Lower Prevalence of HIV Testing Among Sexually Active Older Adults

Emeka Oraka, MPH, a senior health research analyst at ICF International

Emeka Oraka, MPH

According to the Centers for Disease Control and Prevention (CDC), older adults are increasingly affected by HIV infections, as they constitute 17% of new diagnoses, 45% of adult persons living with HIV (PLWH) in the US, and 39% of HIV-related deaths in the US.

Although the prevalence of HIV infection among old adults is increasing worldwide, a recent study in the US suggests that only about a quarter of older adults have been tested for HIV. As a result of less aggressive testing in this patient population, older adults tend to be diagnosed with HIV at a later stage in the disease.

Emeka Oraka, MPH, a senior health research analyst at ICF International in Atlanta, GA, recently led an investigation into the prevalence of HIV testing among older adults and the characteristics of patients being tested. For this study, Oraka and colleagues utilized the General Social Survey (GSS), a biennial survey conducted among the civilian, noninstitutionalized population in the US that collects data on demographics, sexual behaviors and HIV-related behaviors.

Study authors pooled data from the survey from 2008 to 2014 on patients age 65 and older who reported having sex with at least 1 person during the 12 month period prior to their interview. Demographic and health-related data were collected for the following: age, gender, race/ethnicity, education, marital status, annual family income, self-reported sexual identity, condom use at last sexual encounter and high-risk HIV-related behaviors during the previous year. High-risk HIV-related behaviors, which have been defined by the CDC, included the following: 3 or more opposite sex sexual partners, injectable drug use, use of crack/cocaine, sex exchanged for drugs or money and any man having sex with a man.

The sample population of 757 patients was nearly equally distributed among men (53.7%) and women (46.3%) and the 2 predefined age groups, 65 to 70 years (51.3%) and 71 years and older (48.8%). The vast majority of sexually active older adults were white (85.0%), married (84.6%), heterosexual (98.2%), and had an annual household income more than $35,000 (74.3%).

Most patients reported not using a condom during the previous sexual encounter (92.4%), and a much smaller percentage reported at least 1 high-risk HIV-related behavior (15.9%), with the most common being an exchange of sex for drugs or money. Despite these behaviors, 83.7% of respondents had never been tested for HIV, 11% had been tested more than 12 months prior to their interview, and only 2.4% had been tested during the previous 12 months.

After controlling for significant study variables, sexually active older adults age 65 to 70 who were not married and at an increased risk of HIV infection (based on high-risk HIV-related behaviors) were more likely to have tested for HIV.

“The findings from this study are unique in that they are the first to present nationally representative estimates of HIV testing prevalence and factors associated with HIV testing among sexually active older adults,” Oraka and colleagues wrote.

Limitations of this study included the relatively small sample of patients identifying as gay or bisexual and the fact that data was self-reported, which could potentially lead to bias.

Overall, study authors concluded that adults older than 64 should be included in HIV testing initiatives. Researchers should refrain from making assumptions about sexual activity among this patient population, as this will only put these patients at a disadvantage in the realm of HIV treatment and prevention.

This study, “Too old to test? Prevalence and correlates of HIV testing among the sexually active older adults,” was published last month in the Journal of Gerontological Social Work.