Effect of an AIDS education program for older 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.

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.

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.

Training senior service providers about HIV and aging: Evaluation of a multiyear, multicity initiative

The Centers for Disease Control and Prevention estimate that in 2015, one half of all people living with HIV in the United States will be older than age 50. Older adults remain sexually active, and 16% of all new HIV diagnoses occur in adults age 50 and older. However, older adults rarely see themselves at risk for HIV/AIDS, and physicians are frequently reluctant to discuss sex. To address the issue of aging and HIV, ACRIA created its National Older Adults with HIV (NOAH) technical assistance and capacity-building program. NOAH targets aging and HIV providers that serve older adults at risk for or living with HIV. Program goals include increasing knowledge, reducing stigma, and creating partnerships between senior service providers (SSPs) and HIV service providers. In its first 4 years, NOAH training was provided to 150 organizations in eight cities across the United States, reaching 332 agency staff. Outcome evaluation found significant increases in knowledge about HIV and aging, and programmatic impact with regard to integration of older adults and HIV information in participating agencies' activities. Ongoing issues included recruiting SSPs and difficulties in reaching agencies that participated for short- and long-term follow-up. Implications for workforce development are discussed.

Perceived Susceptibility to HIV among Women

Older women's risk of acquiring HIV should not be discounted, because researchers have noted that older women may be at an increased risk of contracting HIV due to their heterosexual sexual practices and/or substance use behaviors. HIV prevention efforts must be directed at older adults who engage in high-risk sexual and drug behaviors, particularly those who may not perceive themselves to be at risk for HIV infection. This study is based on 183 women, mostly African American, divided into two age cohorts (ages 18 to 29, and ages 40 and older). The authors investigate factors associated with HIV risk perception in several domains, including individual, psychosocial, and sociodemographic characteristics as well as sexual and drug use behaviors. Multivariate analyses revealed differences in factors associated with younger and older women's HIV risk perceptions. Our findings indicate a need for HIV risk prevention programs to take age into consideration when developing intervention messages and strategies.

A Qualitative Approach to Increasing HIV Prevention in Primary Care Settings for Older Adults: Perspectives From Primary Care Providers

The purpose of this research was to explore primary care providers' willingness and ability to increase HIV prevention efforts among older adults and to gain recommendations for improving HIV prevention in primary care settings. Data were collected through 24 semistructured interviews with primary care providers. The results of the study reveal that the majority of providers find it necessary to increase HIV prevention efforts in primary care settings and are willing to do so; however, they cannot do so without assistance. Providers suggested strategies to increase HIV prevention in primary care, for instance, expanding the use of electronic reminders to include HIV prevention and increasing collaboration among providers of different specialties. As a result of the interviews, additional recommendations for increasing HIV prevention have been identified. These findings will aid in improving the quality of care provided to individuals older than 50 in primary care settings.

Self-perceptions and Current Practices of High-risk Older Drivers: Implications for Driver Safety Interventions

Many older drivers with visual problems meet the legal requirements for licensing despite having functional impairments that elevate crash risk. In a sample of visually impaired older drivers, over half believed that their vision was not likely to cause them to crash. Eighty percent acknowledged that they would feel more protected against crashing if they avoided certain driving situations. However, 75 percent of the sample reported never or rarely avoiding such situations (e.g. left turns, interstate highways). Almost 70 percent of drivers reported high self-efficacy in their ability to self-regulate and use alternative strategies. These data imply that behavioral interventions promoting compensatory strategies of self-regulation may be useful in maintaining mobility while improving the safety of high-risk older drivers. These findings serve as baseline for our ongoing study evaluating whether an educational intervention will increase self-regulation and improve older driver safety.

The Development and Efficacy of a Theory-Based Educational Curriculum to Promote Self-Regulation Among High-Risk Older Drivers

Knowledge Enhances Your Safety (KEYS) is a curriculum developed for older drivers who maintain driving privileges while coping with visual limitations that increase crash risk. KEYS’ goal is to promote safe driving through self-awareness of vision impairment and adopting self-regulatory strategies. We discuss KEYS’ theoretical framework based on the tenants of the Social Cognitive Theory, Health Belief and Transtheoretical Models, and Principles of Self-Regulation and Regulatory Self-Efficacy. Baseline and 6-month posttest evaluations tested its efficacy in terms of theoretical construct outcomes. KEYS’ participants improved self-perceptions of vision impairment, perceived a greater number of benefits in the performance of self-regulatory behaviors, and moved closer to the preparation and action/maintenance stages of change. Results indicate that high-risk older drivers benefit from educational interventions that promote self-awareness and self-regulation of driving. Future work will evaluate KEYS’ efficacy for high-risk older drivers in promoting driver behavior changes and its impact on crash involvement.

HIV behavioural interventions targeted towards older adults: a systematic review

Background

The increasing number of people living with HIV aged 50 years and older has been recognised around the world yet non-pharmacologic HIV behavioural and cognitive interventions specifically targeted to older adults are limited. Evidence is needed to guide the response to this affected group.

