Abstract
Objective:
This study reviews the existing literature on the prevention of HIV among older adults, including universal and indicated prevention programs and prevention strategies.
Method:
A literature search was conducted between September and October of 2011 to identify studies for this review. Several different electronic databases and a combination of keywords were used to conduct the search. In addition, the reference section of each article was reviewed for additional articles.
Results:
A total of 18 articles were identified and reviewed. Three of the articles examined universal prevention, five of the articles examined indicated prevention, and the remainder of the articles provided strategies and recommendations for the prevention of HIV among older adults.
Discussion:
The existing studies document evidence for preventing future cases of HIV/AIDS among older adults. Additional studies and universal and selected interventions are needed in an effort to reduce the number of older adults being diagnosed with HIV.
Introduction
In recent years, the number of older adults being diagnosed with HIV and dying from AIDS has increased dramatically. Unfortunately, older adults are seldom included in prevention efforts, thereby contributing to the increasing number of individuals being diagnosed with HIV and AIDS. The number of older adults grew 14% each year between the years of 2004 and 2007(Justice, 2010). According to the Centers for Disease Control and Prevention, approximately 31% of those living with HIV are above the age of 50 (Administration on Aging [AOA], 2012 citing CDC). It is estimated that by 2015, 50% of those living with HIV will be above the age of 50 (Effros et al., 2008). Despite the increasing numbers of older adults being diagnosed with HIV there remain relatively few published studies regarding the prevention of HIV among older adults. There are several potential reasons for the limited number of published studies: (a) researchers are influenced by societal norms and beliefs that people above the age of 50 do not engage in sexual behavior (Whipple & Scura, 1996) and (b) difficulties in sampling and other methodological challenges that occur when conducting research regarding sex and HIV/AIDS among older adults (Falvo & Norman, 2004).
Older adults with HIV/AIDS represent several categories of individuals: long-term survivors who have been taking highly active antiretroviral therapy (HAART) for a long time, newly diagnosed individuals above the age of 50, individuals who are not aware that they are infected and are not engaging in risky behavior, and those who do not know that they are infected and are engaging in activities that place themselves and others at risk for the disease (Emlet, Gerkin, & Orel, 2009). Despite common misconceptions older adults have similar risk factors for contracting HIV as younger adults (e.g., unprotected sex or sharing needles). Older adults do maintain sexual desires, can engage in sexual activity, and can be intimate with more than one partner at a time (Muller, 1997; Whipple & Scura, 1996). Sexual transmission is the most common means of exposure to HIV in people above the age of 50 (Chen et al., 1998; Strombeck, 1993; Whipple & Scura, 1996). Research indicates that older adults frequently engage in sexual activity and engage in risky HIV-related behaviors, (Gott & Hinchliff, 2001) such as not using condoms. Despite the increasing number of older adults being diagnosed with HIV/AIDS, myths regarding older adults and relatively infrequent sexual activity, drug use, and other risk taking behavior have led to limited screening and educational efforts among older adults (Grabar, Weiss, & Costagliola, 2006; Mack & Bland, 1999; Orel, Wright, & Wagner, 2005).
Older adults are often less knowledgeable about HIV/AIDS (CDC, 2011a), and, therefore, suffer consequences directly related to the lack of knowledge. Furthermore, older adults often have misinformation about HIV and do not engage in the appropriate methods of protection. For instance, many older adults believe that HIV is a young person’s disease and consequently are less likely to use condoms (Orel et al., 2005). Also, the symptoms of HIV/AIDS can be very similar to other conditions that occur frequently among older adults (Falvo & Norman, 2004). The confusion of symptoms can lead to inaccurate or delayed diagnosis of HIV among older adults (Rose, 1995). Research indicates that late diagnosis, impaired immune response, toxicities associated with HAART among older adults, and lack of knowledge about the efficacy of treatment among older adults may contribute to high rates of mortality soon after diagnosis (Goetz, Boscardin, Wiley, & Alkasspooles, 2001; Mack & Bland, 1999; Manfredi & Chiodo, 2000; Nokes et al., 2000). Because of the potential for rapid transition from HIV to AIDS among older adults, it is extremely important for older adults to receive a timely diagnosis of HIV and to be adherent to their medications as soon as they are prescribed.
