STD Quarterly

Older women may not know their risk for HIV

If your practice includes older women, what is your approach in discussing risks for HIV? It's time to address such issues. Results of a new study indicate that older women may not be interested in being tested for HIV, despite having significant risk factors for lifetime exposure.1

Between 11% and 14% of all new HIV diagnoses are reported in Americans older than age 50.2-5 Despite the rise in diagnoses, seniors have been largely overlooked by HIV prevention and testing programs and have lower HIV testing rates compared with younger adults.6-8 Women are at special risk for HIV. The proportion of all HIV cases diagnosed among women and ethnic minorities has risen sharply since the early 1990s. While women represented 6% of all HIV diagnoses in 1984, their numbers climbed to 27% in 2003.9

What are some of the chief reasons for lower HIV testing rates among older women? Older women often do not get tested because they believe they are not at risk, says Aletha Akers, MD, MPH, assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh School of Medicine and lead author of the current study. Older women may believe that they and their partners do not or no longer engage in behaviors that would place them at risk, she observes.

Recommending seniors be tested

Another major reason for lower testing rates is that providers often do not recommend HIV testing to their older patients, says Akers. Providers may assume that older women are not sexually active or, if they are, they may assume that older women are not at risk and therefore do not obtain a sexual history or offer HIV testing, she notes.

In the current study, researchers underscore the importance of providers to assess current and past risk behaviors among older women who have not been tested for HIV, Akers reports. If a provider only assesses an older woman's current risk behaviors, while ignoring her lifetime risk exposure, he or she may incorrectly assume that an older woman does not need to be tested, she notes.

"Our national HIV education and prevention campaigns have generally ignored older persons," states Akers. "Media campaigns have focused on traditional high-risk groups such as youth, incarcerated individuals, and drug users; this has left older persons with the impression that HIV does not affect them."

Look at the study

To perform the study, researchers analyzed data collected from 514 women ages 50-95, who visited a general internal medicine clinic at a large, inner-city hospital in Atlanta during 2001-2002. Research assistants used a 68-item questionnaire to conduct face-to-face interviews with study participants, most of whom said they were not currently sexually active.

More than 60% of the women had never been tested for HIV, although more than half of them were found to have moderate to high risk for lifetime exposure to the virus based on sexual history and other factors. Less than one-fourth (22%) of the women said they would be interested in HIV testing.

About one-third of women already had been tested. These women were more likely to be younger, sexually active, better educated about HIV, and had received testing at the suggestion of a health care provider, researchers note.

Women with little HIV knowledge and low perceived personal risk were less interested in HIV testing, study findings indicate. Less than 25% of the participants could recall ever receiving counseling to get a test for HIV from a provider, despite their risk factors.1

Get the word out

It is important for seniors to be empowered and have the information to make informed decisions about their sexual health and practices, says Chris Miller, a spokesman for New York City's Department for the Aging. His department is taking special steps to spread the word about HIV prevention: 32% of people living with HIV/AIDS in New York City are people older than the age of 50, and 16% of all new HIV infections are in people older than 50 in the city.

To affect these numbers, New York City's Department for the Aging is preparing its network of service providers for the "graying" of HIV/AIDS, says Miller. It also is educating seniors who currently use its services, he notes.

In February 2007, the agency met with its community partners and senior health volunteers to educate senior center directors and staff, as well as health promotion volunteers, about basic HIV/AIDS information, says Miller. In June, the agency followed up by sending 81,000 of the city's private-label condoms, NYC Condoms, and HIV/AIDS literature to its senior centers.

"We also connected senior centers to local AIDS service organizations for further community-specific education and possible testing," says Miller.

References

  1. Akers A, Bernstein L, Henderson S, et al. Factors associated with lack of interest in HIV testing in older at-risk women. J Womens Health 2007; 16:842-858.
  2. Janssen R. HIV/AIDS in persons 50 years of age and older, testimony before the special Committee on Aging. 109th Congress, 1st session; 2005.
  3. Mack KA, Ory MG. AIDS and older Americans at the end of the twentieth century. J AIDS 2003; 33:S68.
  4. Funnye AS, Akhtar AJ, Biamby G. Acquired immunodeficiency syndrome in older African Americans. J Natl Med Assoc 2002; 94:209.
  5. Centers for Disease Control and Prevention. AIDS among persons aged >50 years — United States, 1991-1996. MMWR 1998; 47:360.
  6. Orel NA, Wright JM, Wagner J. Scarcity of HIV/AIDS risk-reduction materials targeting the needs of older adults among state departments of public health. Gerontologist 2004; 44:693.
  7. Zablotsky D. Overlooked, ignored, and forgotten. Res Aging 1998; 20:760.
  8. Chiao EY, Ries KM, Sande MA. AIDS and the elderly. Clin Infect Dis 1999; 28:740.
  9. McDavid K, McKenna MT. HIV/AIDS risk factor ascertainment: A critical challenge. AIDS Patient Care STDs 2006; 20:285.