HIV behavioural interventions targeted towards older adults: a systematic review

Determinants of Sexual Health Status of Menopausal Women in Osun State, Nigeria

OBJECTIVES

This study aimed to assess sexual health status and associated factors in menopausal women.

METHODS

The study employed a descriptive, cross-sectional design. It included 420 menopausal women aged 40-65 years from Ilesa West Local Government Area of Osun State. A structured questionnaire was used, and the data were analyzed using descriptive and inferential statistics.

RESULTS

The mean age of the study respondents was 54.74 ± 5.49 years. A little over half (52.4%) of the respondents exhibited good sexual health status, whereas 47.6% had poor sexual health status. Logistic regression analysis revealed that lack of financial resources (P = 0.01; odds ratio [OR], 4.00; 95% confidence interval [95% CI], 1.45-11.02), loss of partner (P = 0.01; OR, 9.18; 95% CI, 2.89-29.09), and limited communication with partner (P = 0.01; OR, 3.12; 95% CI, 1.51-6.46) were predictors of poor sexual health status.

CONCLUSIONS

This study provides insight into the determinants of the sexual health status of menopausal women, which may help health care providers and policymakers develop effective strategies to improve the sexual health of menopausal women.

Continuing Low Awareness and Use of Pre-exposure Prophylaxis (PrEP) for HIV among People Who Inject Drugs (PWID), San Francisco, 2022

Clinical trials provide evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition including through sharing of injection equipment among people who inject drugs (PWID). However, uptake among many populations at risk for HIV has been slow, particularly among PWID. We examined data from the National HIV Behavioral Surveillance (NHBS) from San Francisco in 2022 to measure PrEP uptake and identify factors associated with PrEP awareness among PWID. Of 479 PWID with HIV-negative or unknown HIV status, 54.9% were aware of PrEP, 5.9% had discussed PrEP with a healthcare provider, and 1.5% had used PrEP in the past year. Lack of PrEP awareness was associated with being age 50 years and older (adjusted odds ratio [aOR] 0.40, 95% CI 0.27-0.60), being men who have sex with women (vs. men who have sex with men, aOR 0.47, 95% CI 0.24-0.92), having a disability (aOR 0.58, 95% CI 0.35-0.95), using heroin as their most frequently injected drug (aOR 0.51, 95% CI, 0.34-0.78), not having tested for HIV, HCV, or an STD in the past year (aOR 0.43, 95% CI 0.28-0.64), and not having access to new sterile needles in the past year (aOR 0.28, 95%CI 0.08-1.00). We found negligible change in the awareness and uptake of PrEP among PWID since previously measured in NHBS in 2018. Low PrEP use among PWID may be addressed by increasing provider discussion of PrEP with their PWID patients and clients during routine care, expanding testing for injection-related infections among PWID, and integrating PrEP access into harm reduction programs.

Promoting sexual health in older adults: Findings from two rapid reviews

BACKGROUND

Sexual health throughout the life course is increasingly recognised as important to maintaining one's overall health, wellbeing, and relationships. We aimed to provide an overview of the evidence on sexual health needs and sexual health promotion in later life.

METHODS

We undertook two rapid reviews, drawing on systematic review evidence. Searches were conducted in Epistemonikos. Studies were eligible if they reported evidence about the sexual health needs of, or sexual health promotion interventions for, people aged 50+ years. Evidence was quality assessed and summarised in a narrative synthesis.

RESULTS

Fifteen systematic reviews were included in Review 1 (sexual health needs) and 12 in Review 2 (interventions). Key concerns and needs of older adults included the impacts of cultural stigma/misperceptions, barriers to sexual expression, and a need for tailored support in a welcoming environment. Key concerns and needs of health and social care professionals included mixed attitudes towards and knowledge of later-life sexuality and a need for more training and education. Approaches to promoting sexual health in later life included training and workshops for care home professionals, education for older people at risk of/living with HIV, and interventions to address sexual health-related symptoms of menopause. Gaps in the evidence from current reviews and methodological issues in primary studies were identified.

CONCLUSION

Older people have specific needs relating to their sexual health. Health and social care professionals working with older people may benefit from education/training around sexuality in later life. Evidence on effective interventions and strategies is limited.

Sociodemographic Characteristics of HIV-Associated Dementia in the South Carolina Alzheimer's Disease Registry

OBJECTIVES

Studies examining the sociodemographic characteristics associated with human immunodeficiency virus (HIV)-associated dementia (HAD) are lacking, especially in the southern United States. The aim of this study was to describe the characteristics of HAD using South Carolina Alzheimer's Disease Registry data, and examine these characteristics across two time periods.

