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Unmet needs for HIV ancillary services among
persons with diagnosed HIV aged 55 years and older
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JAIDS Dec 22 2023
Byrd, Kathy K. MD, MPH1,a; Buchacz, Kate PhD1; Crim, Stacy M. MPH1; Beer, Linda PhD1; Lu, Jen-Feng MPH2; Dasgupta, Sharoda PhD1
1Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
2DLH Corporation, Atlanta, GA
Overall, 37.7% of cisgender men and women with HIV aged ≥55 years had ≥1 unmet need for ancillary services.
Overall, 16.6% had ≥1 unmet need for HIV support services, 26.9% for non-HIV medical services, and 26.7% for subsistence services.
The most common unmet needs were for HIV peer group support (29.8%), dental care (23.9%), and shelter or housing services (21.9%). As PWH age, they might experience age-related stigma (i.e., ageism) which, like other forms of stigma, is associated with increased social isolation and loneliness. Consequently, older PWH might experience an intersection of stigma due to both their HIV status and age which could lead to challenges accessing social support and could compound health effects.
Also concerning is the high unmet need for patient navigation services. As PWH age, frequency of co-morbidities and medication side effects and interactions increase, making medical care more complicated. 5, 6, 27 Age-related changes, including HIV-associated neurocognitive disorders can affect an older person’s ability to think or remember, which might negatively affect their ability to navigate the healthcare system at a time when their medical needs have become more complex. 42
Due to the compounded burden of HIV, co-morbidities, and geriatric conditions, comprehensive HIV care programs will become increasingly important for older PWH because of their potential to address both medical and ancillary service needs through in-house and wrap around services.
Abstract
Background:
Approximately two in five persons with HIV (PWH) in the United States are aged ≥55 years. HIV ancillary services, such as case management and transportation services, can help older PWH remain engaged in care. We used data from the Medical Monitoring Project (MMP) to describe the prevalence of unmet needs for ancillary services among persons with diagnosed HIV aged ≥55 years.
Setting:
Medical Monitoring Project is an annual cross-sectional study that reports representative estimates on adults with diagnosed HIV in the United States.
Methods:
We used MMP data collected during 6/2019-5/2021 to calculate weighted percentages of cisgender men and cisgender women with HIV aged ≥55 years with unmet needs for ancillary services, overall and by selected characteristics (N=3,200). Unmet need was defined as needing but not receiving a given ancillary service. We assessed differences between groups using prevalence ratios (PRs) and 95% confidence intervals (CIs) with predicted marginal means.
Results:
Overall, 37.7% of cisgender men and women with HIV aged ≥55 years had ≥1 unmet need for ancillary services.
Overall, 16.6% had ≥1 unmet need for HIV support services, 26.9% for non-HIV medical services, and 26.7% for subsistence services.
There were no statistically significant differences in unmet needs for services by gender.
The prevalence of ≥1 unmet need was higher among non-White persons (PR range: 1.35-1.63), persons who experienced housing instability (PR=1.70), and those without any private insurance (PR range: 1.49-1.83).
Conclusion:
A large percentage of older PWH have unmet needs for ancillary services. Given the challenges that older PWH face related to the interaction of HIV and aging-associated factors, deficits in the provision of ancillary services should be addressed.
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