Geographic Patterns of Human Immunodeficiency Virus (HIV) Risk Behaviors Among Older Adults: A Strategy for Identifying Space as a Risk Exposure

Abstract

Objectives: This study examined geographical patterns of HIV risk among adults aged 60 and older. Methods: The 2019 Behavioral Risk Factor Surveillance System (BRFSS) weighted data was used to analyze self-reported participation in HIV risk behaviors among older adults (n = 62,852). Logistic regression models were used on a dichotomous HIV risk variable to map the distribution of HIV risk behaviors across both census regions and divisions. Results: The weighted model revealed significance across regions. Across all regions, identifying as female, identifying as Hispanic, and reporting not having depression were protective from participating in HIV risk behaviors. Discussion: The geographic heterogeneity in patterns of high-risk behaviors among older adults are discussed, along with the implications of partner access (marital status) and emotional health (depression) that need further examination. Recommendations for additional geographic analysis are made.

Keywords

HIV risk behaviors older adults geographic analysis

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References

Abbai

N. S.

Wand

Ramjee

(2016). Biological factors that place women at risk for HIV: Evidence from a large-scale clinical trial in Durban. BioMedCentral Women’s Health, 16(19), 19–27. https://doi.org/10.1186/s12905-016-0295-5

Adimora

Ramirez

Schoenbach

Cohen

(2014). Policies and politics that promote HIV infection in the Southern United States. AIDS, 28(10), 1393–1397. https://doi.org/10.1097/QAD.0000000000000225

Administration for Communty Living . (2021). 2020 profile of older Americans. U.S Department of Health and Human Services. https://acl.gov/sites/default/files/Aging_and_Disability_in_America/2020ProfileOlderAmericans.Final_.pdf

Baum

Kaboli

P. J.

Schwartz

M. D.

(2021). Reduced in-person and increased telehealth outpatient visits during the COVID-19 pandemic. Annals of Internal Medicine, 174(1), 129–131. https://doi.org/10.7326/M20-3026

Boodram

Hotton

A. L.

Shekhtman

Gutfraind

Dahari

(2018). High-risk geographic mobility patterns among young urban and suburban persons who inject drugs and their injection network members. Journal of Urban Health, 95(1), 71–82. https://doi.org/10.1007/s11524-017-0185-7

Busch

A. B.

Huskamp

H. A.

Raja

Rose

Mehrotra

(2022). Disruptions in care for medicare beneficiaries with severe mental illness during the COVID-19 pandemic. JAMA Network Open, 5(1), Article e2145677. https://doi.org/10.1001/jamanetworkopen.2021.45677

Center for Disease and Prevention Control . (2019a). HIV in the southern United States [issue brief]. https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf

Center for Disease and Prevention Control . (2019b). HIV risk behaviors. https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html

Center for Disease and Prevention Control . (2020a). HIV and older Americans. https://www.cdc.gov/hiv/group/age/olderamericans/index.html

10.

Center for Disease and Prevention Control . (2020b). HIV in the United States by region. https://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html

11.

Center for Disease and Prevention Control . (2020c). Behavioral risk factor surveillance system: 2019 summary data quality report July 16, 2020. https://www.cdc.gov/brfss/annual_data/2019/pdf/2019-sdqr-508.pdf

12.

Center for Disease and Prevention Control . (2021). Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveillance Supplemental Report, 26(1), 2021. https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html

13.

Center for Disease and Prevention Control . (2022). HIV in the United States by region: HIV incidence. https://www.cdc.gov/hiv/statistics/overview/incidence.html

14.

Cheng

Garfein

Semple

Strathdee

Zians

Patterson

(2010). Increased drug use and sti risk with injection drug use among HIV- seronegative heterosexual methamphetamine users. Journal of Psychoactive Drugs, 42(1), 11–18. https://doi.org/10.1080/02791072.2010.10399781

15.

Choi

Marks

N. F.

(2008). Marital conflict, depressive symptoms, and functional impairment. Journal of Marriage and Family, 70(2), 377–390. https://doi.org/10.1111/j.1741-3737.2008.00488.x

16.