METHODS

Data were obtained from the population-based, South Carolina Alzheimer's Disease Registry from 2000-2006 and 2010-2016 (N = 165,487). Crude and multivariable logistic regression models were applied to determine sociodemographic characteristics associated with HAD by time period.

RESULTS

Younger, Black, Other, men, and urban populations had greater odds of being diagnosed as having HAD in both time periods. For example, compared with individuals aged 85 years and older, individuals aged 18 to 34 had 97 times the odds (adjusted odds ratio 97.0; 95% confidence interval 31.6-297.8) of being diagnosed as having HAD. In 2010-2016, however, nursing facility populations had a greater odds of being diagnosed as having HAD.

CONCLUSIONS

We found that younger populations (younger than 74 years), communities of color, men, urban populations, and nursing facility populations were more likely to have HAD. Future research should focus on the association between HAD and risk for Alzheimer's disease.

Navigating Life With HIV as an Older Adult on the Kenyan Coast: Perceived Health Challenges Seen Through the Biopsychosocial Model

Objectives: This study explores the perceptions of adults living with HIV aged ≥50 years (recognized as older adults living with HIV-OALWH), primary caregivers and healthcare providers on the health challenges of ageing with HIV at Kilifi, a low literacy setting on the coast of Kenya. Methods: We utilized the biopsychosocial model to explore views from 34 OALWH and 22 stakeholders on the physical, mental, and psychosocial health challenges of ageing with HIV in Kilifi in 2019. Data were drawn from semi-structured in-depth interviews, which were audio-recorded and transcribed. A framework approach was used to synthesize the data. Results: Symptoms of common mental disorders, comorbidities, somatic symptoms, financial difficulties, stigma, and discrimination were viewed as common. There was also an overlap of perceived risk factors across the physical, mental, and psychosocial health domains, including family conflicts and poverty. Conclusion: OALWH at the Kenyan coast are perceived to be at risk of multiple physical, mental, and psychosocial challenges. Future research should quantify the burden of these challenges and examine the resources available to these adults.

Non-pharmacological interventions for the prevention of sexually transmitted infections (STIs) in older adults: A systematic review

BACKGROUND

STIs in older adults (adults aged 50 years and older) are on the rise due to variable levels of sex literacy and misperceived susceptibility to infections, among other factors. We systematically reviewed evidence on the effect of non-pharmacological interventions for the primary prevention of sexually transmitted infections (STIs) and high-risk sexual behaviour in older adults.

METHODS

We searched EMBASE, MEDLINE, PSYCINFO, Global Health and the Cochrane Library from inception until March 9th, 2022. We included RCTs, cluster-randomised trials, quasi-RCTs, interrupted time series (ITS) and controlled and uncontrolled before-and-after studies of non-pharmacological primary prevention interventions (e.g. educational and behaviour change interventions) in older adults, reporting either qualitative or quantitative findings. At least two review authors independently assessed the eligibility of articles and extracted data on main characteristics, risk of bias and study findings. Narrative synthesis was performed.

RESULTS

Ten studies (two RCTs, seven quasi-experiment studies and one qualitative study) were found to be eligible for this review. These interventions were mainly information, education and communication activities (IECs) aimed at fostering participants' knowledge on STIs and safer sex, mostly focused on HIV. Most studies used self-reported outcomes measuring knowledge and behaviour change related to HIV, STIs and safer sex. Studies generally reported an increase in STI/HIV knowledge. However, risk of bias was high or critical across all studies.

CONCLUSIONS

Literature on non-pharmacological interventions for older adults is sparse, particularly outside the US and for STIs other than HIV. There is evidence that IECs may improve short-term knowledge about STIs however, it is not clear this translates into long-term improvement or behaviour change as all studies included in this review had follow-up times of 3 months or less. More robust and higher-quality studies are needed in order to confirm the effectiveness of non-pharmacological primary prevention interventions for reducing STIs in the older adult population.

Intervention program needs for older adults living with HIV who are childhood sexual abuse survivors

OBJECTIVES

Childhood sexual abuse (CSA) prevalence estimates range from 8-11% among older adults and may range from 16 to 22% among older adults living with HIV (OALH). CSA experiences can still impact the quality of life of older adults. To the best of our knowledge, however, there are no CSA-focused interventions tailored for OALH. Using a qualitative approach, this study characterized the desired components of a trauma-focused intervention for OALH who are CSA survivors.

METHODS

Twenty-four (24) adults aged 50 years of age or older who were living with HIV and had experienced CSA were recruited from a large HIV immunology center in South Carolina. Participants completed in-depth, qualitative, semi-structured interviews. We iteratively examined verbatim transcripts using thematic analysis.

