Awareness and Acceptability of Supportive Community-Based Services for Middle-Aged and Older Gay Men Living with HIV in Taiwan

Background and Purpose:

Supportive Community-based Services (SCS) refer to assistance coming from non-medical providers that are frequently provided through governmental agencies or community-based organizations (Cox & Brennan-Ing, 2017). By 2036, there will be over 50% of adults living with HIV that are aged 50 and older in Taiwan. This population, including gay men, faces high levels of comorbidities portending greater caregiving needs as they grow older. Moreover, negative life experiences of trauma and HIV-related stigma have conditioned this population, who require supportive services, to be mistrustful of mainstream institutions. However, little is known about awareness and acceptability of SCS or possible facilitators and barriers to using such services among gay men living with HIV. To understand unmet needs, we quantify awareness and acceptability of SCS for middle-aged and older gay men living with HIV, and examine factors that associated with their awareness and acceptability.

Methods:

From June 2022 to January 2023, a cross-sectional online survey was implemented among a convenience sample of gay men living with HIV recruited from two AIDS Service Organizations in Taiwan. Informed consent was obtained prior to the survey. Items included socio-demographic characteristics, previous hospital experiences, social support from helping professionals (last year), current significant others, anticipated care givers in older life, anticipated disclosure for HIV status and sexuality, HIV-related stigma, and awareness and acceptability of SCS. Multivariable logistic regression was conducted with awareness and acceptability of SCS as dependent variables, controlling for socio-demographic characteristics.

Results:

In total, 233 participants completed the survey. Participants’ mean age was 45.7 years. Majority of them aged betwen 40–49 (79.4%), had a college degree or higher (82.4%), lived in the Greater Taipei Area (66.1%), had a monthly income higher than $939 USD (74.2%). Among participants, only one quarter (24.5%) of them were aware of SCS for older individuals. The majority (90.6%) of them would not accept SCS if they were qualified to apply for the services in the future. In multivariable logistic regression, receiving support from helping professionals last year (AOR=2.94, 95% CI=1.22–7.06) and poor self-assessed mental health status (AOR=1.99, 95% CI=1.07–3.70) were associated with higher odds of SCS awareness. Participants who had ever been discriminated against their HIV status in healthcare settings (AOR=10.54, 95% CI=2.81–39.51) and received support from helping professionals last year (AOR=5.03, 95% CI=1.64–15.4) were associated with higher odds of SCS acceptability.

Conclusions and Implications:

In Taiwan, many middle-aged and older gay men living with HIV lack sufficient information pertaining to SCS. Our findings suggest the need for tailored educational and social marketing efforts to prepare for the introduction of SCS for this population to increase their awareness. The associations of discriminatory experience towards HIV status in healthcare settings with acceptability may reflect the fact that mainstream health services are mistrustful among middle-aged and older gay men living with HIV. For social work practice implications, sensitizing practitioners who provide services to this population with competent of SCS may be the initial step to promote awareness and acceptability.