Sex Differences in HIV Testing among Older Adults in Sub-Saharan Africa: A Systematic Review.

Akalewold T Gebremeskel,Olumuyiwa Omonaiye,Nathali Gunawardena,Sanni Yaya

doi:10.1155/2021/5599588

Abstract

Background Despite being sexually active and engaging in risky sexual behaviours similar to young adults, older adults (50 years or older) are less likely to receive HIV testing, and disaggregated data are still scarce about HIV prevention and treatment in this vulnerable population in sub-Saharan Africa (SSA). This systematic review is aimed at examining sex differences in HIV testing and counseling (HTC) among older adults in SSA. Methods A systematic search of four databases, namely, MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and Global Health, was conducted from 2000 to January 2020. The primary outcome of interest for this study was gender differences in HTC among older adults in SSA. Observational studies including cross-sectional, retrospective, and prospective cohort studies were included. Eligible studies must have reported sex differences in HIV testing uptake in a standard HTC service among older adults in SSA. Results From the database search, 4143 articles were identified. Five studies were ultimately included in the final review. Of the 1189 participants, 606 (51.1%) and 580 (48.9%) were female and male, respectively. The review findings suggested that both men and women preferred HTC providers that are the same sex as them with women additionally preferring a provider who is also of a similar age. Men and women differed in their pathways to getting tested for HIV. The review documented mixed results with regard to the associations between sex of older adults and uptake of HTC. Older adult HTC uptake data are limited in scope and coverage in sub-Saharan Africa. Conclusion This review revealed shortage of evidence to evaluate optimum HTC utilization among older adults. Few studies examined sex differences in HIV testing among older adults in the region. There is a need for stakeholders working in the area of HIV prevention and treatment to focus on older adult health utilization evidence organization, disaggregated by age and sex. Hence, high-quality research designs are needed on the topic in order to generate good quality evidence for targeted interventions to improve HTC among older adults in sub-Saharan Africa.

Highlights

Despite being sexually active and engaging in risky sexual behaviours similar to young adults, older adults (50 years or older) are less likely to receive HIV testing, and disaggregated data are still scarce about HIV prevention and treatment in this vulnerable population in sub-Saharan Africa (SSA)
According to the United Nations Programme on HIV and AIDS (UNAIDS) 2021 epidemiological report, 37.6 million people are living with HIV in 2020, over two-thirds of whom are in SSA [1]
In order to respond and address this continued growing of ageing and vulnerable older people in SSA and in the context of meeting the Sustainable Development Goals (SDGs) 2030, goal 3 [6], which is to ensure healthy lives and promote well-being for all at all ages, it is crucial that a systematically organized evidence-based approach is undertaken in order to provide useful information about the health and well-being of older adults in SSA in relation to HIV preventive care and support

Summary

Introduction

Despite being sexually active and engaging in risky sexual behaviours similar to young adults, older adults (50 years or older) are less likely to receive HIV testing, and disaggregated data are still scarce about HIV prevention and treatment in this vulnerable population in sub-Saharan Africa (SSA). This systematic review is aimed at examining sex differences in HIV testing and counseling (HTC) among older adults in SSA. Eligible studies must have reported sex differences in HIV testing uptake in a standard HTC service among older adults in SSA. In order to respond and address this continued growing of ageing and vulnerable older people in SSA and in the context of meeting the Sustainable Development Goals (SDGs) 2030, goal 3 [6], which is to ensure healthy lives and promote well-being for all at all ages, it is crucial that a systematically organized evidence-based approach is undertaken in order to provide useful information about the health and well-being of older adults in SSA in relation to HIV preventive care and support. HIV testing and counseling (HTC) play a critical role in HIV prevention, care, and treatment as it helps identify those who have HIV and provide the platform for linkage to information, services, and support that is required after a positive or negative test result [7]

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