RESULTS

Three main themes emerged: program format and modality, program content, and program coordinator. Most participants expressed a desire for a trauma-focused intervention program in which the CSA experience was addressed and they could talk to someone either individually, as a group, and/or both.

CONCLUSION

A trauma-focused intervention addressing CSA may be helpful for OALH who are CSA survivors. Future research should focus on designing and implementing age-appropriate interventions addressing the CSA experience, increasing resilience, and developing adaptive coping skills.

An analysis of the relationship between HIV risk self-perception with sexual behaviour and HIV status in South African older adults

Objective: To examine how older adults perceive their own risk of acquiring HIV; and how this perception correlates with their sexual behaviour and HIV status.Methods: We used cross-sectional survey data for 435 adults aged 50 years and older from South Africa. All participants completed a questionnaire on their basic socio-demographic and economic factors, self-reported health, sexual behaviour, HIV knowledge and attitudes, and self-perceived risk of HIV acquisition. In addition, anthropometrical measurements (weight, height, blood pressure, cholesterol) and HIV testing were conducted. Multinomial logistic regressions were used to determine the association between self-perceived HIV risk (categorised as "not at risk", at "low risk", at "high risk" and "didn't know") and being sexually active and testing HIV-positive, controlling for socio-demographic, behavioural and health-related factors.Results: Of the 435 respondents, 9.4% perceived themselves as at high risk of HIV infection, 18.9% as at low risk and 53.6% believed they were not at risk of HIV. Most respondent who perceived themselves as at low risk or not-at-risk at all of HIV were not sexually active. Older adults that were sexually active were more likely to consider themselves as at high risk of acquiring HIV (relative risk ratio [RRR] 2.05; 95% confidence interval (CI) 1.05-4.00; p = 0.036), as well as to test HIV positive (RRR 10.5; 95% CI 3.8-29.1; p < 0.001). Self-perceived HIV risk was significantly associated with age, sex, population group, and a greater awareness about HIV and how it is transmitted.Conclusions: Older persons who perceived themselves as at high risk of HIV were closely associated with sexual activity and testing HIV positive. Therefore, there is an urgent need for older persons, particularly those who remain sexually active, to screen and test for HIV routinely. Furthermore, there should be policy and programme interventions, such as the development of a simple risk-assessment tool for older adults to determine their risk for HIV. Older persons have been neglected in sexual health and HIV programmes. There is, therefore, a need to encourage older persons to take up appropriate HIV risk reduction and prevention behaviours.

Development of a Tablet Computer Application for HIV Testing and Risk History Calendar for Use With Older Africans

Life history calendars (LHCs) are able to capture large-scale retrospective quantitative data, which can be utilized to learn about transitions of behavior change over time. The Testing and Risk History Calendar (TRHC) is a version of life history calendar (LHC) which correlates critical social, sexual and health variables with the timing of HIV testing. In order to fulfill the need for time-bound data regarding HIV testing and risk of older persons in South Africa, a pilot of the TRHC was performed using a paper fold-out grid format. Though the TRHC study in this format was effective as older persons were able to recall details about their HIV testing and risk contexts, the interview process was tedious as data were collected manually. Development of a tablet application for TRHC study will improve data quality and make data entry and collection more automated. This paper presents the development of the TRHC application prototype in order to collect TRHC data electronically and provides a platform for efficient large-scale life history calendar data collection.

Health and Health Service Needs: Comparison of Older and Younger Women with Criminal-Legal Involvement in Three Cities

Objectives: We profiled the health and health services needs of a sample of older adult women (age 50+) with criminal-legal system (CLS) involvement and compared them with younger women (age 18-49), also CLS-involved. Methods: Using survey data collected from January to June 2020 from adult women with CLS involvement in three US cities, we profiled and compared the older adult women with younger women on behavioral and structural risk factors, health conditions, and health services access and use. Results: One-third (157/510) were age 50+. We found significant differences (p < .05) in health conditions and health services use: older women had more chronic conditions (e.g., hypertension and stroke) and more multimorbidity and reported more use of personalized care (e.g., private doctor, medical home, and health insurance). Discussion: Although older women with CLS involvement reported good access to health services compared with younger women, their chronic health conditions, multimorbidity, and functional declines merit attention.

