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Nyirenda M, Mnqonywa N, Tutshana B, Naidoo J, Kowal P, Negin J. An analysis of the relationship between HIV risk self-perception with sexual behaviour and HIV status in South African older adults. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:277-286. [PMID: 36102066 DOI: 10.2989/16085906.2022.2090395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/17/2022] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Makandwe Nyirenda
- South African Medical Research Council, Burden of Disease Research Unit, Cape Town, South Africa
- University of KwaZulu-Natal, College of Health Sciences, School of Nursing and Public Health, Durban, South Africa
| | - Nonzwakazi Mnqonywa
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Bomkazi Tutshana
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Jayganthie Naidoo
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Paul Kowal
- International Health Transitions, Canberra, Australia
| | - Joel Negin
- The University of Sydney, School of Public Health, Sydney, Australia
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Kalu ME, Ojembe BU, Akinrolie O, Okoh AC, Adandom II, Nwankwo HC, Ajulo MS, Omeje CA, Okeke CO, Uduonu EM, Ezulike JC, Anieto EM, Emofe D, Nwachukwu EC, Ibekaku MC, Obi PC. Setting priorities for ageing research in Africa: A systematic mapping review of 512 studies from sub-Saharan Africa. J Glob Health 2021. [PMID: 34327003 PMCID: PMC8284542 DOI: 10.7189/11.15002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA. Methods This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas. Results We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions. Conclusions There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research.
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Affiliation(s)
- Michael E Kalu
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,School of Rehabilitation Science, McMaster University, Hamilton Ontario Canada
| | - Blessing U Ojembe
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Health, Ageing & Society, McMaster University, Hamilton Ontario Canada
| | - Olayinka Akinrolie
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Applied Health Science Program, University of Manitoba, Winnipeg, Canada
| | - Augustine C Okoh
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org)
| | - Israel I Adandom
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Department, Cedacrest Hospitals, Abuja, Nigeria
| | - Henrietta C Nwankwo
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Faculty of Health Science, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Michael S Ajulo
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org)
| | - Chidinma A Omeje
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Chukwuebuka O Okeke
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ekezie M Uduonu
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Juliet C Ezulike
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Social Work, University of Nigeria, Nsukka, Nigeria.,Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Ebuka M Anieto
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Diameta Emofe
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Department, Humanity Hospital Effurun, Delta State, Nigeria
| | - Ernest C Nwachukwu
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Department, Enugu State University of Science and Technology Teaching Hospital-Parklane, Enugu, Nigeria
| | - Michael C Ibekaku
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Physiotherapy, University of Benin Teaching Hospital, Benin city, Nigeria
| | - Perpetual C Obi
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Unit, Peak Wellness Centre, Abuja, Nigeria
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3
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Kalu ME, Ojembe BU, Akinrolie O, Okoh AC, Adandom II, Nwankwo HC, Ajulo MS, Omeje CA, Okeke CO, Uduonu EM, Ezulike JC, Anieto EM, Emofe D, Nwachukwu EC, Ibekaku MC, Obi PC. Setting priorities for ageing research in Africa: A systematic mapping review of 512 studies from sub-Saharan Africa. J Glob Health 2021; 11:15002. [PMID: 34327003 PMCID: PMC8284542 DOI: 10.7189/jogh.11.15002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA. METHODS This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas. RESULTS We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions. CONCLUSIONS There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research.
