Knowledge of human immunodeficiency virus and acquired immunodeficiency syndrome, perception of risk, and behaviors among older adults

HIV and AIDS prevention: knowledge, attitudes, practices and health literacy of older persons in the Western Cape and KwaZulu-Natal Provinces, South Africa and in Lesotho

BACKGROUND

Population ageing and access to anti-retroviral therapies in South Africa have resulted in ageing of the HIV/AIDS epidemic, which has implications for policy, planning and practice. Impactful interventions on HIV/AIDS for older persons require knowledge on effects of the pandemic on this population. A study was undertaken to assess knowledge, attitudes, and practices (KAP) of HIV/AIDS, as well as health literacy (HL) level of a population aged ≥ 50 years.

METHODS

A cross-sectional survey was conducted at three sites in South Africa and two sites in Lesotho with an educational intervention at the South African sites. At baseline, data were collected for assessment of KAP of HIV/AIDS and HL levels. The pre- and post-intervention comprised participants at South African sites being familiarised with the contents of a specially constructed HIV/AIDS educational booklet. Participants' KAP was reassessed six weeks later. A composite score of ≥ 75% was considered adequate KAP and an adequate HL level.

RESULTS

The baseline survey comprised 1163 participants. The median age was 63 years (range 50-98 years); 70% were female, and 69% had ≤ 8 years' education. HL was inadequate in 56% and the KAP score was inadequate in 64%. A high KAP score was associated with female gender (AOR = 1.6, 95% CI = 1.2-2.1), age < 65 years (AOR = 1.9, 95% CI = 1.5-2.5) and education level (Primary school: AOR = 2.2; 95% CI = 1.4-3.4); (High school: AOR = 4.4; 95% CI = 2.7-7.0); (University/college: AOR = 9.6; 95% CI = 4.7-19.7). HL was positively associated with education but no association with age or gender. The educational intervention comprised 614 (69%) participants. KAP scores increased post intervention: 65.2% of participants had adequate knowledge, versus 36% pre-intervention. Overall, younger age, being female and higher education level were associated with having adequate knowledge about HIV/AIDS, both pre- and post-intervention.

CONCLUSIONS

The study population had low HL, and KAP scores regarding HIV/AIDS were poor but improved following an educational intervention. A tailored educational programme can place older people centrally in the fight against the epidemic, even in the presence of low HL. Policy and educational programmes are indicated to meet the information needs of older persons, which are commensurate with the low HL level of a large section of that population.

HIV/AIDS and Aging Minority Populations

This article focuses on emerging issues associated with HIV/AIDS in aging minoritypopulations. Based on a review of the literature as well as available national surveillance data, this article discusses current knowledge about HIV/AIDS in agingminority populations, particularly as they relate to sociodemographic, cultural, andhealth status factors. The authors not only examine the circumstances of older personsinfected by HIV/AIDS but also those affected by HIV/AIDS as a result of additionalof caregiving responsibilities. Recommendations for future research are provided.

Use of the PHM Framework to Create Safe-Sex Ads Targeted to Mature Women 50 and Older

This research applies the Witte's persuasive health message (PHM) framework to the development of creative concepts that promote sexual health strategies to senior-aged women. The PHM framework proposes an integrated approach to improving message effectiveness and maximizing persuasion in health communication campaigns. A focus group method was used to explore two research questions focused on message effectiveness and persuasion. The findings suggest the PHM framework can be a useful starting point for ensuring that health communicators identify the criteria most relevant to successful ad promotions.

Condom Attitudes of Heterosexual Men Ages 50 and Older Using Prescribed Drugs (Viagra, Cialis, Levitra) to Treat Erectile Dysfunction

The purpose of this study was to explore attitudes about condoms that may affect condom use by heterosexual men ages 50 and older who were sexually active and currently using prescribed oral phosphodiesterase type 5 inhibitor medications (Viagra®, Cialis®, or Levitra®) for treatment of erectile dysfunction. The study was part of a larger study that explored the need for safer-sex health promotion and education for these men. Fifty men completed factor subscales of the Condom Attitude Scale. Subscales were scored and analyzed. Positive factors were found with regard to the Interpersonal Impact, Inhibition, Perceived Risk, Perceived Seriousness, and Global Attitudes subscales. Factors with negative or neutral responses included the Effect on Sexual Experience, Relationship Safety, and Promiscuity subscales. Independent t tests revealed no differences between married and nonmarried men for the mean score on any of the subscales, but there was a difference on the Global Attitude Scale, with younger men having a more positive global attitude than older men. Study findings can be used in the development of health promotion educational activities on condom use as a safer-sex practice.