HIV and aging among adults aged 50 years and older on antiretroviral therapy in Eswatini

Background: Antiretroviral therapy (ART) has decreased HIV-related morbidity and mortality and increased life expectancy of people living with HIV (PLHIV). Globally, the number of older PLHIV (OPLHIV; ≥50 years) is growing and predicted to increase substantially in coming years. In sub-Saharan Africa, where the majority of OPLHIV reside, there are limited data on the health and well-being of OPLHIV.Methods: We conducted an exploratory descriptive study that included structured interviews with 50 OPLHIV receiving ART at an outpatient HIV clinic in Eswatini and in-depth qualitative interviews (IDIs) with a sub-set of ten participants to elicit their experiences of living with HIV as an older adult, including quality of life, physical health, and mental health. Quantitative analyses were performed to obtain both descriptive statistics and cross-tabulations. A thematic analysis of IDI narratives was conducted based on three levels of the socio-ecological model to identify sub-themes and response patterns.Results: All study participants were virally suppressed. Self-reported non-communicable disease (NCD) risk factors and markers were common, with 40% (n = 20) reporting being current or former smokers, 0% consuming the recommended servings of fruits and vegetables per day, and 57% (n = 28 of 49 reporting screening) reporting having hypertension. However, the majority (88%; 44 of 50) had sufficient physical activity; most of the activity was in the work domain. Slightly more than one-third (38%; 13 of 34 tested) had a high random blood sugar level. Barriers to living with HIV were primarily structural (food insecurity, unemployment, access to transportation and health care).Conclusions: OPLHIV should be screened for NCDs, and services for NCDs should ideally be integrated with HIV services. While all participants had controlled HIV, this study highlights the need for strategies that facilitate OPLHIV's HIV service utilisation. With the increasing numbers of OPLHIV, these issues cannot be ignored.

'Too old to test?': A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi

BACKGROUND

Despite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults.

METHODS

We conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations.

RESULTS

Midlife-older adults (30-74 years of age) associated their age with respectability and identified HIV as "a disease of youth" that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying "lack of wisdom". These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults.

CONCLUSIONS

Characteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.

Evaluation of a technology-enhanced intervention for older women with HIV infection: a proof of concept study

The syndemic effects of HIV infection, side effects of highly active antiretroviral medications, and age-related changes lead to increased risk for comorbidities and functional decline for older people with HIV. This proof of concept (PoC) study evaluated perceived usefulness, satisfaction, acceptability, intervention processes, resource management, and outcome effect variances of ThE CARE Intervention guided by the Self-Determination Theory. To test the utility of ThE CARE, we conducted a one-group pre/posttest intervention design with a convenience sample of 20 women, 50 years and older. The mean age was 56 years (SD = 11) and years since HIV diagnosis was 23.7 (SD = 8.6). ThE CARE intervention was found useful and participants "felt empowered" utilizing the app. Fourteen participants (70%) reported high-intensity distress and negative impact on life from neuropathic pain, anxiety (55%), fatigue (50%), and depressive symptoms (35%). Self-awareness and self-regulation also improved. Modest results of acceptability, usability, and positive trends in the outcome measures suggest possible effects. The interactivity and cultural relevance of ThE CARE would enhance women's autonomous motivation and perceived competence to actively engage in self-care. The PoC study provides important foundational information to advance science in mHealth interventions for older women with HIV.

Assessing the feasibility of a life history calendar to measure HIV risk and health in older South Africans

Life history calendars capture patterns of behavior over time, uncovering transitions and trajectories. Despite the growing numbers of older persons living with HIV in southern Africa, little is known about how HIV testing and risk unfold in this population. Operationalizing a life course approach with the use of an innovative Testing and Risk History Calendar [TRHC], we collected pilot data on older South Africans' risk and HIV testing. We found older persons were able to provide (1) reference points to facilitate recall over a 10-year period, (2) specifics about HIV tests during that decade, and (3) details that contextualize the testing data, such as living arrangements, relationships, and health status. Interviewer debriefing sessions after each interview captured information on context and links across domains. On a larger scale, the TRHC has potential to reveal pathways between sexual behavior, HIV testing and risk perception, and health at older ages.

Newly diagnosed cases of HIV in those aged 50 years and older and those less than 50: 2008-2017

BACKGROUND

Canada's population is aging, with nearly forty percent of Canadians aged 50 years or more. As the population ages, unique challenges related to health are becoming evident, including increasing rates of sexually transmitted and bloodborne infections. Understanding the epidemiology of HIV in older adults is important to guide prevention and control programs.

OBJECTIVE

To assess trends in newly diagnosed cases of HIV in Canada among those aged 50 years and older (≥50 years) and those aged less than 50 (<50 years), and to compare their basic demographic characteristics and exposure categories for the period of 2008 to 2017.

METHODS

National surveillance of HIV is conducted by the Public Health Agency of Canada through voluntary submission of data by provincial/territorial public health authorities. Descriptive analyses were conducted on reported cases of HIV between January 1, 2008, to December 31, 2017 to compare the demographic profiles and exposure category for the two age groups.

