reported not undergoing HIV testing within the past 12 months. Belief in conspiracy theories was positively associated with recent HIV testing (adjusted odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.05-3.60), whereas mistrust in the government was negatively associated with testing (OR = 0.43, 95% CI = 0.26-0.73).

IMPLICATIONS

Psychological barriers are prevalent among at-risk older adults seeking services at venues with high HIV prevalences and may influence HIV testing. Identifying particular sources of misinformation and mistrust would appear useful for appropriate targeting of HIV testing strategies.