Clements-Nolle

Marx

Guzman

Katz

(2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91(6), 915–921. https://doi.org/10.2105/AJPH.91.6.915

17.

Coady

Latka

Thiede

Golub

Ouellet

Hudson

Kapadia

Garfein

(2007). Housing status and associated differences in HIV risk behaviors among young injection drug users (IDUs). AIDS and Behavior, 11(6), 854–863. https://doi.org/10.1007/s10461-007-9248-1

18.

Coleman

(2017). Health related quality of life and depressive symptoms among seropositive African Americans. Applied Nursing Research, 33, 138–141. https://doi.org/10.1016/j.apnr.2016.11.007

19.

Dannefer

(2003). Cumulative advantage/disadvantage and the life course: Cross-fertilizing age and social science theory. The Journals of Gerontology: Series B, 58(6), S327–S337. https://doi.org/10.1093/geronb/58.6.s327

20.

Douthit

K. Z.

Dannefer

(2007). Social forces, life course consequences: Cumulative disadvantage and ‘getting Alzheimer’s. In Wilmoth

Ferraro

(Eds.), Gerontology: Perspectives and issues (pp. 223–243). Springer Publishing Company.

21.

Green

K. M.

Doherty

E. E.

Fothergill

K. E.

Ensminger

M. E.

(2012). Marriage trajectories and health risk behaviors throughout adulthood among urban African Americans. Journal of Family Issues, 33(12), 1595–1618. https://doi.org/10.1177/0192513X11432429

22.

Gumuser

E. D.

Haidermota

Finneran

Natarajan

Honigberg

M. C.

(2021). Trends in cholesterol testing during the COVID-19 pandemic: COVID-19 and cholesterol testing. American Journal of Preventive Cardiology, 6, Article 100152. https://doi.org/10.1016/j.ajpc.2021.100152

23.

Haesler

Bauer

Fetherstonhaugh

(2016). Sexuality, sexual health and older people: A systematic review of research on the knowledge and attitudes of health professionals. Nurse Education Today, 40, 57–71. https://doi.org/10.1016/j.nedt.2016.02.012

24.

Henry

Kaiser Family Foundation . (2020). Black Americans and HIV/AIDS: The basics. https://www.kff.org/hivaids/fact-sheet/black-americans-and-hivaids-thebasics/

25.

Jeste

D. V.

Savla

G. N.

Thompson

W. K.

Vahia

I. V.

Glorioso

D. K.

Martin

A. S.

Palmer

Rock

Golshan

Kraemer

Depp

C. A.

(2013). Association between older age and more successful aging: Critical role of resilience and depression. American Journal of Psychiatry, 170(2), 188–196. https://doi.org/10.1176/appi.ajp.2012.12030386

26.

Kates

(2011). Medicaid and HIV: A national analysis. The Kaiser Family Foundation. https://www.kff.org/wp-content/uploads/2013/01/8218.pdf

27.

Logan

T. K.

Cole

Leukefeld

(2002). Women, sex, and HIV: Social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychological Bulletin, 128(6), 851–885. https://doi.org/10.1037/0033-2909.128.6.851

28.

Logan

T. K.

Leukefeld

(2000). HIV risk behavior among bisexual and heterosexual drug users. Journal of Psychoactive Drugs, 32(3), 239–248. https://doi.org/10.1080/02791072.2000.10400446

29.

Mayer

Beyrer

(2007). HIV epidemiology upate and transnission factors: Risks and risk contexts-16^th International AIDS Conference Epidemiology Plenary. Clincial Infectious Diseases, 44(7), 981–987. https://doi.org/10.1086/512371

30.

McDaniel

Lai

Chou

(2023). HIV testing and risk behaviors associated with depression in the United States. Preventive Medicine Reports, 34, 102247–102310. https://doi.org/10.1016/j.pmedr.2023.102247

31.

Meyer

Slone

S. E.

Ogungbe

Duroseau

Farley

J. E.

(2023). Impact of the COVID-19 pandemic on HIV healthcare service engagement, treatment adherence, and viral suppression in the United States: A systematic literature review. AIDS and Behavior, 27(1), 344–357. https://doi.org/10.1007/s10461-022-03771-w

32.

