Author
MILASZEWSKI Dorota; et al.;
Title
A systematic review of education for the prevention of HIV/AIDS among older adults.
Journal citation/publication details
Journal of Evidence-Based Social Work, 9(3), June 2012, pp.213-230.
Summary
A range of sources, including primary studies, literature reviews, and opinion pieces were included in this systematic review. There were very few qualitative or quantitative studies. Most of the gathered evidence relates to the major challenges to providing HIV/AIDS education for older adults, such as the issue of ageism both among health professionals and the general public. The need for further research in the older population is highlighted, and practitioners are cautioned against adapting existing prevention initiatives designed for younger people.
Context
Despite being the fastest growing population with HIV/AIDS infection in the USA, research focusing on people aged 50 years and older remains sparse. In addition, some risk factors for contracting HIV/AIDS are exacerbated in this age group such as a greater reluctance to use condoms and engage in safer-sex practices, as well as the existence of physiological changes that increase the likelihood of transmission of infection. As with younger people, the best strategy for the prevention of AIDS/HIV in this population is education. The aim of this study was to systematically review the literature on ‘challenges to the delivery of health education to prevent HIV/AIDS infection among older adults, clinical guidelines for education delivery, and education models used with older adults.’
Methods
What sources were searched?
A range of social science and medical databases was searched with the assistance of two professional librarians; they included Ageline, AIDS and cancer Research Abstracts, PsycINFO, Social Services Abstracts, Sociological Abstracts, Medline, AMED, CINAHL, EMBASE, and Health STAR. Databases were searched in February 2008, from the date of inception. Unpublished ‘grey’ literature was sought by searching ERIC, the Cochrane Library Database, and OAIster, and the New York Academy of Medicine Grey Literature Report.
What search terms/strategies were used?
Searches were conducted using the following keywords: (prevention OR health education OR health promotion) AND (human immunodeficiency virus* OR acquired immune deficiency syndrome* OR HIV* OR acquired immune deficiency syndrome*) AND (older adult* OR elder* OR geriatric* OR senior citizen* OR older person* OR older wom* OR older man OR older men*). The Cochrane Library and OAIster were searched using the terms ‘HIV* AND elderly AND prevention’, and the New York Academy of Medicine Grey Literature Report was searched using ‘HIV AND elderly’.
What criteria were used to decide on which studies to include?
Studies had to focus on primary prevention of HIV/AIDS through the delivery of health education and/or promotion strategies aimed at adults aged 50 years, or older. A range of document types were eligible for inclusion from qualitative and quantitative studies to literature reviews and sources of clinical guidelines on HIV prevention strategies targeting older people. Articles were not rejected on the basis of language.
Who decided on their relevance and quality?
Two reviewers independently assessed the titles and abstracts against the inclusion criteria with 90% agreement. The selected articles were then obtained in full and screened by three authors, working independently, who were unanimous in their opinion on the articles to be included in the review. There is no evidence that the included articles were formally assessed on quality.
How many studies were included and where were they from?
The search strategies resulted in a total of 629 articles being identified. Fifty were selected for full text examination and 21 papers were included in the systematic review. All but two articles were from the USA.
How were the study findings combined?
The review is narrative in nature; the results are presented under the headings ‘Challenges to providing HIV/AIDS education and prevention to the elderly’, ‘Clinical guidelines’, and ‘Educational models’.
Findings of the review
Most of the included papers were literature reviews. There were also two quantitative studies, three mixed methods studies, two qualitative studies and three critical analyses.
The three main challenges to providing education for HIV/AIDS prevention to older people were ageism on the part of health professionals, a reluctance to discuss sexuality among older adults, and misconception of their risk of contracting HIV. Ageism was reported in 13 of the 16 sources that discussed challenges. Ageist attitudes were fuelled by misconceptions that older adults are not at risk of HIV/AIDS, that they are asexual, and that targeting prevention programmes at this group is futile.
Sixteen sources reported on clinical guidelines on preventing HIV/AIDS in older adults. Most of the guidelines were based on literature review, critical analysis and /or opinion, rather than on the results of empirical studies. Guidelines mainly focused on the importance of sharing information and risk assessment, considering sociocultural factors when designing interventions, and creative strategies for delivering prevention programmes.
Only six sources described education models which can be categorised into three main types: an educational session led by health professionals, found to be effective in increasing knowledge of HIV/AIDS; public health printed materials aimed at older people, found to be inappropriate and ineffective in one study, and; a combination of educational and prevention programmes incorporating early interventions such as counselling, testing, referrals, and treatment which target both older people and health professionals.
Authors' conclusions
‘The reviewed articles highlighted several clinical guidelines for HIV prevention among older adults. However, very few studies were found that quantitatively or qualitatively assessed the needs of older adults regarding HIV knowledge, or tested the effectiveness of existing HIV education initiatives that targeted older adults. The lack of evidence-based HIV prevention and education recommendations is of concern.’
Implications for policy or practice
None are discussed.