Research That Matters (January 17 - 20, 2008)

Purpose: There was a 41% increase in the number of older and middle aged Latinas infected with HIV/AIDS between 1998 and 2002. However, prevention efforts have not kept pace. Voluntary Counseling and Testing (VCT) has long been the cornerstone of HIV prevention initiatives (Valdiserri et al, 1997). Although previous research has been conducted on the correlates of VCT for Latino migrant farm workers (Fernandez et al., 2005) and older adults of all races (Ebrahim, 2004), such inquiry has not been focused on older and middle aged Latinas. The aim of this study is twofold: 1) To create a profile of personal and health related characteristics and their relationship to VCT and 2) To test whether the predisposing, enabling and need components of the Anderson Behavioral Model (ABM) correlate with seeking VCT.

Methods: Data for the sample consisted of 135 older and middle aged (>45) Latinas. Primary measures for this secondary analysis included health service, sexual risk and a multi-dimensional acculturation scale. Logistic regression using structural equation modeling (SEM) techniques were used to test multivariate relationships of variables, resulting in a model of VCT. SPSS, AMOS and MPlus software assisted in analysis to obtain the best fitting model.

Results: A surprising majority (60.7%) of older and middle aged Latinas had been tested for HIV/AIDS. Participant ages ranged from 45 to 88 with the vast majority born outside the United States (86.7%). Most (64.5%) reported low annual incomes of less than $15,000. Of those that had received VCT, most had been tested at a community clinic (65.5%). The best fitting model resulting from the SEM analysis had values of x2 (14, p = > .725) = 10.497; CFI = 1.00; GFI =.986; RMSEA = .000 with a p-value of close-fit of .904. Within the ABM framework, domains of need were found to be more influential on VCT than predisposing or enabling factors. The strongest predictors of VCT included provider endorsement with an odds ratio of 6.375(p < .001); age with an odds ratio of .927 (p < .001); and community clinic for regular health care with an odds ratio of 3.884 (p < .05). Although present, sexual risk factors were not found to significantly predict VCT. Linguistic acculturation was found to be predictive of VCT with an odds ratio of 1.256 (p<.05). Although measures of discrimination did not produce a significant path to VCT, the inclusion of this variable contributed to good fit statistics.

Conclusions and Implications: Older and middle aged Latinas have seldom been the target of outreach for screening and testing for HIV. The findings from this study indicate that efforts by providers and community clinics to Spanish speaking woman may be particularly important. Such efforts could include VCT as part of routine medical care as recently recommended by the Centers for Disease Control (CDC, 2006). The presence of risk factors despite lack of provider or cultural awareness highlights the importance of finding culturally appropriate ways to encourage older and middle aged Latinas to seek VCT.