In spite of the increasing number of older adults, those 50 and older, being diagnosed and aging with HIV/AIDS there is little research on the prevention of HIV among older adults. In addition, there are few educational resources adapted for older adults in an effort to assist with prevention (i.e., universal, selected, or indicated) (Orel et al., 2004). Universal prevention strategies address an entire population, for instance national, local community, school, and neighborhood (IOM, 1997). Selected prevention strategies target subsets of the total population that are considered to be at risk for a specific condition (IOM, 1997). Indicated prevention strategies are designed for those who have a certain condition to prevent further spread of the condition and complications that may arise (IOM, 1997). The lack of appropriate educational interventions is of significant concern. Due to the increasing number of older adults in general, and the increase in HIV-positive older adults (CDC, 2011b), it is imperative to increase awareness and management strategies for the challenges faced by older adults with HIV/AIDS as well as to increase universal prevention efforts (CDC, 2011a). To prevent the current problem from continuing, it is essential that interventions for the prevention HIV/AIDS be created for older adults.
Due to the growth of older adults and HIV-positive older adults (CDC, 2011b), it is imperative to increase awareness of prevention strategies among older adults (CDC, 2011a). Accordingly, this investigation reviews the existing literature on HIV/AIDS prevention among older adults including the following: (a) educational interventions (i.e., universal prevention), (b) strategies for prevention of HIV among older adults, and (c) indicated prevention interventions (e.g., risk reduction). This investigation will aid in increasing the awareness of what has already been done regarding HIV prevention among older adults, as well as understanding the effectiveness of what has already been done prior to establishing further intervention efforts.
Method
A literature search was conducted between September and October of 2011 to identify studies for this review. Studies were retrieved from the following electronic databases: Academic Search Premier, AgeLine, PsycINFO, PubMED, and Google Scholar. Each database was explored using the following or a combination of the following keywords: HIV, AIDS, education, intervention, older adults, prevention, knowledge, and risk reduction. In addition, the reference section of each article was reviewed for additional articles.
To be included in this review articles had to meet the following criteria: (a) published in a peer-reviewed journal, (b) conducted interventions focusing on the prevention of HIV/AIDS among older adults (those 50 and older), (c) conducted assessments of the implemented intervention (if applicable), (d) provided strategies and guidelines for prevention of HIV/AIDS among older adults (e) conducted in the United States, (f) participants in the study were mainly older adults, and (g) were published no earlier than 1996. Studies were excluded if they did not meet the above criteria.
Data were extracted from eligible studies into a table using Microsoft Word. The following data was extracted from each study: authors, publication date, study objectives, study population, study location, study design, theoretical framework, description of intervention, intervention outcomes, and rating based on the Quality Assessment Tool for Quantitative Studies. In addition, strategies and recommendations for the prevention of HIV/AIDS among older adults was reviewed and summarized. In an effort to assess the quality and validity of the studies included in this review we carefully reviewed the type of data and the analysis to ensure that they were appropriate for the type of research being conducted. Furthermore, we only included studies that had been reviewed by peers and had been approved by an Institutional Review Board.
In addition, we used the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practices Project in Canada. This tool was used for eight intervention studies evaluated in this review. This tool is suitable to be used in systematic reviews of effectiveness (Deeks et al., 2003), and can be used for randomized control trials, as well as quasi-experimental studies, and uncontrolled studies. The tool consists of the following eight sections: selection bias, study design, confounders, blinding, data collection methods, intervention integrity, and analyses. However, the final score is composed of the first six sections only. Each of the six sections is given a score of strong, moderate, or weak. Finally each article is given a global score of strong (no weak score on any of the six sections), moderate (one weak score out of the six sections), or weak (two or more weak scores out the six sections).
Twenty-two articles that pertained to HIV/AIDS among older adults were found. However, four of the articles were excluded either because they were published prior to 1996 or they did not pertain to the prevention of HIV/AIDS among older adults. The remaining 18 articles were separated into three categories: universal prevention interventions (for those without HIV) (5), indicated prevention interventions (for those with HIV) (3), and strategies for universal and indicated prevention (10). In this article, we synthesize and compare the core components of the studies selected for this review, including, when possible, study objective, study population, study location, study design, theoretical framework, intervention strategies, and outcomes. In addition, we report the rating each intervention study received based on the Quality Assessment Tool for Quantitative Studies.
Results
Population Characteristics
The majority of the studies reviewed received a rating of “moderate,” indicating having only one weakness in the study design (Coleman, Jemmott, Jemmott, Strumpf, & Ratcliffe, 2009; Falvo & Norman, 2004; Lovejoy et al., 2011; Orel, Stelle, Watson, & Bunner, 2010; Rose, 1996). Only one study received a “strong” rating (Illa et al., 2010). Tables 1 and 2 summarize study information from the five universal interventions and three indicated interventions.