O'Rand

A. M.

(1996). The precious and the precocious: Understanding cumulative disadvantage and cumulative advantage over the life course. The Gerontologist, 36(2), 230–238. https://doi.org/10.1093/geront/36.2.230

33.

Oser

C. B.

Pullen

Stevens-Watkins

Perry

B. L.

Havens

J. R.

Staton-Tindall

Leukefeld

C. G.

(2017). African American women and sexually transmitted infections: The contextual influence of unbalanced sex ratios and individual risk behaviors. Journal of Drug Issues, 47(4), 543–561. https://doi.org/10.1177/0022042616678610

34.

Patel

S. Y.

Mehrotra

Huskamp

H. A.

Uscher-Pines

Ganguli

Barnett

M. L.

(2021). Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US. JAMA Internal Medicine, 181(3), 388–391. https://doi.org/10.1001/jamainternmed.2020.5928

35.

Reif

S. S.

Whetten

Wilson

E. R.

McAllaster

Pence

B. W.

Legrand

Gong

(2014). HIV/AIDS in the southern USA: A disproportionate epidemic. AIDS Care, 26(3), 351–359. https://doi.org/10.1080/09540121.2013.824535

36.

Rhodes

Simic

(2005). Transition and the HIV risk environment. British Medical Journal, 331(7510), 220–223. https://doi.org/10.1136/bmj.331.7510.220

37.

Roberson

Shorter

Woods

Priest

(2018). How health behaviors link romantic relationship dysfunction and physical health across 20 years for middle-aged and older adults. Social Science & Medicine, 201, 18–26. https://doi.org/10.1016/j.socscimed.2018.01.037

38.

Rooney

A. S.

Moore

R. C.

Paolillo

E. W.

Gouaux

Umlauf

Letendre

S. L.

Jeste

D. V.

Moore

D. J.

HIV Neurobehavioral Research Program . (2019). Depression and aging with HIV: Associations with health-related quality of life and positive psychological factors. Journal of Affective Disorders, 251, 1–7. https://doi.org/10.1016/j.jad.2019.03.025

39.

Roy

C. M.

Bollman

E. B.

Carson

L. M.

Northrop

A. J.

Jackson

E. F.

Moresky

R. T.

(2021). Assessing the indirect effects of COVID-19 on healthcare delivery, utilization, and health outcomes: A scoping review. The European Journal of Public Health, 31(3), 634–640. https://doi.org/10.1093/eurpub/ckab047

40.

Sabharwal

Wilson

Reilly

Gupte

C. M.

(2015). Heterogeneity of the definition of elderly age in current orthopaedic research. SpringerPlus, 4(1), 516. https://doi.org/10.1186/s40064-015-1307-x

41.

SAS version 9.4 (TS1M1 SAS Institute Inc., Cary, NC, USA).

42.

Stevens-Watkins

Knighton

Mitchell

Oser

Leukefeld

(2013). Perception of eligible Black men as a context for HIV risk behavior among Black women. Journal of Community Psychology, 41(6), 776–782. https://doi.org/10.1002/jcop.21571

43.

U.S. Census Bureau . (nd). Census regions and division of the United States. https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf

44.

U.S. Department of Health and Human Services . (2023). Impact on racial and ethnic minorities. https://www.hiv.gov/hiv-basics/overview/data-and-trends/impact-on-racial-and-ethnic-minorities/

45.

Wigfall

L. T.

Williams

E. M.

Sebastian

Glover

S. H.

(2010). HIV testing among deep South residents 50 to 64 Years old with cardiovascular disease and/or diabetes. Journal of the National Medical Association, 102(12), 1150–1157. https://doi.org/10.1016/S0027-9684(15)30769-0

46.

Zhang

(2014). Too much covariates in a multivariable model may cause the problem of overfitting. Journal of Thoracic Disease, 6(9), 196–197. https://doi.org/10.3978/j.issn.2072-1439.2014.08.33