RESULTS

Between 2008 and 2017, the proportion of newly diagnosed HIV cases among those ≥50 years increased from 15.1% to 22.8%. The HIV diagnosis rates for both older males and older females increased over time, with a relatively higher increase for females. A higher proportion of newly diagnosed HIV cases were male in the older group (81.2%) compared to the younger group (74.6%). Among both older and younger males, the most common exposure category for HIV was being gay, bisexual and other men who have sex with men (gbMSM), followed by heterosexual contact and injection drug use; however, the relative proportions varied by age with the gbMSM category being higher in the <50 group.

CONCLUSION

In Canada, over 20% of all newly diagnosed cases of HIV are now in people 50 years of age and older. HIV testing and prevention initiatives, historically aimed at younger populations, may not have the same impact for older populations. These data can be used to inform future public health actions designed to address HIV in older populations.

Comparison of Antiretroviral Therapy Adherence Among HIV-Infected Older Adults with Younger Adults in Africa: Systematic Review and Meta-analysis

As access to antiretroviral treatment in low- and middle-income countries improves, the number of older adults (aged ≥ 50 years) living with HIV is increasing. This study compares the adherence to antiretroviral treatment among older adults to that of younger adults living in Africa. We searched PubMed, Medline, Cochrane CENTRAL, CINAHL, Google Scholar and EMBASE for keywords (HIV, ART, compliance, adherence, age, Africa) on publications from 1st Jan 2000 to 1st March 2016. Eligible studies were pooled for meta-analysis using a random-effects model, with the odds ratio as the primary outcome. Twenty studies were included, among them were five randomised trials and five cohort studies. Overall, we pooled data for 148,819 individuals in two groups (older and younger adults) and found no significant difference in adherence between them [odds ratio (OR) 1.01; 95% CI 0.94–1.09]. Subgroup analyses of studies using medication possession ratio and clinician counts to measure adherence revealed higher proportions of older adults were adherent to medication regimens compared with younger adults (OR 1.06; 95% CI 1.02–1.11). Antiretroviral treatment adherence levels among older and younger adults in Africa are comparable. Further research is required to identify specific barriers to adherence in the aging HIV affected population in Africa which will help in development of interventions to improve their clinical outcomes and quality of life.

"For us here, we remind ourselves": strategies and barriers to ART access and adherence among older Ugandans

BACKGROUND

Very little is known about the barriers and facilitators to antiretroviral therapy (ART) access and adherence among older Africans. Most studies on ART have focused on individuals who are 15-49 years of age.

METHODS

We used in-depth interviews with 40 persons living with HIV, aged 50 to 96 years, who had either initiated ART (n = 26) or were waiting to initiate ART (n = 14), to explore barriers and facilitators to ART access and adherence in rural Uganda.

RESULTS

Guided by the Andersen Behavior Model, thematic content analysis highlighted 21 primary factors related to environment, patient and health behavior. Nine of the factors were common to both access and adherence, the remaining 12 were evenly split between access and adherence. Transportation costs, food insecurity, and healthcare workers' knowledge, attitudes and behaviors were key barriers.

CONCLUSIONS

These barriers were similar to those outlined for younger populations in other studies, but were compounded by age. Despite barriers, either due to the exceptional nature of HIV care or overreporting, both ART access and self-reported adherence were better than expected. Older persons living with HIV highlighted health care needs for non-HIV-related illnesses, suggesting while HIV care is adequate, care for the ailments of "old age" is lagging.

Evaluating HIV Educational Materials for Older People

OBJECTIVE

To address the gap in knowledge about HIV risk reduction materials that target older adults. This review offered a comprehensive and rigorous examination of HIV risk reduction education materials that targeted older adults in the United States, assessing the gap in their coverage and content.

METHOD

A cross-sectional review of both print and Internet sources from state departments of public health, state and area agencies on aging, and web resources that targeted older populations was performed.

RESULTS

Of 29 health departments and 13 state and area agencies on aging that responded to the request, there were 9 HIV education materials identified that targeted older people. Of those materials, only 2 addressed the majority of aging-specific recommendations made from a previous study that described important HIV risk reduction information.

DISCUSSION

Recommendations are made about dissemination ideas to increase awareness and utilization of HIV educational materials.

Behavioral and cognitive interventions to improve treatment adherence and access to HIV care among older adults in sub-Saharan Africa: an updated systematic review

BACKGROUND

Approximately 14% of Africans infected with HIV are over the age of 50, yet few intervention studies focus on improving access to care, retention in care, and adherence to antiretroviral therapy (ART) in this population. A review of the published literature until 2012, found no relevant ART management and care interventions for older people living with HIV (OPLHIV) in sub-Saharan Africa. The aim of this systematic review is to update the original systematic review of intervention studies on OPLHIV, with a focus on evidence from sub-Saharan Africa.