Study and Interventions Characteristics of the Universal Prevention Interventions
Study and Intervention Characteristics of the Indicated Interventions
Notes: 1Study occurred in four phases, however the sample for the intervention is listed. 2Information pertains to those in the intervention group only. 3Participants were age 45+. 4 Remaining 13% comprised on White, Hispanic, and other.
The majority of the articles reviewed for this study, whether it was an intervention or only provided strategies for prevention, targeted individuals above the age of 50. Of the eight studies that evaluated an intervention, four consisted of predominately females (Altschuler, Katz, & Tynan, 2004; Falvo & Norman, 2004; Orel et al., 2010; Rose, 1996) and four consisted of mainly males (Coleman et al., 2009; Illa et al., 2010; Lovejoy et al., 2011; Small, 2010). Furthermore, five of the study samples consisted of greater than 50% Caucasian participants (Altschuler et al., 2004; Falvo & Norman, 2004; Orel et al., 2010; Rose, 1996; Small, 2010), whereas three of the study samples consisted of greater than 50%, specifically African Americans (Coleman et al., 2009; Illa et al., 2010; Lovejoy et al., 2011). Three studies included a very small number of Hispanics (Altschuler et al., 2004; Illa et al., 2010; Orel et al., 2010). One study included a small percentage of Asians (Altschuler et al., 2004). In addition, the interventions were evaluated among retired, (Falvo & Norman, 2004; Small, 2010) low income, (Altschuler et al., 2004; Falvo & Norman, 2004; Lovejoy et al., 2011; Orel et al., 2010; Small, 2010) heterosexuals (Falvo & Norman, 2004; Illa et al., 2010; Lovejoy et al., 2011), and homosexuals (Coleman et al., 2009; Illa et al., 2010).
Intervention Characteristics
The interventions targeted either universal or indicated prevention among older adults (Altschuler et al., 2004; Coleman et al., 2009; Falvo & Norman, 2004; Illa et al., 2010; Lovejoy et al., 2011; Orel et al., 2010; Rose, 1996; Small, 2010). Five of the studies evaluated universal prevention interventions among HIV negative older adults (Altschuler et al., 2004; Falvo & Norman, 2004; Orel et al., 2010; Rose, 1996; Small, 2010), whereas three of the studies targeted indicated prevention among HIV-positive older adults (Coleman et al., 2009; Illa et al., 2010; Lovejoy et al., 2011).
Three of the studies did not mention the use of a theoretical framework (Altschuler et al., 2004; Falvo & Norman, 2004; Small, 2010). The remaining five interventions used several different guiding theories and frameworks, for instance the health belief model (Orel et al., 2010; Rose, 1996), social cognitive theory, theory of reasoned action, the theory of planned behavior (Coleman et al., 2009), motivational interviewing, (Lovejoy et al., 2011) motivation-behavior skills model, and self-efficacy (Illa et al., 2010).
The majority of the universal interventions recruited participants from locations that serve older adults, for instance senior centers or recreation centers (Falvo & Norman, 2004; Orel et al., 2010; Small, 2010). The majority of the indicated interventions recruited participants from AIDS service organizations (Coleman et al., 2009) or other medical settings. Furthermore, several researchers provided incentives to recruit and retain participants, for example Orel et al. (2010) provided refreshments, lunch, and door prizes to participants.
The most frequently used location for interventions was community settings, for instance senior centers, recreation centers, AIDS service organizations, and urban medical centers (Coleman et al., 2009; Falvo & Norman, 2004; Illa et al., 2010; Orel et al., 2010; Rose, 1996; Small, 2010). However, one intervention took place over the telephone (Lovejoy et al., 2011). The majority of the interventions used a repeated measures design, with at least a pre and posttest. Three out of the eight intervention studies conducted at least a 3-month follow-up (Coleman et al., 2009; Illa et al., 2010; Lovejoy et al., 2011). The length of each intervention varied from 45 mins (Falvo & Norman, 2004) to 3 hrs (Small, 2010). The content in the intervention was different based on the intended audience. The interventions that targeted HIV-negative individuals focused on topics such as, defining HIV and AIDS, myths regarding HIV/AIDS, transmission on HIV, prevention, and testing procedures (Falvo & Norman, 2004; Rose, 1996; Small, 2010). The interventions that targeted HIV-positive individuals focused on increasing condom use as means of preventing additional infections and the infection of others (Coleman et al., 2009; Lovejoy et al., 2011). One intervention included topics such as assertive communication with partners and developing tactics to increase condom use (Illa et al., 2010). Last, Orel et al. (2010) offered HIV testing on site immediately following the completion of the sexual health workshop.
