Even older women at high risk have little interest in being tested for HIV, study finds

PITTSBURGH, Aug. 7 – Few older women were interested in being tested for the virus that causes AIDS despite having significant risk factors for lifetime exposure, according to a study published in the July/August edition of the Journal of Women’s Health. The risk is especially great among African-American women, who represent 73 percent of new HIV cases in women over age 50.

“Older people largely have been overlooked in HIV prevention and testing programs, and consistently have lower HIV testing rates as compared with younger adults,” said Aletha Akers, M.D., M.P.H., assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and the study’s lead author.

“Those who are tested tend to do so late in their disease, when they are more likely to have overt symptoms such as opportunistic infections. Often, they progress more rapidly to AIDS and die within a year of HIV diagnosis, which leaves little opportunity for treatment or secondary prevention for their partners.”

For this investigation, Dr. Akers and her colleagues analyzed data collected from 514 women ranging in age from 50 to 95. The women visited a general internal medicine clinic at a large, inner-city hospital in Atlanta over a period of 11 months in 2001 and 2002.

To evaluate attitudes concerning lifetime HIV infection risk and interest in HIV testing, trained research assistants administered a 68-item questionnaire in a private room over the course of a single, face-to-face interview with study participants, most of whom said they were not currently sexually active.

More than 60 percent of the participants had never been tested for HIV, although more than half of them could be described as moderate- to high-risk for lifetime exposure to the virus based on sexual history and other factors. Only 115, or 22 percent of participants, said they would be interested in HIV testing.

Their most often cited reasons were curiosity and concern about a current or past sexual partner’s behaviors. About a third of women had already been tested. Previously tested women were more likely to be younger, sexually active, better educated about HIV and tested at the suggestion of a health care provider.

Most women, however, felt little need for testing. “Those who lacked interest were more likely to be older, African-American and not sexually active,” said Dr. Akers, who also is an assistant investigator at the university-affiliated Magee-Womens Research Institute.

“These women had a low perceived risk, which was not always accurate based on their histories. A third of all the women who were not interested in HIV testing reported lifetime risk factors for the disease, but we found that they tended to point to ‘those people’ when talking about the danger of HIV rather than at themselves or their partners.”

In short, women with little HIV knowledge and low perceived personal risk were less interested in HIV testing, a finding that is consistent with attitudes in much younger, high-risk adults, the study found. Fewer than 25 percent of the participants could recall ever receiving counsel to get a test for HIV from a provider, despite their risk factors.

“Yet, in part because of a lack of education and prevention efforts targeted at older populations, older women appear to be less capable of accurately assessing their lifetime risk of HIV even when they have significant risk factors and live in communities with high rates of infection,” Dr. Akers said. “We need to design prevention strategies and AIDS education for this vulnerable population and help providers to incorporate HIV risk screening into the services offered to older women from high-prevalence communities.”

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In addition to Dr. Akers, other authors are Lisa Bernstein, M.D., Susan Henderson, M.D., and Joyce Doyle, M.D., all of the Emory University School of Medicine, Atlanta; and Giselle Corbie-Smith, M.D., M.Sc., of the University of North Carolina, Chapel Hill.

The study was funded by the Emory Medical Care Foundation and the Robert Wood Johnson Clinical Foundation.