METHODS

We conducted a systematic review of the available published literature from 2012 to 2017 to explore behavioral and cognitive interventions addressing access to ART, retention in HIV care and adherence to ART in sub-Saharan Africa that include older adults (50+). We searched three databases (MEDLINE, EMBASE, and Education Resources Information Center) using relevant Medical Subject Headings (MeSH) terms as well as a manual search of the reference lists. No language restrictions were placed. We identified eight articles which were analyzed using content analysis with additional information obtained directly from the corresponding authors.

RESULTS AND DISCUSSION

There were no studies that exclusively focused on OPLHIV. Three studies referred only to participants being over 18 years and did not specify age categories. Therefore, it is unclear whether these studies actively considered people living with HIV over the age of 50. Although the studies sampled older adults, they lacked sufficient data to draw conclusions about the relevance of the outcomes of this group.

CONCLUSIONS

These findings underscore the need to increase the evidence-base of which interventions will work for older Africans on ART.

Covariates of high-risk sexual behaviour of men aged 50 years and above in sub-Saharan Africa

Since the advent of HIV/AIDS, sexuality studies in sub-Saharan Africa (SSA) have focused mainly on the sexual behaviour of the younger generation (15-49 years) and little has been done to understand the sexual behaviour of those a 50 years and above. The objective of this study is therefore to examine the covariates of high-risk sexual behaviour among men aged 50 years plus within the SSA region. Data from Demographic and Health Surveys of 10 SSA countries were pooled together and a sample of 5394 men aged 50 years plus who have ever had sex was analysed. Findings show that in SSA, a large proportion of men aged 50 years plus (74%) were sexually active and a substantial proportion of these men engaged in unsafe sexual behaviours, such as having multiple sexual partners and unprotected sex. The multivariate logistic regression analysis showed that involvement with multiple sexual partners was significantly associated with older age, urban residence, religion, having primary or secondary education, and ever taken an HIV test. Condom use at last sex was significantly associated with age at first sex, multiple sexual partners, level of education and ever been tested for HIV. These results suggest that HIV prevention and intervention programmes should also target older men as they are also sexually active and at risk of being infected because of unsafe sexual practices.

Sexual culture in low-income older adult housing: norms, behaviours and risks

This paper explores the behaviours and meanings associated with intimacy and sexuality among older adults with diverse partners living in subsidised senior housing. It utilises survey and qualitative data from a mixed methods of ageing/HIV exposure to illustrate gendered views on sexual and intimate behaviours, and attitudes towards transactional/commercial sex. Data suggest that women were cautious about engaging in intimate relationships, while men sought them and the companionship they provided to address loneliness. Reasons for non-intimacy were age and health problems. Generally speaking, both men and women had positive attitudes towards sex. Men took risks by having multiple partners and using condoms irregularly; women believed they could avoid risks by taking time to get to know their partners, but never used condoms. Forty per cent of men who saw sex workers were not regular condom users. They traded risk of gossip, violence and infection for companionship with women seeking money and physical safety. Findings have implications for policies, counselling and interventions for older sexually active adults in institutional and residential settings.

Redefining Aging in HIV Infection Using Phenotypes

Purpose of review

This article critically reviews the utility of “phenotypes” as behavioral descriptors in aging/HIV research that inform biological underpinnings and treatment development. We adopt a phenotypic redefinition of aging conceptualized within a broader context of HIV infection and of aging. Phenotypes are defined as dimensions of behavior, closely related to fundamental mechanisms, and, thus, may be more informative than chronological age. Primary emphasis in this review is given to comorbid aging and cognitive aging, though other phenotypes (i.e., disability, frailty, accelerated aging, successful aging) are also discussed in relation to comorbid aging and cognitive aging.

Recent findings

The main findings that emerged from this review are as follows: (1) the phenotypes, comorbid aging and cognitive aging, are distinct from each other, yet overlapping; (2) associative relationships are the rule in HIV for comorbid and cognitive aging phenotypes; and (3) HIV behavioral interventions for both comorbid aging and cognitive aging have been limited.

Summary

Three paths for research progress are identified for phenotype-defined aging/HIV research (i.e., clinical and behavioral specification, biological mechanisms, intervention targets), and some important research questions are suggested within each of these research paths.

