Health Service Use Among Older Gay Men Living with HIV: A Qualitative Exploration

Aging gay men living with HIV consist of a diverse and growing group of individuals often overlooked in contemporary lesbian, gay, bisexual and transgender (LGBT) and HIV research. While exact census estimates do not currently exist, it is estimated that over 2.5 million older LGBT adults are currently living in the United States 9% of whom are living with HIV. Influenced by a unique social history including the medicalization of homosexuality, as well as the AIDS crisis which fundamentally altered societal views towards this population for decades, aging gay men living with HIV have developed a health profile distinct from both their heterosexual and younger gay counterparts. Research suggests, this population experiences higher rates of chronic illness, substance use and behavioral health concerns including increased rates of cardiovascular disorders, certain cancers, as well as substance use, depression and suicidal ideation.

Of particular concern are the unique health service use behaviors among aging gay men living with HIV; which are found to be associated with negative health outcomes. Previous research suggests this population uses health services less often than heterosexual men living with HIV, as well as younger gay men_.

Using Anderson’s Health Behavioral Model of Health Service Use, this study explores factors facilitating health service use among aging gay men living with HIV. Qualitative data from ten participants recruited from one Federally-Qualified Health Center were analyzed using theoretical thematic analysis.

Data collection occurred during Spring 2018. Participants were recruited using purposive sampling where potential participants were recruited based on their experience using health services. Flyers were posted throughout the FQHC where interested participants were encouraged to contact the primary researcher. The interview consisted of a semi-structured format which included close-ended demographic questions and open-ended questions.

Analysis was conducted using NVivo 12. Data was analyzed using theoretical thematic analysis where specific theoretical perspective guide the development of themes. Anderson’s healthcare utilization model was used to guide the analysis. The analysis used an essentialist approach reporting the experiences of participants based on the meaning or reality placed on events or concepts as defined by the participant.

Results were separated into three categories relating to Anderson’s Health Behavioral Model of Health Service Use (need, predisposing and enabling factors). Need factors included: subjective and objective need for services. Predisposing factors included: sexual minority identity, HIV diagnosis and age. Enabling factors included: quality of services, comfort with medical providers, medical provider knowledge and sexual concordant providers.

Results of this study provide both theoretical and practical implications for working with aging gay men living with HIV including findings which support the use of Anderson’s Health Behavioral Model of Health service use for this population as a means of synthesizing facilitators for health service use to improve services and practice considerations such as creating and maintaining supportive relationships and encouraging the development of coping skills used to reduce the impact of barriers to health service use.