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Affiliation(s)
- Michael E Kalu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- School of Rehabilitation Science, McMaster University, Hamilton Ontario Canada
| | - Blessing U Ojembe
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Health, Ageing & Society, McMaster University, Hamilton Ontario Canada
| | - Olayinka Akinrolie
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Applied Health Science Program, University of Manitoba, Winnipeg, Canada
| | - Augustine C Okoh
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
| | - Israel I Adandom
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Department, Cedacrest Hospitals, Abuja, Nigeria
| | - Henrietta C Nwankwo
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Faculty of Health Science, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Michael S Ajulo
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
| | - Chidinma A Omeje
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Chukwuebuka O Okeke
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ekezie M Uduonu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Juliet C Ezulike
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Ebuka M Anieto
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Diameta Emofe
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Department, Humanity Hospital Effurun, Delta State, Nigeria
| | - Ernest C Nwachukwu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Department, Enugu State University of Science and Technology Teaching Hospital-Parklane, Enugu, Nigeria
| | - Michael C Ibekaku
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Physiotherapy, University of Benin Teaching Hospital, Benin city, Nigeria
| | - Perpetual C Obi
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Unit, Peak Wellness Centre, Abuja, Nigeria
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Mohammadi Y, Mirzaei M, Shirmohammadi-Khorram N, Farhadian M. Identifying risk factors for late HIV diagnosis and survival analysis of people living with HIV/AIDS in Iran (1987-2016). BMC Infect Dis 2021; 21:390. [PMID: 33906638 PMCID: PMC8077959 DOI: 10.1186/s12879-021-06100-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background Late-diagnosis of HIV is a major challenge for the control and prevention of AIDS in the world. The present study aimed to specify factors associated with the late diagnosis of HIV in Iran from 1987 to 2016. Methods In this retrospective cohort study, data for 4402 diagnosed HIV/AIDS patients were extracted from 158 behavioral disease counseling centers of 31 Iranian provinces. We defined late diagnosis as having a CD4 count less than 350 within 3 months after diagnosis. Multiple logistic regression analysis was used to determine the factors influencing late diagnosis. Moreover, we used multivariate Cox regression to assess the association of these factors with the patients’ survival. Results In this study, the prevalence of late diagnosis among the patients was 58.2%. People aged 50 years and over (adjusted OR = 3.55), transmission through blood transfusion (adjusted OR = 2.89), co-infection with tuberculosis (adjusted OR = 2.06), and male gender (adjusted OR = 1.38) were the strongest predictors for late diagnosis of HIV. On the other hand, baseline CD4 (adjusted HR = 2.21), people aged 50 and over (adjusted HR = 1.81), male gender (adjusted HR = 1.76), being a widow (adjusted HR = 1.68), people with unknown transmission way (adjusted HR = 18.24), people who inject drugs (adjusted HR = 1.87), diagnosis at previous years (adjusted HR = 2.45) and co-infection with tuberculosis (adjusted OR = 1.77) significantly associated with the survival of patients. Conclusion The prevalence of late diagnosis is high among Iranian HIV/AIDS. The risk factors of late diagnoses include being males and aged 50 years and over, transmission through blood transfusion, and co-infection with tuberculosis. Therefore, implementation of screening programs for early diagnosis of HIV these high risk groups is recommended to Iranian health providers and policymakers.
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Affiliation(s)
- Younes Mohammadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Mirzaei
- Hamadan Health Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Maryam Farhadian
- Research Center for Health Sciences, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, P.O. Box 4171-65175, Hamadan, Iran.
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5
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Psychological threat avoidance as a barrier to HIV testing in gay/bisexual men. J Behav Med 2019; 42:534-544. [PMID: 30600404 DOI: 10.1007/s10865-018-0003-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/07/2018] [Indexed: 02/02/2023]
Abstract
The present study examined how three psychosocial barriers-anticipated HIV stigma, HIV infectiousness-reduction beliefs, and optimism about available HIV treatments-related to HIV testing history and acceptance of an at-home HIV test among men who have sex with men. We also examined the mediating role of a variable that affects medical screening for other health conditions but has not yet been investigated in HIV contexts: the tendency to avoid psychologically threatening information. Volunteers completed a paper and pencil survey and were offered a free at-home HIV test during the 2015 Atlanta Pride Festival in Atlanta, GA. Anticipated HIV stigma, infectiousness beliefs, and treatment optimism were inconsistently related to HIV testing history and acceptance of an at-home HIV test, but all had direct effects on the desire to avoid HIV information. In a mediation model, each of these psychosocial barriers had indirect effects on both HIV testing outcomes via information avoidance. These findings suggest that information avoidance is an important proximal HIV testing barrier, thus providing a novel target for interventions and information campaigns.
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Knight L, Mukumbang FC, Schatz E. Behavioral and cognitive interventions to improve treatment adherence and access to HIV care among older adults in sub-Saharan Africa: an updated systematic review. Syst Rev 2018; 7:114. [PMID: 30071903 PMCID: PMC6090879 DOI: 10.1186/s13643-018-0759-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/24/2018] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Lucia Knight
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa.
| | - Enid Schatz
- Department of Health Sciences and Department of Women's and Gender Studies, University of Missouri, Columbia, USA
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Schatz E, Knight L. "I was referred from the other side": Gender and HIV testing among older South Africans living with HIV. PLoS One 2018; 13:e0196158. [PMID: 29684054 PMCID: PMC5912735 DOI: 10.1371/journal.pone.0196158] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/06/2018] [Indexed: 12/02/2022] Open
Abstract
South Africa has a Universal Test and Treat (UTT) policy in place to ensure that everyone tests for HIV and can access treatment if they test positive. The aim of this study is to document the pathways that older South Africans who are living with HIV take to access testing and treatment in this context. Despite the aging of the HIV epidemic in South Africa and clear evidence that testing older persons (over age 50) is necessary, very little is known about the circumstances under which older persons test for HIV or their motivations for doing so. In this study, we analyze 21 qualitative, in-depth interviews with women and men aged 50 and over who are living with HIV from two townships outside of Cape Town. Using grounded theory to specify emerging themes, we find similarities and differences between older men and women in their pathways to testing. Men primarily test for HIV when their spouse is diagnosed or in connection with TB testing and treatment. Older women, who are more likely to be widowed or divorced, often test for HIV only when they are symptomatic or not responding appropriately to care for non-communicable diseases. Most importantly, we find that older South Africans do not seek testing as a response to risk. Instead, older men and women test only once they are symptomatic and referred by a provider, or as a result of a partner's status. Our respondents, particularly the women, expressed "shock" and confusion at learning they were HIV-positive because they do not see themselves as at risk of acquiring HIV. Because the benefits of UTT are greatest with early detection and treatment, older persons' tendency to test at such a late stage of illness decreases the individual and population level advantages of UTT. More research is needed to understand older persons' risk and testing behavior so that policy and programs include HIV testing messages that reach this population.
