Table 2.

Study characteristics

Author, yearStudy designCountrySample sizeSample characteristicsTesting ratesPractical factors associated with testPerceptual factors associated with testPractical factors associated with non-testPerceptual factors associated with non-test
Ford, 201518Cross-sectional analysis from survey dataUSA143,247Age range 50–64 years 52% female 77% white3% had tested for HIV in the previous 12 monthsSaw doctor in the last year; high reported risk behaviours
Ford, 201319Cross-sectional analysis from survey dataUSA226Age range 50–85 years, mean age 56.1 years (SD = 5.1)64.6% male 46.5% Hispanic, 25.2% non-Hispanic black, 18.1% non-Hispanic white, 10.2% other55% tested within previous 12 months; 26.5% never tested for HIVRecent reported IVDU; having health insuranceBeliefs in AIDS-related conspiracy theoriesGovernment mistrust
Iyer, 201125Cross-sectional, questionnaire based survey of physiciansUSA47 complete questionnairesPhysicians were asked about testing in adults age >65 years; physicians 66% maleNot reportedLack of time; lacking information about HIVPhysicians uncomfortable with risk factor questioning; clinicians perceived patients to lack understanding
Lekas, 200517Cross sectional, retrospective, qualitative, interview-based studyUSA35Age range 52–68 years, mean age 59.8 years (SD=4.9) 71% male 40% African American, 46% white, 14% Puerto RicanNot reportedGay/bisexual men: encouraged to test by a HCP; having physical symptoms; awareness of HIV; wanting to protect partnerGay/bisexual men: high perceived risk and exposure; suspicion of HIV infection; to take better care of their health; eliminate uncertainty about statusGay/bisexual men: hopelessness associated with lack of treatments; denial of high-risk behaviour; seeing friends/partners die of AIDS; lack of awareness regarding HIV risk factors; attributing symptoms to something other than HIV.
Heterosexual drug users: experiencing HIV-related symptoms; being offered a test by a HCPHeterosexual non drug user: knowing someone with AIDS; experiencing symptoms; being offered a test by a HCPHeterosexual drug users: lack of knowledge of HIV and risk factors in the 1980s; fear of a positive result; drug use delayed acknowledgment of risk; perceived increased stigma at being olderHeterosexual non-drug user: not feeling part of a high-risk group
Adekeye, 201215Cross-sectional analysis from survey dataUSA12,366Age >50 years 46.4% male 75.4% white, 51.9% non-Hispanic white, 25.9% Hispanic25.4% had previously been tested for HIV. Of these, 70.1% had tested >5 years agoHaving tested for HIV before; knowing about or knowing someone with TBPerceived high/medium risk for HIVPerceived low/no risk for HIV
Alencar, 201526Qualitative study using semi-structured interviewsBrazil11Age range 60–75 years, average 68 years73% maleNot reportedTesting during hospitalisationPerception HCP saw older people as asexual; feeling HCPs (particularly younger HCPs) were uncomfortable with addressing sexuality of older patients
Barnett, 201116Mixed methods (quantitative and qualitative) survey with patients and in-depth interviews with staffUSASurvey n=99 Interviews n=17Age >50 years 54.5% male 39.4% African American, 28.3% Hispanic, 24.2% European American, 6.1% Asian, 2% OtherNot reportedAs part of a regular (annual) check-up; HCPs consider testing when patients present with an indicator disease or disclose risk factors during history takingHigh perceived risk of HIVHCP didn’t consider HIV in older as much as younger patients; HCPs feel patients are not comfortable discussing sexuality; HCPs felt older people take precautions against HIV; HCPs felt there was a lack of information provided to older people about HIV
Ford, 2015 (AC)23Cross-sectional analysis from survey dataUSA1,238 (≥50 n=226)Age range 17–85 years 65% male77% had been tested in the past. 56% tested within last 12 monthsHaving a usual source of careLower perceived risk of HIV
46% Hispanic/Latino, 25.2% black, 18.1% white, 10.6% other
Kuteesa, 201224Descriptive design using qualitative research methods (participant observation, in-depth interviews and focus groups)Uganda40 (focus group discussions (n=24); individual interviews (n=16))Age range 50–80 years, mean age 65 years50% femaleNot reportedStigma related to HIV or being older with HIV; fear of a positive HIV result
Mensforth, 201420Retrospective case notes reviewUK34>60 yearsNot reportedHCP having a reason to test; patient presenting with an opportunistic infection; patient diagnosed with another STI,HCP not identifying a clinical indicator disease
patient presenting with seroconversion illness; partner with a positive HIV status; as part of an asymptomatic STI screen
Wigfall, 201022Cross-sectional analysis from survey dataUSA3,521Age range 50–64 years, mean age 57 years 59% female 67% non-Hispanic white, 33% non-Hispanic black30.8% had been tested for HIV in the pastReporting no problems with health insurance; having financial means to pay for healthcarePerceived fair or poor health status
Wigfall, 201111Cross-sectional analysis from survey dataUSA2,027Age range 50–64 years 100% Female26% had been tested for HIV in the past (excluding blood donation); 14% had tested for HIV in post reproductive ageLow reported HIV risk
Zingmond, 200127Cross-sectional analysis from survey dataUSATotal n=2,864; ≥50 group n=286In the ≥50 group: age range 50–77 years, mean age 55.3 years, median age 53.5 years 16% femaleNot reportedTesting due to illness; testing in hospital; having a usual source of care
48% white, 41% African American, 10% Hispanic, 2% other
Akers, 200712Qualitative and quantitative cross-sectional analysis from survey dataUSA514Age range 50–95 years, mean age 62 years (SD=8.1) 100% female 73% African American32.9% had tested in the past. 70.6% reported being not interested in HIV testingHigh HIV knowledge scoreCuriosity; safety; high-risk partner; never previously tested for HIV; testing to be healthyHaving previously tested for HIV; don’t like needlesPerceived low risk of HIV; not feeling a test was necessary; not feeling at risk of HIV; not wanting to test for HIV; not perceiving to have HIV
Akers, 200813Cross-sectional analysis from survey dataUSA488Age range 50–84 years, mean age 61.9 years (SD=8.1), median age 61 years 100% Female34.6% had tested previouslyHCP offering an HIV testHCP not suggesting an HIV test; poorer HIV knowledge; lower actual risk of HIVLow perceived risk of HIV; low level of sexual activity
73% African American, 17% white/non-Hispanic, 22% other
Siegel, 199921Descriptive, qualitative study; in-depth interviewsUSA78Age range 50–68 years, mean age 56 years (SD=5.5) 74% maleNot reportedExperiencing symptoms attributed to HIVBeing asymptomatic or attributing symptoms to something other than HIV
41% African American, 19% Puerto Rican, 40% non-Hispanic white
Mack, 199928Cross-sectional analysis from survey dataUSA21,998Age range 50–64 years 52.3% female 78% white, 10% black,9% HispanicEver tested: older adults (50– 64 years) = 26.6%; younger adults (18– 49 years) 46.8%Part of routine check-up; due to hospitalisation; during blood donation; because of illness; because of doctor referralDon’t test because of pregnancyLower HIV knowledge
  • HCP = healthcare professional; IVDU = intravenous drug user; STI = sexually transmitted infection; TB = tuberculosis