Prevention of HIV Among Older Adults

Objective:

This study reviews the existing literature on the prevention of HIV among older adults, including universal and indicated prevention programs and prevention strategies.

Method:

A literature search was conducted between September and October of 2011 to identify studies for this review. Several different electronic databases and a combination of keywords were used to conduct the search. In addition, the reference section of each article was reviewed for additional articles.

Results:

A total of 18 articles were identified and reviewed. Three of the articles examined universal prevention, five of the articles examined indicated prevention, and the remainder of the articles provided strategies and recommendations for the prevention of HIV among older adults.

Discussion:

The existing studies document evidence for preventing future cases of HIV/AIDS among older adults. Additional studies and universal and selected interventions are needed in an effort to reduce the number of older adults being diagnosed with HIV.

Herpes simplex virus type 2 seropositivity and relationship status among U.S. adults age 20 to 49: a population-based analysis

BACKGROUND

U.S. population studies show herpes simplex virus type 2 (HSV-2) seroprevalence levelling by approximately age 30, suggesting few new infections after that age. It is unclear whether this pattern is driven by greater percentages in stable relationships, and to what extent adults who initiate new relationships may be at risk of incident HSV-2 infection.

METHODS

Survey and laboratory data from the 1999-2008 waves of the U.S. National Health and Nutrition Examination Survey (NHANES) were combined for 12,862 adults age 20-49. Weighted population estimates of self-reported genital herpes, HSV-2 seroprevalence, and past-year sexual history were calculated, stratified by age, sex, race, and relationship status. Multivariable logistic regression was used to assess whether relationship status provided additional information in predicting HSV-2 over age, race and sex, and whether any such associations could be accounted for through differences in lifetime number of sex partners.

RESULTS

Those who were unpartnered had higher HSV-2 prevalence than those who were married/cohabitating. Among unpartnered 45-49 year olds, seroprevalence was 55.3% in women and 25.7% in men. Those who were married/cohabitating were more likely to have had a past-year sex partner, and less likely to have had two or more partners. The effect of age in increasing the odds of HSV-2 was modified by race, with higher HSV-2 prevalence among Black Americans established by age 20-24 years, and the effect of race decreasing from age 30 to 49. Relationship status remained an independent predictor of HSV-2 when controlling for age, race, and sex among those age 30 to 49; married/cohabitating status was protective for HSV-2 in this group (OR = 0.69)

CONCLUSIONS

Whereas sexually transmitted infections are often perceived as issues for young adults and specific high-risk groups, the chronic nature of HSV-2 results in accumulation of prevalence with age, especially among those not in married/cohabitating relationships. Increased odds of HSV-2 with age did not correspond with increases in self-reported genital herpes, which remained low. Adults who initiate new relationships should be aware of HSV-2 in order to better recognize its symptoms and prevent transmission.

No One Is Immune: A Community Education Partnership Addressing HIV/AIDS and Older Adults

There has been a dramatic increase in the number of new HIV diagnoses among people aged 50 to 64 in the United States, and according to the Centers for Disease Control and Prevention (CDC), in just 7 years (by 2015) 50% of those living with AIDS will be aged 50 or older. To address this public health concern, viable HIV/AIDS prevention and treatment options for individuals over the age of 50 are necessary. This article discusses the No One Is Immune initiative that planned, implemented, and coordinated evidence- based HIV/AIDS prevention and education programs specifically tailored for middle-aged and older adults. Guided by the health belief model, an educational conference entitled "Sexuality, Medication, and HIV/AIDS in Middle and Later Adulthood" was conducted along with research activities that assessed HIV/AIDS knowledge gained using both qualitative and quantitative measures. This project can be replicated by other providers within the aging network.

Optimistic bias, information seeking and intention to undergo prostate cancer screening: A Taiwan study on male adults

BACKGROUND

This study explores optimistic bias and information seeking in prostate cancer patients and how they impact intention to undergo prostate cancer screening.

