Older Women Don't Want HIV Tests

PITTSBURGH, Aug. 9 -- Most women age 50 or older were not interested in HIV testing when it was offered, even if they had risk factors for infection, researchers here found.
Only 22% of older women in an area with high HIV prevalence were interested in testing although more than half had risk factors for exposure, reported Aletha Akers, M.D., M.P.H., of the University of Pittsburgh, and colleagues, in the July/August issue of the Journal of Women's Health.
The CDC revised its guidelines in September 2006 to recommend routine HIV testing for all adults ages 13 to 64 seen in healthcare settings unless the patient declines and at least annual screening for those at high risk.
But, the findings suggest "it may not be right to simply exclude women over age 64 in high risk communities," Dr. Akers said. "Providers shouldn't just take the CDC recommendations by the letter."
Older adults, particularly older women, have been largely ignored by HIV prevention campaigns, the researchers noted, which "is a concern, given that this is one of the fastest growing segments of the U.S. population as baby boomers age."
To help nail down the size of the problem, the researchers analyzed data from a cross-sectional study conducted in the general internal medicine clinic of a large inner-city hospital in Atlanta. The city had a 1.9% cumulative AIDS prevalence during the study period from June 2001 to July 2002.
A total of 514 women ages 50 or older completed the 68-item questionnaire in a face-to-face interview. They ranged in age up to 95, but 64% were younger than 64. Most participants were African-American (73%), not sexually active (73%), and had low HIV knowledge (65%).
Although 74% perceived themselves at low HIV risk, all would have been considered high risk using the CDC's definition at the time of the study because of the prevalence of HIV in the area where they lived.
Furthermore, 55% had moderate-risk or high-risk factors for exposure over their lifetime. For moderate-risk women, the most common factors were having two to five sexual partners since 1978 (82%).
For high-risk women, the most common factors were sex with an intravenous drug user (39%), a blood transfusion between 1979 and 1985 (34%), and prostitution (24%).
However, just 22% of the women expressed interest in HIV testing when it was offered during the interview.
Notably, women who were not interested in HIV testing were more likely to have moderate-risk or high-risk factors for lifetime exposure to HIV than women who were interested in testing (63% versus 37%, P<0.001).
In multivariate analysis, women who had no interest in HIV screening but had never been tested were more likely to be older (P=0.038), be African-American (P=0.023), and perceive themselves at low risk (P=0.020).
Likewise, the third of all women who were uninterested despite having moderate- or high-risk factors were more likely to be older (P=0.006) and African-American (P=0.004).
The most commonly cited reasons for disinterest in HIV testing were:
29% believed that testing was unnecessary.
17% did not perceive herself at risk, such as "I don't mess around."
17% had been tested before.
Those who were interested were more likely to be at moderate or high risk than at low risk (14% versus 27%, P<0.001). The most common reasons given for interest were:
39% curiosity, such as "Just to make sure I'm O.K."
23% safety, such as "Because you never know what someone has left behind."
10% concerns about a partner's behaviors, such as "Why not, my husband has them [sexually transmitted infections] all the time."
"The findings in this study underscore the fact that older women's motivation for obtaining HIV testing is influenced by their knowledge about HIV, perceived risk of contracting the virus, and actual risk status," Dr. Askers and colleagues said.
This should come as no surprise because similar factors influence younger adults, they noted.
But, "unlike younger women, older women have been largely ignored by HIV education, prevention, and testing programs," they wrote.
"As a consequence, they appear to be less capable of accurately assessing their lifetime risk … even when they have significant risk factors and reside in communities with high rates of HIV infection," they added.
Physicians and public health providers need to recognize the danger of this situation, the investigators said.
"This requires that health providers perform HIV risk assessments and recommend HIV testing for at-risk older women, especially those residing in high-risk communities," they concluded.
The study was supported by the Emory Medical Care Foundation. Dr. Akers received funding from the Robert Wood Johnson Clinical Foundation during the study but reported no conflicts of interest. Primary source: Journal of Women's HealthSource reference: Akers A, et al "Factors Associated with Lack of Interest in HIV Testing in Older At-Risk Women" J Womens Health 2007;16:842-858.