Attitudes and barriers towards HIV screening: A qualitative study of people living with HIV/AIDS (PLWHA) in Malaysia

BACKGROUND

Understanding patients' perspective towards HIV screening in Malaysia is pivotal to explore challenges faced by these individuals. This would be beneficial for developing local plans to improve the health-seeking behaviours among population at risk of HIV/AIDS.

METHODS

A qualitative research methodology was adopted to explore HIV/AIDS patients' views about disease screening. A semi-structured interview guide was used for in-depth patient interviews. All interviews were audio-recorded and were subjected to a standard content analysis framework for data analysis.

RESULTS

Most patients were positive about screening and the value of knowing about their status early. However, fear of social stigma, discrimination, lack of support system and lack of public understanding were identified as major concerns affecting their willingness to be screened. They were concerned about mandatory screening being implemented without improvement in support system and public education.

CONCLUSIONS

Reluctance to seek HIV screening is an important factor contributing to transmission in developing countries. In the Malaysian context, efforts should be made to strengthen screening strategies especially in the most-at-risk populations to monitor the epidemic and target prevention strategies.

PRACTICE IMPLICATIONS

In a multicultural context, HIV preventive strategies must include disease awareness, including measure to tackle barriers towards screening.

They ‘don't cure old age’: older Ugandans’ delays to health-care access

Uganda's population is ageing, which comes with increased and varied burdens of disease and health-care needs. At the same time, gerontological care in Uganda remains neglected. This paper examines the factors that cause older Ugandans to delay health-care access. We conduct a thematic analysis of data drawn from nine focus groups held with rural Ugandans aged 60-plus. Our analysis highlights the factors that delay older persons’ access to health care and how these align with the Three-Delay Model, which was originally developed to assess and improve obstetric care in low-resource settings. Our participants report delays in deciding to seek care related to mobility and financial limitations, disease aetiology, severity and stigma (Delay I); reaching care because of poor roads and limited transportation options (Delay II); and receiving appropriate care because of ageism among health-care workers, and poorly staffed and under-supplied facilities (Delay III). We find these delays to care are interrelated and impacted by factors at the individual, community and health-system levels. We conclude by arguing for multi-pronged interventions that will address these delays, improve access to care and ultimately enhance older Ugandans’ health and wellbeing.

Healthy Aging in Older Women Living with HIV Infection: a Systematic Review of Psychosocial Factors

Due to life-enhancing effects of antiretroviral therapy, HIV-positive persons have the potential for long life comparable to their uninfected peers. Older women (age 50+) living with HIV (OWLH) are often an under-recognized aging group. We conducted a systematic review to examine psychosocial factors that impact how OWLH live, cope, and age with HIV. Initial key word search yielded 1527 records, and 21 studies met our inclusion criteria of original quantitative or qualitative research published between 2013 and 2016 with results specific to OWLH. These focused on health care and self-management, sexual health and risk, stigma, loneliness, mental health (depression, substance use), and protective factors (coping, social support, well-being). Due to the scarcity of studies on each topic and inconclusive findings, no clear patterns of results emerged. As the number of OWLH continues to grow, more research, including longitudinal studies, is needed to fully characterize the psychosocial factors that impact aging with HIV.

Sexual Behaviors and HIV Status: A Population-Based Study Among Older Adults in Rural South Africa

OBJECTIVE

To identify the unmet needs for HIV prevention among older adults in rural South Africa.

METHODS

We analyzed data from a population-based sample of 5059 men and women aged 40 years and older from the study Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities (HAALSI), which was carried out in the Agincourt health and sociodemographic surveillance system in the Mpumalanga province of South Africa. We estimated the prevalence of HIV (laboratory-confirmed and self-reported) and key sexual behaviors by age and sex. We compared sexual behavior profiles across HIV status categories with and without age-sex standardization.

RESULTS

HIV prevalence was very high among HAALSI participants (23%, 95% confidence interval [CI]: 21 to 24), with no sex differences. Recent sexual activity was common (56%, 95% CI: 55 to 58) across all HIV status categories. Condom use was low among HIV-negative adults (15%, 95% CI: 14 to 17), higher among HIV-positive adults who were unaware of their HIV status (27%, 95% CI: 22 to 33), and dramatically higher among HIV-positive adults who were aware of their status (75%, 95% CI: 70 to 80). Casual sex and multiple partnerships were reported at moderate levels, with slightly higher estimates among HIV-positive compared to HIV-negative adults. Differences by HIV status remained after age-sex standardization.

CONCLUSIONS

Older HIV-positive adults in an HIV hyperendemic community of rural South Africa report sexual behaviors consistent with high HIV transmission risk. Older HIV-negative adults report sexual behaviors consistent with high HIV acquisition risk. Prevention initiatives tailored to the particular prevention needs of older adults are urgently needed to reduce HIV risk in this and similar communities in sub-Saharan Africa.