Intervention Effects
The majority of reported intervention effects correspond to the increase in general HIV/AIDS knowledge and to the reduction of risky sexual behaviors (Coleman et al., 2009; Falvo & Norman, 2004; Illa et al., 2010; Lovejoy et al., 2011; Orel et al., 2010; Rose, 1996). For instance, Falvo and Norman, (2004) found significant increases in HIV/AIDS knowledge (p < .001) following their sex education workshop. In addition, Falvo and Norman found that the increases in knowledge were retained at the 3-month follow-up (p < .001). The three interventions that targeted HIV-positive individuals reported decreases in inconsistent condom use, for instance Illa et al., (2010) found a significant increase in consistent condom use after an educational intervention at the 6-month follow-up (p = .003). In addition, there were reductions in the percentage of participants who reported having multiple sexual partners, for instance Coleman et al. (2009), reported an approximate 30% reduction among the participants who reported multiple sexual partners. Although not significant, Illa et al. (2010) found reductions in sexual self-efficacy (participant’s beliefs about their ability to engage in safe sex) after the intervention.
Two out of the five educational interventions that targeted HIV-negative older adults found significant increases in overall knowledge following the intervention (Falvo & Norman, 2004; Rose, 1996) and in one study the participants retained their knowledge at the 3-month follow-up (p < .01) (Falvo & Norman, 2004). Small (2010) did find that participants had a high level of interest in receiving and participating in HIV education programs (p < .05). Although not significant, Small (2010) did report an increase in substantive HIV/AIDS knowledge. Furthermore, Small (2010) identified three salient thematic categories relevant to HIV/AIDS prevention messages as a result of the focus groups: acknowledgement of risk factors (e.g., participants recognized that drug use was a risk factor for older adults), barriers to HIV/AIDS education (e.g., lack of appropriate health information in layman terms), and suggestions for implementation of HIV/AIDS education programs (e.g., presenting the information in a location where seniors already gather). In addition to increasing general knowledge regarding HIV/AIDS among participants, Rose (1996) reported significant increases in perceived susceptibility (p < .01) and perceived seriousness (p < .01) of the disease.
Altschuler et al. (2004) found that females (p = 0.23), Hispanics, (p = .000), and those who are moderately to very religious (p = .023) were more likely to indicate that they would attend an HIV education program when surveyed about interest in prevention and education programs. Furthermore, it was found that having a relationship with someone with HIV/AIDS (26%), having a fear of contracting HIV/AIDS (23%), and having a desire for updated information (36%) were found to encourage participation in HIV/AIDS education programs (Altschuler et al., 2004). Altschuler et al. (2004) also found that as age increases, the likelihood of indicating that a respondent would attend an HIV/AIDS educational program decreases. Following the pilot test of the HIV/AIDS educational program participants indicated they learned that HIV/AIDS was relevant to their lives, they felt empowered to speak to their health care providers regarding their sexual health, and were appreciative to have the opportunity to discuss an otherwise taboo topic (i.e., HIV/AIDS) with their peers (Altschuler et al., 2004).
Strategies
Strategies for universal prevention focus on educating older adults about risk factors for HIV (Strombeck & Levy, 1998) and also educating health care professionals to be able to provide prevention information effectively to older adults (Strombeck & Levy, 1998). Orel et al. (2004) suggest that public health agencies develop age-sensitive HIV/AIDS educational materials tailored for broad and culturally diverse older populations. For example, educational materials should be sensitive to different languages, religious beliefs, sexual orientation, and generational differences (Agate, Mullins, Prudent, & Liberti, 2003). Rose (2004) suggests that needs assessments be performed to aid in developing meaningful, culturally competent, and age-specific HIV prevention programs.
Orel et al.(2004) recommend that public health agencies support research to study older adults’ sexual practices and drug using behaviors. In addition, it is suggested that health care professionals be trained to assess alcohol and drug use, and obtain thorough health histories including sexual and substance abuse histories from their patients (Williams & Donnelly, 2002). Moreover, it is recommended that health care professionals provide HIV/AIDS risk reduction materials with certain medical regimen, for instance sexual enhancement drugs (Orel et al., 2004).
