Healthcare Provider Barriers to HIV Screening Among Older African Americans: An Integrative Literature Review

Saturday, 28 October 2017

Attallah Siedah Dillard, MSN
School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA

Problem Statement:

Although generally associated with young adults, of the 50,000 new HIV infections reported annually in the United State nearly 11% are among adults age 50 older (Brooks et al, 2012). Within this percentage older African Americans (AAs) are disproportionately affected by HIV infection. Older AAs experience a 12 times greater prevalence of HIV infection compared to their racial counterparts (Kirk & Goetz, 2009). In attempting to understand HIV testing of older AAs, research concludes that although rates of HIV testing are higher among AAs than any other racial group, 21.4% of AAs remain undiagnosed (Center of Disease Control, 2011). Some literature contributes this deficiency in diagnosis to a lack of screening occurring among the older adult population (Adekeye, Heiman, Onyeabor, & Hyacinth, 2012). Findings have suggested that healthcare providers (HCPs) underrate the importance of aged sexual health, as they perceive sexuality to be insignificant to their older adult patients, ultimately avoiding discussion of sexual health such as HIV and STIs (Gott et al, 2004; Grant & Ragsdale 2008).


Although individual studies have suggested HCP influences on decreased screening among the older adult population, there has been no literature reviews examining these influences as barriers to HIV/AIDS screening among older AAs. The purpose of this integrative literature review is to examine the degree to which published research has examined HCP barriers to HIV/AIDS screening among older AAs (age >50 years).


 Literature was searched using electronic databases PubMed, Web of Science, CINHAL, and Google Scholar using a combination of key terms and MeSH terms consisting of ‘healthcare providers OR physician OR primary care providers’, ‘healthcare staff’, ‘perceptions OR attitudes OR views of aged sexuality’, ‘discussions of sexuality’, ‘older adults OR adults aged 50 and older OR aged’, ‘older AAs OR Blacks’, ‘HIV OR HIV knowledge OR HIV training’, ‘communication’ and ‘screening’. Initially the search only focused on identifying articles assessing healthcare provider perceptions of HIV and sexuality among older AAs, however this search approach continuously yielded no articles. As a result, the search was expanded to ascertain articles identifying HCP knowledge, perceptions and attitudes of aged sexuality and HIV among the general older adult population, removing the older African American variable. Inclusion criteria for articles included the following: (1) study sample consisted of HCPs whose patient population consist of older adults (age 50 and older) (2) studies reporting outcome variables of HCP knowledge, perception, or attitudes of sexuality and/or HIV/AIDS of older adults. Exclusion criteria consisted of the following: (1) literature reviews, (2) opinion papers, (3) conference abstracts, (4) articles not written in English, and (5) articles focused on prevalence of HCP HIV screening among older adults and HCPs perception of sexuality in relation to younger populations. After applying these criteria, 12 articles were identified for inclusion for the analysis of the literature review.

 Results: Findings from the literature review were synthesized into the following themes: (1) HCP perceptions of older adults and sexuality; (2) HCP perceptions of older adults and HIV/AIDS risk HCPs; (3) HCP professional barriers influencing discussions of sexuality with older adults, (4) personal variables influencing attitudes and practices of aged sexuality among HCPs. Researchers have identified that many HCPs hold ageist stereotypes of older adults being sexually inactive which in return prevents them from discussing sexual health. There seems to be a presumption that conversations of HIV and sexual health history are more relevant to younger patients. Additionally, HCPs often vary in their opinion as to who is responsible for initiating sexual health discussions—patient or provider. Some studies have identified that HCPs prefer a more reactive where in which they will only provide sexual health information if it is brought up by the patient. Another major finding in the literature was the HCPs self-reported level of knowledge and training of elderly sexuality as being inadequate. HCPs believe their formal medical training did not provide them with the appropriate skills to initiate the conversations with older adults. Furthermore, many HCPs report discomfort and a lack of confidence in taking a sexual history, as many don’t want to offend their patients with this sensitive topic.

Implications: Although the literature is fairly non-existent for understanding how HCP barriers impact HIV screening for older AAs, research has identified many HCP barriers for the general older adult population. Further exploration of the HCP barriers preventing HIV screening among older AA is imperative for the health of older African American adults as exponential growth is expected for this population. Early identification of HIV infection may help to prevent transmission among older adults resulting in decreased rates of HIV infection among older AAs.