What do we know about older adults and HIV? a review of social and behavioral literature

Abstract

The fastest growing segment of the United States HIV population is people aged 50 and older. This heterogeneous group includes people with diverse pathways into HIV positive status in later life, including aging with the disease as well as later life-acquired infections. As people with HIV live into older ages, solving problems of successful secondary prevention and ongoing treatment requires more specific knowledge of the particular aging-related contextual sociocultural, psychosocial, and personal factors salient to the situations of persons living with HIV. Greater knowledge of these factors will help solve challenges to reducing psychological burden and promoting health maintenance for people with HIV. Yet, the current literature on aging and HIV remains nascent. To assess the state of knowledge of the sociocultural and behavioral factors associated with aging with HIV, we conducted a systematic critical content review of peer-reviewed social and behavioral research on aging and HIV to answer the question, “How have older age, and social, cultural, and behavioral aspects of the intersection of HIV and age been addressed in the literature?” We searched First Search, Proquest, Psych Info, Pub Med, Wilson Select Plus, and World Cat and identified 1549 articles. We then reviewed these to select peer-reviewed articles reporting results of research on the social and behavioral aspects of living with HIV at age 50 and older. Fifty-eight publications were identified that met study inclusion criteria. While few publications reported clear age-related differences, there were significant ethnic differences in living with HIV in later life and also differences among older people when groups were defined by mode of transmission. Findings are discussed in light of constructs from gerontology which may contribute to clarifying how later life, life course stage, and psychological development intersect with, influence, and are influenced by HIV disease and long-term anti-retroviral therapy use.

Keywords:

• HIV/AIDS
• age
• risk
• ethnicity
• adherence
• gerontology

Notes

1. The term “older adult” refers to people aged 50 or older; “younger adult” refers to people younger than 50.

2. Research to untangle the interaction between biological aging, disease process, and long-term ART use was reviewed by Luther and Wilkin (2007) and Hardy and Vance (2009). Here, we review the social and behavioral research that addressed that question.

3. Gerontologists do not consider 50 years of age to be a marker of social and behavioral conditions associated with older age. Its use in HIV-related social and behavioral research may limit the validity of the findings in understanding issues associated with aging and HIV (Crystal et al., 2003; Mack & Bland, 1999).

4. The study by Vance and Woodley (2005) which used 50 years of age as the outside marker of the sample (38–50 years) was excluded because it did not include older adults.

5. In the “other” category, 72% of younger adults acquired HIV heterosexually compared to 44% of older people while 20% of older adults acquired HIV from transfusions compared to 10% of younger adults.