METHODS

A national sample of 427 Taiwanese male adults aged at least 45 years (mean (M) = 57) were recruited to complete a telephone-based survey questionnaire between April 30 and May 8, 2008.

RESULTS

The questionnaire results showed that respondents considered themselves less likely than others to get prostate cancer. The relationship between optimistic bias and intention to undergo prostate cancer screening was non-significant, while information seeking positively and significantly predicted such an intention.

CONCLUSIONS

The findings of this study imply that health educators should include risk-awareness strategies and information seeking interventions in the design of cancer prevention programs.

Factors associated with lack of interest in HIV testing in older at-risk women

OBJECTIVE

To determine the factors and reasons associated with lack of interest in HIV testing among older women from a high prevalence community.

METHODS

We conducted a cross-sectional study of women aged >or=50 seeking medical care. The main outcome measures were (1) interest in HIV testing and (2) reasons for women's interest or lack of interest assessed using open-ended questions. We compared the characteristics of women based on testing interest and fit two multivariable logistic regression models to identify factors associated with lack of testing interest among never tested women and women with moderate or high HIV risk factors. Responses to short answer questions were analyzed according to participants' HIV testing interest. Coding was performed by two independent reviewers using deductive application of themes identified in previously published literature on HIV testing interest.

RESULTS

Of 564 eligible women, 514 (91%) enrolled. Only 22% were interested in HIV testing. Those who lacked interest were more likely to be older (63.3 vs. 58.4, p < 0.001), African American (77% vs. 60%, p < 0.001), have poor HIV knowledge (68% vs. 57%, p = 0.02), and have low perceived HIV risk (82% vs. 69%, p = 0.01). Lack of interest in HIV testing was associated with increasing age and African American race among women with moderate or high-risk factors, whereas age, African American race and low perceived risk were important for never tested women. Common reasons for lacking interest in testing were perceived lack of need, perceived lack of risk, and a prior history of HIV testing.

CONCLUSIONS

Few of these older, high-risk women were interested in HIV testing despite the fact that more than half had risk factors for having been exposed to HIV during their life-time. Efforts to increase HIV testing interest should educate older women about HIV risk and transmission factors and promote accurate risk self-assessment.

Treatment perceptions and attitudes of older human immunodeficiency virus-infected adults

OBJECTIVE

To apply the Health Belief Model (HBM) in assessing the association of health beliefs, perceived benefits, perceived barriers, alternative therapy use, and sexual risk behaviors in relation to the treatment of human immunodeficiency virus (HIV) in a group of older HIV-infected patients.

METHODS

A convenience sample of 100 older (50 years and above) HIV-infected patients in 2 Washington, DC, clinics was enrolled. A cross-sectional methodology used structured interviews to investigate the association among antiretroviral adherence, use of alternative therapies, treatment perceptions, and risk behaviors. Student t tests were conducted to examine significant relationships between HBM perceptions and demographic characteristics. Logistic regressions were conducted to assess likelihood of antiretroviral and alternative therapy use.

RESULTS

The majority of the participants were black and had a high school education. Although participants believed that HIV was a severe disease, they did not perceive themselves to be susceptible to early progression to acquired immunodeficiency syndrome. Participants believed that antiretrovirals were beneficial, and they were not particularly burdened by perceived costs of antiretrovirals. The perceived costs (or barriers) of antiretrovirals were inversely associated with CD4 count (r=-0.25, P=.01) and positively associated with viral load (r=0.33, P < .01). Overall 21% of patients in this population indicated use of alternative therapies. Patients who tended to have a higher perception of severity of HIV and a higher perceived burden in using antiretrovirals were more likely to use alternative therapy. There was no difference in HBM perceptions among antiretroviral users and nonusers.

CONCLUSIONS

In general, the benefits of taking antiretrovirals were clear to most patients, and the same patients did not view access to antiretrovirals as a significant barrier to treatment. Many patients, although aware of the severity of HIV disease, were not seeking modifications to sexual behavior. Furthermore, the actual medication-taking behavior of these patients resulted in significant impacts to their clinical status. Study results can be applied in the development of specific interventions that are intended to decrease HIV transmission among older adults and to improve medication-taking behavior among those who are already infected with HIV.