Ory, Zablotsky, and Crystal (1998) recommend that researchers develop and test interventions to prevent HIV/AIDS among older adults. To reach more older adults educational programs should use titles that are more acceptable to older audiences, for instance instead of using the words HIV/AIDS in the title, a title such as “Safer Sex After 50” should be used (Agate et al., 2003). In addition, educational programs should be incorporated into other health related educational programs for adults, for instance incorporating AIDS-related topics into a program for women about bone density and osteoporosis (Agate et al., 2003). Furthermore, programs should match the physical need and limitations of older adults, for example it is recommended that programs be about 15 to 20 mins in length (Agate et al., 2003). Programs and interventions should be designed to increase general HIV/AIDS knowledge (i.e., appropriate factual knowledge) among older adults (Altschuler et al., 2004), but also programs should increase perceived susceptibility and seriousness of the disease (Orel et al., 2010). Programs should incorporate peer educators and offer HIV/AIDS websites that provide links to existing organizations/agencies that provide information about HIV/AIDS and aging. Last, interventions should identify and dismantle ageism in relation to HIV/AIDS and highlight the fact that it is never too late to introduce healthy behaviors, for instance safe sex practices (Coon, Lipman, & Ory, 2003).
Strategies for indicated prevention focus on the health care system. For instance, there is a need to increase the number of HIV-infected persons who are aware of their serostatus (Janssen et al., 2001). Furthermore, it has been recommended that physicians need additional education regarding HIV/AIDS among older adults so that they provide early medical interventions among those who are HIV-positive (Levy, Ory, & Crystal, 2003; Siegel, Raveis, & Krauss, 1992), including testing, the provision of high-quality care and treatment, and the promotion of adherence to medications (Janssen et al., 2001). It has been recommended that education be increased among HIV-positive individuals as a means to decrease engagement in risky behaviors (Janssen et al., 2001). In addition, it is suggested that patients be educated on how to communicate with health care professionals, ways to improve adherence, and information on the effectiveness of medications (Strombeck & Levy, 1998).
Discussion
The results of this review indicate that despite the increasing number of older adults being diagnosed with HIV and dying from AIDS (CDC, 2011b), there are relatively few published interventions aimed at the prevention of HIV among older adults. Yet, the interventions that have been tested have shown evidence of effectiveness. The results of this review also indicate that there are more articles available that provide strategies for the prevention of HIV among older adults than interventions evaluating suggested strategies, for instance evaluating intervention in health care settings.
Our review identified 18 articles pertaining to the prevention of HIV/AIDS among older adults, reported from 1996 to the present. The majority of interventions in this review report significant increases in HIV/AIDS knowledge among HIV-negative older adults. Similarly, the studies in this review report significant risk reduction, specifically consistent use of condoms among older HIV-positive adults. In addition, the articles that did not test an intervention offered numerous strategies for both universal and indicated prevention among older adults. However, the most commonly cited recommendation was to increase the involvement of health care professionals in the prevention of HIV and the treatment of HIV among older adults. Other recommendations include developing and evaluating appropriate interventions aimed at preventing HIV among older adults.
Although it is encouraging that the majority interventions identified in this review were efficacious and target important populations, several gaps still remain. Only one intervention specifically targeted African Americans. African American men and women are the racial group that is most affected by HIV; the CDC reports that in 2009 African Americans accounted for only 14% of the U.S. population, but accounted for 44% of HIV infections (CDC, 2012). Hispanics, similar to African Americans, are also disproportionately affected by HIV/AIDS. In 2009, Hispanics accounted for 16% of the U.S. population but accounted for 20% of new HIV infections (CDC, 2011c). Only three studies included Hispanics in the intervention, approximately 14% or less of the total study populations and no study specifically targeted Hispanics. Other minority groups, such as Asians and Native Americans were mentioned in only two of the interventions and accounted for 10% or less of the study population.
The majority of the universal prevention interventions included mainly females. In 2009, male-to-male sexual contact was reported as the most common methods of transmission, (CDC, 2011b), yet no studies identified in this review targeted homosexual or nonidentified gay males for universal prevention. The indicated prevention interventions focused on sexual behavior as a means of risk reduction (e.g., condom use or multiple sexual partners); however, injection drug use also increases an individual’s risk for HIV (Linsk, 2000) and therefore should be included in indicated prevention efforts.