Health status and years of sexually active life among older men and women in South Africa

Little is known about sexual activity in old age, particularly in Africa. The objective of this paper is to estimate years of sexually active life for older men and women, and examine the association between sexual activity and self-rated health status. Data were extracted from two large cross sectional HIV household surveys conducted in 2005 and 2012 in South Africa. The Sullivan method was used to estimate sexually active life expectancy, whilst logistic regression was used to assess associations with sexual activity. Sexually active life expectancy was higher among men across all the age groups in both surveys. At age 50, the sexually active life expectancy for men was double that for women - 2005 (12.6 vs. 5.9 years), 2012 (12.7 vs. 7.2 years). Self-rated health was significantly associated with sexual activity in men (adjusted Odds Ratio (aOR) 1.56; 95% CI 1.11-2.19; p<0.001). Among older women, moderate exercise was associated with being sexual active, while HIV infection was significantly associated with reduced sexual activity. The presence of chronic conditions was also significantly associated with reduced sexual activity among men. The results confirm that older adults are sexually active, and that factors associated with sexual activity are different for men and women. HIV among women and chronic conditions among men are areas of intervention to improve sexual activity in older people.

Extent of Knowledge about HIV and Its Determinants among Men in Bangladesh

Background

Bangladesh is currently a low human immunodeficiency virus (HIV) prevalent country. However, the risk factors are widespread and the number of at-risk population is also rising, which warrants special policy attention. The risks of transmission were shown to be correlated with the level of HIV knowledge of individuals. In this study, we aimed to explore the level and influencing factors of HIV knowledge among adult men in Bangladesh.

Methodology

Data for the present study were collected from the sixth round of Bangladesh Demographic and Health Survey. Participants were 3305 men between 15 and 54 years of age regardless of HIV status. The primary outcome variable was the HIV knowledge score, which was calculated by responses to questions regarding general concepts and the mode of transmission of HIV. Association between the HIV knowledge score and the explanatory variables were analyzed by binary logistic regression methods.

Result

The mean HIV knowledge score was 7.2 (SD 1.3). Results indicate that being an urban resident [p < 0.001; odds ratios (OR) = 0.56, 95% confidence intervals (CI) = 0.48–0.64], having secondary/higher educational level (p < 0.001 OR = 0.56, 95%CI = 0.48–0.64), reading newspaper [p = 0.006; OR = 0.76, 95%CI = 0.62–0.92], and communication with community health workers (CHWs) (p = 0.05; OR = 0.77, 95%CI = 0.60–10.00) were significantly associated with a high (equal or above mean value) HIV knowledge level.

Conclusion

The level of HIV knowledge among Bangladeshi men is low. Leveraging HIV awareness programs targeting adult men to prevent future expansion of the epidemic should be a high priority. Revitalization and restructuring of the education sector and strengthening CHW’s engagement to improve knowledge about HIV transmission among men could generate beneficial returns for HIV prevention programs.

Journeying with HIV patients across the health care spectrum - an examination of a seamless model of HIV Psychiatry of a large urban general hospital

OBJECTIVE

To describe a model of HIV psychiatry used in an urban hospital in Toronto and examine it against current literature.

METHOD

Using a narrative method, we elaborate on how this model delivers care across many different settings and the integral roles that the HIV psychiatrist plays in each of these settings. This is articulated against a backdrop of existing literature regarding models of HIV care.

RESULTS

This model is an example of an integrated model as opposed to a traditional consultation-liaison model and is able to deliver seamless care while remaining focused on patient-centric care.

CONCLUSION

An HIV psychiatrist delivers seamless and patient-centric care by journeying with patients across the healthcare spectrum and playing different roles in different care settings.

Review of recent behavioral interventions targeting older adults living with HIV/AIDS

Increasing attention has been paid to older adults living with HIV over the past few years given the increasing prevalence of HIV in this age group. Yet, despite numerous studies documenting psychosocial and behavioral differences between older and younger HIV-infected adults, few evidence-based behavioral interventions have been developed for this population. This review found only 12 manuscripts describing behavioral intervention studies in older HIV-positive adults published between 2011 and 2014, and they reported on a total of six interventions. Despite promising findings, there is a clear need for large-scale clinical trials to replicate these initial results and further develop additional interventions to address important clinical issues such as depression, sexual risk behaviors, cognition, and other significant issues affecting this cohort. This represents an exciting opportunity for behavioral scientists and HIV specialists to develop interventions that combine the psychological and behavioral with medical aspects of the disease.