Understanding late diagnosis of HIV in people aged 50 and above

Abstract

Background: Despite a decrease in the number of new HIV diagnoses in the UK generally, the number and proportion of new diagnoses among individuals aged ≥50 years have continued to increase. This group are disproportionately affected by late diagnosis, and poorer health outcomes.

Primary aim: To better understand the reasons for late diagnosis of HIV in people aged ≥50 years.

Methods: Four studies were undertaken: a secondary data analysis of national surveillance data; a systematic review of literature; a qualitative study with patients diagnosed late with HIV aged ≥50 years; and a qualitative study with clinicians who had been involved in the care of a patient participant in the three years prior to their HIV diagnosis.

Results: Late diagnosis, and increased morbidity and short-term mortality are associated with an HIV diagnosis in older age. Individuals diagnosed in older age are more ethnically diverse, and the majority likely acquired HIV in the UK regardless of region of birth. Seven patient-related themes were identified as associated with undergoing testing for HIV in older age: experience of early HIV/AIDS campaigns; knowledge prior to HIV diagnosis; presence of symptoms and symptom attribution; risk and risk perception; generational approach to health and sexual health; stigma; type of testing and testing venue. Seven clinician-related themes associated with offering HIV tests to an older patient were identified: knowledge; stigma; stereotyping and perception of risk; symptom attribution; discussing HIV with patients; consent procedures; practical issues.

Conclusion: There are several unique factors associated with undergoing HIV testing in older age including: a double burden of stigma associated with a diagnosis in older age; lower risk perception often as a result of perceived asexuality in older age; outdated HIV-related knowledge; and misattribution of symptoms, often to something age-related. Successful interventions will have to address both patient- and clinician-related factors.

Date of Award	2019
Original language	English
Awarding Institution	University of Brighton
Supervisor	Juliet Wright (Supervisor), Kevin A. Davies (Supervisor), Richard De-Visser (Supervisor) & Valerie Delpech (Supervisor)