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Affiliation(s)
- Enid Schatz
- Department of Health Sciences & Department of Women’s & Gender Studies, University of Missouri, Columbia, Missouri, United States of America
| | - Lucia Knight
- School of Public Health, University of Western Cape, Bellville, South Africa
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8
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Abstract
Sub-Saharan Africa (SSA) has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation, SSA is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases (NCD). The aim of this review is to highlight available research on the health status of older persons in SSA, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in SSA on older persons (aged 50 years and older) related to health indicators including nutritional status, NCD and HIV burden. While it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions.
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9
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Rosenberg MS, Gómez-Olivé FX, Rohr JK, Houle BC, Kabudula CW, Wagner RG, Salomon JA, Kahn K, Berkman LF, Tollman SM, Bärnighausen T. Sexual Behaviors and HIV Status: A Population-Based Study Among Older Adults in Rural South Africa. J Acquir Immune Defic Syndr 2017; 74:e9-e17. [PMID: 27926667 PMCID: PMC5147032 DOI: 10.1097/qai.0000000000001173] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Molly S. Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health—Bloomington, Indiana University, Bloomington, IN
- Center for Population and Development Studies, Harvard University, Cambridge, MA
| | - Francesc X. Gómez-Olivé
- Center for Population and Development Studies, Harvard University, Cambridge, MA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Julia K. Rohr
- Center for Population and Development Studies, Harvard University, Cambridge, MA
| | - Brian C. Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Demography, Australian National University, Canberra, Australia
| | - Chodziwadziwa W. Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Joshua A. Salomon
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Lisa F. Berkman
- Center for Population and Development Studies, Harvard University, Cambridge, MA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Departments of Epidemiology
- Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Stephen M. Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Till Bärnighausen
- Center for Population and Development Studies, Harvard University, Cambridge, MA
- School of Demography, Australian National University, Canberra, Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa; and
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Negin J, Gregson S, Eaton JW, Schur N, Takaruza A, Mason P, Nyamukapa C. Rising Levels of HIV Infection in Older Adults in Eastern Zimbabwe. PLoS One 2016; 11:e0162967. [PMID: 27828979 PMCID: PMC5102380 DOI: 10.1371/journal.pone.0162967] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/31/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the scale-up of antiretroviral treatment across Africa, many people are living longer with HIV. Understanding the ageing of the HIV cohort and sexual behaviour among older adults are important for appropriately responding to the changing demographics of people living with HIV. METHODS We used data from a large population-based open cohort in eastern Zimbabwe to examine HIV prevalence trends and incidence among those aged 45 years and older. Five survey rounds have been completed between 1998 and 2011. Incidence was analysed using midpoint between last negative and first positive HIV test. RESULTS Across the survey rounds, 13,071 individuals were followed for 57,676 person years. While HIV prevalence among people aged 15-44 has fallen across the five rounds, HIV prevalence among those aged 45-54 has increased since the 2006-08 survey round. In the 2009-11 round, HIV prevalence among men aged 45-54 was 23.4% compared to 11.0% among those aged 15-44. HIV positive people aged 45-54 now represent more than 20% of all those living with HIV in Manicaland. Among those aged 45 years and older, there were 85 seroconversions in 11,999 person years for an HIV incidence of 0.708 per 100 person years. Analysis of cohort data and assessment of behavioural risk factors for HIV infection among older people shows significantly lower levels of condom use among older adults and a number of seroconversions past the age of 50. CONCLUSIONS The cohort of people living with HIV is ageing in Zimbabwe and the behaviour of older adults puts them at risk of HIV infection. Older adults must be included in both HIV prevention and treatment programs.
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Affiliation(s)
- Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
- * E-mail:
| | - Simon Gregson
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
| | - Jeffrey W. Eaton
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
| | - Nadine Schur
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Peter Mason
- Biomedical Research and Training Institute, Harare, Zimbabwe
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Constance Nyamukapa
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
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