Predictors of HIV Testing Uptake Among Older Adults in the United States

Background and Purpose: In the United States, more than 1.2 million people are HIV-infected and one in eight (12.8%) people with HIV infection are unaware of their infection. Late detection of HIV in older adults accelerates aging and complicates clinical management of other medical comorbidities.  It is well documented that HIV testing rates are low among older adults, but there is scant literature on predictors of HIV testing uptake among older adults. The purpose of this study was to analyze factors associated with uptake of HIV testing among older adults in the United States.

Method: This study conducted a secondary analysis using data from the 2013-2014 National Health and Nutrition Examination Survey. A total of 1,056 older adults (55+ years old) were included in the analysis. The study used the Systems Model of Clinical Preventive Care Model, the underpinning theoretical framework, to identify predictors of HIV testing (e.g. predisposing factors, enabling factors, situational factors, and reinforcing factors). Binomial logistic regression was employed to analyze predictors of HIV testing uptake among older adults.

Results: Uptake of HIV testing among older adults was negatively associated with age (OR = .92, p < .05), income-to-poverty ratio (OR=.82, p < .05), and Asian ethnicity (OR=.41, p < .05). However, HIV testing was positively associated with male gender (OR=1.47, p < .05), education level (OR = 1.48, p < .05), public insurance (OR = 1.64, p < .05), same sex encounters (OR = 3.82, p < .05), African American ethnicity (OR = 1.99, p < .05), and Hispanic ethnicity (OR = 1.88, p < .05).

Discussion and Implication: Findings suggest that Asian, economically disadvantaged, female older adults are less likely to uptake HIV testing. Targeted HIV testing education efforts for this population are warranted. Additionally, having public insurance was identified as a predictor of HIV testing uptake in the present study. Therefore, facilitating economically disadvantaged older adults’ eligibility for public insurance (e.g., Medicaid) will likely improve access to HIV testing services and increase HIV testing rates among U.S. older adults. All in all, suboptimal HIV testing among Asian, economically disadvantaged, and female older adults cannot be ignored.