Older women and HIV: how much do they know and where are they getting their information?

OBJECTIVES

To assess older urban women's knowledge about sexual transmission of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and to evaluate the relationship between their HIV/AIDS knowledge level and sources of information.

DESIGN

Cross-sectional survey conducted between June 2001 and July 2002. Trained research assistants administered a questionnaire in a face-to-face interview.

SETTING

General medicine clinic in a large public hospital in a high HIV/AIDS incidence area.

PARTICIPANTS

Five hundred fourteen women aged 50 and older.

MEASUREMENTS

Nine questions assessing knowledge of risk of HIV sexual transmission with potential scores ranging from 0 to 9 correct answers. Participants identified all sources of HIV information.

RESULTS

The mean knowledge score was 3.7 out of a possible 9 correct responses (range 0 (3%) to 8 (1%)). Younger age, employment, and higher educational level were associated with higher knowledge scores, whereas marital status was unrelated. No respondent correctly answered all of the nine questions. The most commonly identified sources of HIV/AIDS information were television (85%), friends (54%), and newspapers (51%). Only 38% of respondents identified health professionals as a source of information about HIV/AIDS. Health professionals, newspapers, and family members were each independently associated with higher knowledge scores (P<.05).

CONCLUSION

Older women in a general medicine clinic had limited knowledge of sexual transmission of HIV. HIV/AIDS education specifically targeted to this subpopulation is warranted, and health professionals may have an important role in disseminating such messages.

Planning HIV Education Programs for Older Adults: Cultural Implications

In this article the author discusses a needs assessment, through the use of discussion groups of various cultures, exploring the perceptions and attitudes of older adults about human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and HIV education. Five discussion groups (one with Latino older adults, two with African-American older adults, one with White older adults, and one with Chinese-American older adults) were conducted. Semi-structured guiding questions were used with all groups. The questions centered on three major areas: perceptions of older adults and HIV and AIDS, use of condoms for HIV and AIDS prevention, and HIV prevention programs for older adults. The group sessions were approximately 1 hour, were recorded on tape, and were transcribed. The sessions were conducted in the languages of the target population. Because the project was a needs assessment for program development, the number of participants in each cultural discussion group was small, and the nurse group leaders were not experienced in focus group methodology themes and generalizations cannot be made. However, specific findings from the group sessions and recommendations for HIV prevention are presented for further exploration.

Knowledge of AIDS, perceived risk of AIDS, and at-risk sexual behaviors among older adults

PURPOSE

To identify older adults' knowledge of acquired immune deficiency syndrome (AIDS), perceptions of their risk of AIDS, and at-risk behaviors by using a questionnaire derived from the health belief model.

DATA SOURCES

A descriptive correlation design was used to survey persons 50 years of age and older who participate in university-based senior programs. The sample of 166 persons (55% return rate) had a mean age of 71 years and included 33% males. The sample is representative of the participants in these programs.

CONCLUSIONS

Five hypotheses based on the health belief model were tested. Statistical analyses showed significant predictors of the likelihood of using recommended safe sexual practices were gender, knowledge of AIDS, perceived susceptibility to AIDS, and perceived threat of AIDS. The results indicated the respondents were knowledgeable about human immunodeficiency virus (HIV) transmission through casual contact and medical aspects of AIDS. Although the respondents recognized the seriousness of AIDS, they generally did not believe that they were susceptible to this disease, even though about 10% indicated sexual activity outside of a long-term relationship.

IMPLICATIONS FOR PRACTICE

The study findings support the need for nurse practitioners to assess sexual behaviors in and provide information about safe sex practices to older clients because of the documented rising incidence of AIDS in persons over 50 years of age.

