HIV disproportionately affects older African Americans: they face higher rates of infection and mortality than older adults of other racial groups, and they are less likely to receive care.
While various studies have examined the reasons for these disparities, no literature review has consolidated their results. Researchers from the University of Maryland School of Public Health and the College of Behavioral and Social Sciences did just that, building a corpus of relevant studies and analyzing their findings to glean insights into best practices for treating older African Americans and ultimately reducing race- and age-related HIV disparities.
The research was led by Dr. Thurka Sangaramoorthy, associate professor of anthropology at the University of Maryland, in collaboration with School of Public Health researchers Ms. Amelia Jamison from the Center for Health Equity and Dr. Typhanye Dyer from the department of epidemiology and biostatistics.
To conduct their review, the authors used research databases to gather peer-reviewed studies conducted between January 2003 and April 2018 that assessed HIV care among older African Americans.
After combing through 1023 relevant titles, the researchers concentrated on 13 relevant, peer-reviewed studies that focused on participation in HIV care and treatment. All together, the studies’ findings help the public health community understand what helps and hinders older African Americans in their diagnosis and treatment of HIV.
One study focused on HIV testing and diagnosis among a sample of older, majority-black women, finding that most had little or no interest in getting tested, despite their increased risk for infection. Many knew little about the disease or their risk, and few reported their healthcare providers had recommended them for testing.
Seven studies looked at factors influencing older African Americans’ engagement in HIV treatment. The studies found that these individuals are grappling with multiple stigmas — related not just to HIV and race, but also to gender, sexuality, substance use and incarceration — that stymied their ability to acquire care. A lack of funds or transportation, a rigid work schedule and comorbidities also made it difficult to keep up with care. But if the individuals studied had a supportive social network and received their HIV care in a clinic-based setting, they were more likely to retain treatment.
The final five studies examined adherence to antiretroviral treatment, which works to suppress the virus and keep those living with HIV healthy. They found that older African Americans largely adhered to their treatment, and they were more likely to do so if they had greater health literacy, a simple medication regimen, a sense of self-efficacy and a higher income. Substance abuse, comorbidities, low income and lack of insurance hindered their participation.
The review clarifies how the public health community can help older African Americans get the HIV care they need.
“Such work can help better inform interventions and services to improve health outcomes for this population and contribute to the national goal of reducing HIV-related health disparities,” Dr. Sangaramoorthy said.
[Photo: Dr. Thurka Sangaramoorthy]
The study,”Older African Americans and the HIV Care Continuum: A Systematic Review of the Literature, 2003-2018,” was published in AIDS and Behavior.