One out of every four individuals with HIV/AIDS is age 50 or older; however, these seniors are far more likely to be diagnosed when they are already in the later stages of infection. A late diagnosis impacts the health of not only the infected individual but also the health of others to a greater degree than an early diagnosis would. A team of UCLA researchers conducted a study to determine the underlying reasons. They published their findings online on January 28 in the journal The Gerontologist.
The researchers uncovered psychological barriers that prevented these seniors from being tested. Among them was a general mistrust of the government (i.e., the belief that the government is run by a few big interests looking out for themselves) and AIDS-related conspiracy theories, including, for example, the belief that the virus is man-made and was created to kill certain groups of people. The researchers have found that government mistrust and conspiracy fears are deeply ingrained in these seniors; thus, deterring them from undergoing a HIV test.
According to the Centers for Disease Control and Prevention (CDC), 43% of HIV-positive people between the ages of 50 and 55, and 51% of those 65 or older, develop full-blown AIDS within a year of their diagnosis; furthermore, these seniors account for 35% of all AIDS-related deaths. In addition, because many of them are not aware that they have HIV, they could be unknowingly infecting others.
“Our work suggests that general mistrust of the government may adversely impact peoples’ willingness to get tested for HIV/AIDS,” noted primary investigator Chandra Ford, PhD, an assistant professor of community health sciences at the UCLA Fielding School of Public Health. She added, “HIV/AIDS is increasing among people 50 and older, but there’s not a lot of attention being paid to the HIV-prevention needs of these folks. Older adults are more likely to be diagnosed only after they’ve been sick, and as a result, they have worse prognoses than younger HIV-positive people do. Also, the CDC recommends that anyone who’s in a high-risk category should be tested every single year. These findings mean that the CDC recommendations are not being followed.”
The study group comprised 226 seniors aged 50 to 85 years. The investigators focused on testing the association between mistrust of the government, belief in AIDS conspiracy theories and having been tested for HIV in the previous year. The study participants were recruited from three types of public health venues that serve at-risk populations: STD clinics, needle-exchange sites, and Latino health clinics. Of the participants, 46.5% were Hispanic, 25.2% were non-Hispanic blacks, 18.1% were non-Hispanic whites and 10.2% were of other races or ethnicities. The data were collected between August 2006 and May 2007. The investigators found that 72% of the participants did not trust the government, 30% reported a belief in AIDS conspiracy theories, and 45% had not taken an HIV test in the prior 12 months. The more strongly participants mistrusted the government, the less likely they were to have been tested for HIV in the prior 12 months.
The investigators were surprised by several of their findings. For example, the fact that HIV testing rates among this population were not higher at the locations where the participants were recruited, given that these locations attract large numbers of people with HIV. Dr. Ford explained, “This finding is concerning because the venues all provide HIV testing and care right there.” An even bigger surprise was that the more strongly participants believed in AIDS conspiracy theories, the more likely they were to have been tested in the previous 12 months.
“We believe they might be proactively testing because they believe it can help them avoid the threats to personal safety that are described in many AIDS conspiracies,” noted Dr. Ford. She added, “For instance, if I hold these conspiracy beliefs and a doctor tells me I tested negative, I might get tested again just to confirm that the result really is negative.” In contrast, she noted, individuals who reported mistrusting the government may not have been tested because the venues where they were recruited were, in fact, government entities.
The researchers reported some limitations to their study. For example, the study design did not allow the researchers to determine whether the participants held their beliefs before or after being tested; thus, the researchers could not determine what prompted their mistrust of the government or conspiracy. Also, it is possible that the prevalence of these theories is higher in this group than it is in the general public and that some participants may have been afraid to tell the truth.
The investigators plan further research on the topic. Their next step is to study other groups of seniors to determine if these views are more widely held than just among the at-risk population the researchers studied.