Risk factors and HIV transmission to midlife and older women: knowledge, options, and the initiation of safer sexual practices

Despite the increased impact of HIV/AIDS on women in the United States, the HIV-related experience of mature and older women has been largely overlooked by behavior scientists. Appropriate strategies for increasing awareness, assessing personal risk, and implementing safer sex behaviors among women in their 50s or older have not been developed. Relative to knowledge of personal risk and self-protective measures, older women have lower levels of knowledge about HIV/AIDS and the effectiveness of condoms than their younger counterparts. Although a significant portion of postmenopausal women remain sexually active, little is known about how mature women in long-term relationships can initiate self-protective behaviors if they come to recognize a risk or how those who meet new sexual partners can be motivated to use condoms. Investigations regarding safer sexual practices must be conducted in a way that addresses biologic events (e.g., menopause), life course changes, and cohort effects. Rather than trying to generalize findings from studies performed with younger women, it is necessary to integrate risk reduction strategies into models of sexual health and well-being for women across their life course.

Designing effective HIV/AIDS social and behavioral interventions for the population of those age 50 and older

Social and behavioral HIV/AIDS prevention interventions designed to test their effects on older cohorts are sorely lacking in the scientific literature even though middle-aged and older people represent a significant minority of both existing and new AIDS cases. This article raises key issues relevant in developing and evaluating HIV/AIDS social and behavioral interventions for older cohorts. These interventions must build on our current understanding of behavior change and HIV prevention successes with younger populations while considering important intervention principles gathered from work with older populations in other health arenas. In addition, the authors expand on recent national panels and published reviews relevant to the topic and provide a set of intervention recommendations for use in tandem with these intervention principles. The article also calls for additional research into the sociocultural contexts that influence risk-taking among older cohorts and for the development of interventions at multiple levels. Pragmatic considerations such as identifying and dismantling ageism in interventions, delineating intervention outcomes, and planning for intervention transferability, dissemination, and sustainability also are raised.

HIV/AIDS-related knowledge and attitudes: a comparison of older persons and young adults in Thailand

Levels of AIDS related knowledge are widely assumed to be high in Thailand, a country with probably the most effective response to the HIV/AIDS pandemic to date in the developing world. But efforts to verify these levels are sparse in recent years, and very little attention has ever been paid to AIDS knowledge and attitudes within the Thai older population. Because many Thai older persons (aged 50 and over) remain sexually active late in life, and because many more will be involved in interactions with and care taking of young adult persons suffering from AIDS, we explore AIDS knowledge and attitudinal data we collected during 1999 from a sample of 773 older Thais from four provinces and Bangkok. The sample provinces were chosen to include a wide range of prevalence levels and social contexts regarding the epidemic. We compare the results with data from a sample of 398 young adults using the same questionnaire, collected at the same sites, at the same time (total N = 1,171). We find an overall high level of awareness about AIDS across our age groups of interest, but also identify important deficiencies among the young adults and especially among the older Thais. Implications of the findings are discussed.

HIV & AIDS in older adults

Many Americans mistakenly believe that older adults are not at risk for HIV/AIDS. Older people do not perceive themselves to be at risk for HIV infection, either. In reality, approximately 10% of AIDS cases are among people older than 50. Many health care providers lack an awareness of the risk of HIV/AIDS in the elderly population, and as a result, many older people with these conditions are misdiagnosed with other ailments. Major manifestations of HIV/AIDS in elderly adults include Pneumocystis carinii pneumonia, herpes zoster, tuberculosis, cytomegalovirus, oral thrush, Mycobacterium avium complex, and HIV dementia. Elderly HIV-positive women have special health concerns, such as cervical cancer. Nurses and nurse practitioners can heighten their colleagues' awareness of the existence of HIV/AIDS in the elderly population and educate their older patients on HIV/AIDS. Furthermore, information about sexuality and sexual practices of older adults should be incorporated into all health science curricula. Additional research is needed to determine the extent of the problem and how health care providers can best serve their older patients' needs.

Effect of an AIDS education program for older adults

The purpose of this study was to examine the effect of an age-specific AIDS education program on HIV/AIDS knowledge, perceived susceptibility to AIDS, and perceived severity of AIDS in older adults. The health belief model served as a framework. The age-specific AIDS education program was developed based on a knowledge, beliefs, and behaviors survey of 458 older adults at senior citizen centers. The program included case study presentations of actual older people with AIDS along with an emphasis on myths identified in the initial survey. There was a significant increase in total knowledge about AIDS (p < .001), perceived susceptibility (p < .01), and perceived severity (p < .001) after the educational program. Based on the results of this study, nurses are in an excellent position to provide primary and secondary AIDS prevention strategies for all age groups, including the older adult population.