Methods

We conducted a systematic review of the available published literature in MEDLINE, Embase and the Education Resources Information Center. A search strategy was defined with high sensitivity but low specificity to identify behavioural interventions with outcomes in the areas of treatment adherence, HIV testing uptake, increased HIV knowledge and uptake of prevention measures. Data from relevant articles were extracted into excel.

Results

Twelve articles were identified all of which originated from the Americas. Eight of the interventions were conducted among older adults living with HIV and four for HIV-negative older adults. Five studies included control groups. Of the included studies, four focused on general knowledge of HIV, three emphasised mental health and coping, two focused on reduced sexual risk behaviour, two on physical status and one on referral for care. Only four of the studies were randomised controlled trials and seven – including all of the studies among HIV-negative older adults – did not include controls at all. A few of the studies conducted statistical testing on small samples of 16 or 11 older adults making inference based on the results difficult. The most relevant study demonstrated that using telephone-based interventions can reduce risky sexual behaviour among older adults with control reporting 3.24 times (95% CI 1.79-5.85) as many occasions of unprotected sex at follow-up as participants. Overall however, few of the articles are sufficiently rigorous to suggest broad replication or to be considered representative and applicable in other settings.

Conclusions

More evidence is needed on what interventions work among older adults to support prevention, adherence and testing. More methodological rigourised needed in the studies targeting older adults. Specifically, including control groups in all studies is needed as well as sufficient sample size to allow for statistical testing. Addition of specific bio-marker or validated behavioural or cognitive outcomes would also strengthen the studies.

Effect of an educational intervention on knowledge, attitudes and preventive behaviours related to HIV and sexually transmitted infections in female sex workers in southern Iran: a quasi-experimental study

This quasi-experimental, before–after study was designed to assess the effect of an educational intervention on knowledge and attitudes about sexually transmitted infections, HIV and preventive behaviours among female sex workers in Shiraz, Iran. A single-group pre–post test design was used and the study was done between August and December 2009. The participants were 80 female sex workers recruited from three drop-in centers in Shiraz, with stratified random sampling. Pre-intervention knowledge was assessed by interview with a standard questionnaire. The educational intervention consisted of a lecture, face-to-face education, printed information, an educational movie, role playing and a contest. After 2 months, the effect of the intervention was evaluated (post-test). The average age of the participants was 32.6 ± 9.1 years. After the intervention, the mean score for general knowledge about HIV and sexually transmitted infections increased from 13.7 ± 0.95 (pre-test) to 19.47 ± 11.62 (post-test, p < 0.001). There were significant improvements in attitude and the number of participants who self-reported preventive behaviours such as using a condom consistently (from 45 to 63) ( p < 0.001). The results show that the educational programme was successful in increasing the participants’ HIV- and AIDS-related knowledge and attitudes, and in decreasing their risk behaviours.

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.

A systematic review of education for the prevention of HIV/AIDS among older adults

Through a comprehensive literature search, the authors of this systematic review identified 21 articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. Three major challenges to providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk. Clinical guidelines for social workers, nurses, and physicians identified the importance of sharing information and assessing risk, considering cultural diversity, and devising creative delivery strategies. Three models of HIV/AIDS education include group education programs delivered by social workers or other health professionals, peer education models, and one-on-one early intervention models including HIV/AIDS testing. Additional outreach and research on HIV/AIDS prevention among older adults is needed.

Senior and Health-Professionals' Perceptions and Communication about Prescriptions and Alternative Therapies

Les patients et les professionnels éprouvent de la difficulté à communiquer entre eux en ce qui concerne les ordonnances et les médecines parallèles. Cette recherche visait à étudier et à rapprocher les perceptions et les échanges de 714 aîné(e)s et professionnels de la santé sur ces produits de santé. D'abord, on a effectué des entretiens personnels et ethnographiques avec des professionnels de la santé et des aîné(e)s pour déceler les questions de préoccupation pertinentes. Ensuite, on a utilisé des groupes de discussion pour évaluer les questions et la formulation des éléments initialement développées. Troisièmement, une étude a permis d'établir des associations et la validité prédictive des variables des deux premières étapes. Parmi les grandes lignes des thèmes, on note des perceptions différentes sur (a) la valeur et l'utilisation des médecines parallèles, (b) la précision de l'information sur les ordonnances et les médecines parallèles et (c) la communication sur la mauvaise utilisation des ordonnances et l'utilisation des médecines parallèles. Les aîné(e)set les professionnels ont présenté des recommandations d'amélioration de la pratique clinique.

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.

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.

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.

The older homosexual:

Lesbian, gay, bisexual, and transgender older adults require a comprehensive medical, behavioral, mental health, and social support evaluation as do all elders. Open communication and minimizing barriers in both the patient-provider relationship and throughout the continuum of care settings offer a safe environment for current and future care. Special attention should be given to ensure proper knowledge of social support systems including durable power of attorneys, housing and financial planning, and community services available.