New HIV Diagnoses among Older Adults in the EU/EEA: Missed Opportunities and Barriers to Testing

Abstract

Background: HIV burden among older adults in the European Union/European Economic Area (EU/EEA) is increasing. We investigate factors associated with HIV infection, diagnosis and health seeking behaviour among older adults in 31 EU/EEA countries. Methods: We defined older and younger adults as >=50 and 15-49 years old, respectively. We extracted new HIV diagnoses reported during 2004-2014 and stratified them by age, gender, migration status, transmission route and CD4 count. We searched Embase and PubMed to identify studies on factors influencing provision and uptake of HIV testing among older adults in EU/EEA and other high-income countries. Results: The rate of HIV diagnoses among older adults in the EU/EEA significantly increased over time by average of 2.3% (95%CI 1.3%-3.2%; p=0.0003) per year. In 2014 the rate was 2.6 per 100 000 population (range 0.2-6.1 per 100 000), with the majority of the cases attributed to heterosexual transmission (2083, 40.8%) and sex between men (1614, 31.6%), a distribution associated with age (p< 0.0001). Being native to the reporting country and presenting late were significantly associated with older age (p< 0.0001 for both). Published evidence indicated a lower likelihood of HIV testing among older adults compared to younger age groups, although with wide variation between studies. HIV test uptake was a function of several factors related to patient and provider. Conclusions: In the EU/EEA the rate of new HIV diagnoses among older adults is steadily increasing. Distinctive socio-demographic factors characterise this population sub-group, such as being predominantly native, heterosexual and late presenters for HIV diagnosis. Expanding opportunities for provider-initiated HIV testing among older adults is a critical public health intervention.