Many of the interventions reviewed did not use randomized controlled or controlled study designs, nor was clear whether or not the measures used to evaluate the interventions were valid or reliable; this caused many of the interventions to obtain a rating of moderate or weak based on the Quality Assessment Tool for Quantitative Studies. Universal, selected, and indicated prevention intervention could benefit from using stronger study designs.
Both universal and indicated prevention interventions should include multiple methods of reducing risks. Several of the indicated prevention interventions included information on the importance of being adherent to anti-HIV medications. Universal prevention interventions should include information on the success of medications in maintaining the health of those with HIV to emphasize the point that HIV is no longer a death sentence and that early detection and treatment are essential to the successful management of the disease (Janssen et al., 2001). Also, similar to one of the indicated prevention interventions, universal interventions should include information regarding communication and negotiations with sexual partners to increase safe sexual practices, for instance consistent condom use (Illa et al., 2010). Last, it is not clear from the information provided in the articles identified for this review whether or not rural areas were targeted locations for interventions. Rural areas are often overlooked for HIV prevention (CDC, 2010); however they should be included in all forms of prevention interventions as HIV can effect individuals in rural areas as well as those in urban areas.
Like other systematic reviews of intervention studies and strategies for interventions, this review has its limitations. First, a more extensive list of key search terms or a different combination of search terms could have yielded additional articles to include in this review, for instance using the term aging. In addition, the inclusion of more search engines may have yielded more articles for review, such as EBSCOhost or Web of Science. Future research should explore these areas to increase the awareness of what has already been done regarding the prevention of HIV and gaps that exist.
Recommendations for Future Research
To address some of the limitations identified in this review, we have some recommendations for future HIV/AIDS prevention interventions. First, researchers should test interventions in different regions across the United States. Interventions should be tested in more regions across the United States even regions with lower incidence rates of HIV, to maintain low numbers (CDC, 2009). In addition, interventions should be conducted at more diverse locations, for instance health care settings. Second, researchers should strive to include a variety of minority groups in interventions so that more individuals are reached (Naranjo &Davis, 2000), furthermore these interventions should be sensitive to cultural differences. For instance, there is a need for more selected interventions (i.e., interventions for those considered to be a high risk for HIV), for instance Hispanics and African American older adults, as they are often not the target of HIV interventions, as evidenced by this review. To recruit and retain minority participants’ researchers may have to use different recruitment techniques and present interventions at a variety of locations. Third, it may prove beneficial to expand upon the material included in the interventions. The inclusion of the differences between younger and older adults with HIV/AIDS, symptoms, and treatment may increase an older adult’s knowledge and understanding of the disease and what can be done to manage the disease. Fourth, peer educators should be considered in interventions. A peer educator who has been diagnosed with HIV or AIDS could increase the impact of the intervention among the participants (Agate et al., 2003). For instance, including a peer educator with HIV or AIDS may assist in increasing the participant’s perceived susceptibility, this should be empirically examined. Fifth, researchers should use randomized or controlled study deigns to better test the efficacy of the intervention. Using randomized or controlled study designs reduces the likelihood of having selection bias and confounding variables, thereby increasing the ability to generalize the findings of the study. Sixth, researchers should strive to develop and test valid and reliable measures to be used with HIV interventions for older adults. Using valid and reliable measures in conjunction with randomized or controlled study designs increases the ability to better test the efficacy of interventions. Last, prevention interventions should, when possible, include more follow-ups for instance, 3- and 6-month follow-ups or longer periods of time between the initial posttest and the follow-up (Coon et al., 2003). Including follow-ups can increase the researcher’s knowledge regarding the long-term effectiveness of the intervention.
Conclusion
In conclusion, updating our current knowledge regarding interventions and strategies aimed at preventing future HIV/AIDS infection via educational interventions is important in understanding what has already been done and what should be done in the future. Only eight studies were found that specifically evaluated a universal or indicated intervention among older adults. Given the fact that more and more older adults are being diagnosed with HIV and AIDS, it is clear that more effective interventions are needed. As evidenced by this review there is an immediate need for more intervention on all levels for older adults (i.e., universal, selected, and indicated). Such interventions should use randomized or controlled study designs and use valid and reliable measures. Furthermore, the interventions should target more minority populations. We hope that the information provided here (i.e., what has already been done in the field and recommendations for the future) will be helpful to researchers and organizations dedicated to preventing HIV/AIDS among older adults.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.