Individuals aged ≥ 50 years continue to be disproportionately affected by late HIV diagnosis, which is associated with poorer health outcomes and onward transmission. Despite HIV testing guidelines and high acceptability of HIV testing among all patients, clinicians are less likely to offer a test to an older individual. The aim of this study was to identify clinician-related factors associated with offering HIV testing to patients aged ≥ 50 years.
Methods
Twenty clinicians who had been involved in the care of an older patient diagnosed late with HIV were interviewed.
Results
Thematic analysis identified seven factors associated with offering HIV testing to older people: knowledge, stigma, stereotyping and perception of risk, symptom attribution, discussing HIV with patients, consent procedures and practical issues.
Conclusions
Although some factors are not unique to older patients, some are unique to this group. Many clinicians lack up-to-date HIV-related knowledge, feel anxious discussing HIV with older patients and perceive asexuality in older age. In order to increase the offer of HIV testing to this group, we identified clinician-related barriers to test offer that need to be addressed.
Public Health England. PHE. In: Trends in HIV testing, new diagnoses and people receiving HIV-related care in the United Kingdom: date to the end of December; 2019, London2020.
2.
KirwanPChauCBrownA, et al.HIV in the UK - 2016 report. In: Public Health England, London2016., editor.
3.
CroxfordSKitchingADesaiS, et al.Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. Lancet Public Health2017; 2(1): e35–e46.
4.
SmithRDDelpechVCBrownAE, et al.HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS2010; 24(13): 2109–2115.
5.
KrentzHBGillJ. Despite CD4 cell count rebound the higher initial costs of medical care for HIV-infected patients persist 5 years after presentation with CD4 cell counts less than 350 μl. AIDS2010; 24(17): 2750–2753.
6.
ChauCKirwanPBrownA, et al.HIV diagnoses, late diagnoses and numbers accessing treatment and care. In: Public Health England; 2016.
7.
BrownAKirwanPChauC, et al.Towards elimination of HIV transmission, AIDS and HIV-related deaths in the UK – 2017 report. In: Public Health England, London2017.
8.
British HIV Association. British Association for Sexual Health and HIV, British Infection Society. London: UK National guidelines for HIV testingBHIVA, 2008.
9.
National Institute for Health and Care Excellence. NICE. In: HIV testing: increasing uptake among people who may have undiagnosed HIV (Joint NICE and Public Health England guideline), London2016.
10.
Health Protection Agency. Time to Test for HIV: Expanding HIV Testing in Healthcare and Community Services in England. London: Health Protection Agency, 2011.
11.
GottMHinchliffSGalenaE. General practitioner attitudes to discussing sexual health issues with older people. Soc Sci Med2004; 58(11): 2093–2103.
12.
YoussefECooperVDelpechV, et al.Barriers and facilitators to HIV testing in people age 50 and above: a systematic review. Clin Med (Lond)2017; 17(6): 508–520.
13.
YoussefEWrightJDelpechV, et al.Factors associated with testing for HIV in people aged ≥50 years: a qualitative study. BMC Public Health2018; 18(1): 1204.
14.
BraunVClarkeV. Using thematic analysis in psychology. Qual Res Psychol2006; 3(2): 77–101.
15.
BurkeRCSepkowitzKABernsteinKT, et al.Why don't physicians test for HIV? A review of the US literature. AIDS2007; 21(12): 1617–1624.
16.
DaviesCGompelsMMayM. Public and healthcare practitioner attitudes towards HIV testing: review of evidence from the United Kingdom (UK). Isrr2015; 3(3): 91–122.
17.
SimmonsEMMBrownMJSlyK, et al.Barriers and facilitators to HIV testing in primary care among health care providers. J Natl Med Assoc2011; 103(5): 432–438.
18.
HunterEPerryMLeenC, et al.HIV testing: getting the message across--a survey of knowledge, attitudes and practice among non-HIV specialist physicians. Postgrad Med J2012; 88(1036): 59–65.
19.
BairdBCharlesAHoneymanM, et al.Understanding Pressures in General Practice. London: The Kings Fund, 2016.
20.
YoussefEWrightJDelpechV, et al.Factors associated with testing for HIV in people aged ≥50 years: a qualitative study. BMC Public Health. (under review)2018; 18(1204).
21.
ElmahdiRGerverSMGomez GuillenG, et al.Low levels of HIV test coverage in clinical settings in the U.K.: a systematic review of adherence to 2008 guidelines. Sex Transm Infect2014; 90(2): 119–124.
22.
WhiteBLWalshJRayasamS, et al.What makes me screen for HIV? Perceived barriers and facilitators to conducting recommended routine HIV testing among primary care physicians in the southeastern United States. J Int Assoc Provid AIDS Care2015; 14(2): 127–135.
23.
IyerKArumugamVCastorT, et al.Physicians’ screening for HIV risk factors in older adults. J Am Geriatr Soc2011; 59(S200).
24.
BarnettL. Factors contributing to the increase in HIV/AIDS and late diagnoses of the virus among older adults. Walden University ScholarWorks, 2012.
25.
Bodley-TickellATOlowokureBBhaduriS, et al.Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system. Sex Transm Infect2008; 84(4): 312–317.
26.
LindauSTSchummLPLaumannEO, et al.A study of sexuality and health among older adults in the United States. N Engl J Med2007; 357: 762–774.
27.
NayRMcAuliffeLBauerM. Sexuality: from stigma, stereotypes and secrecy to coming out, communication and choice. Int J Old People Nurs2007; 2(1): 76–80.
28.
de VisserROBadcockPBRisselC, et al.Safer sex and condom use: findings from the second Australian study of health and relationships. Sex Health2014; 11(5): 495–504.
29.
ReeceMHerbenickDSchickV, et al.Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. J Sex Med2010; 7(Suppl 5): 266–276.
30.
BauerMMcAuliffeLNayR. Sexuality, health care and the older person: an overview of the literature. Int J Old People Nurs2007; 2(1): 63–68.
31.
de VisserROBadcockPBSimpsonJM, et al.Attitudes toward sex and relationships: the second Australian study of health and relationships. Sex Health2014; 11(5): 397–405.
