Factors associated with lack of interest in HIV testing in older at-risk women

To determine the factors and reasons associated with lack of interest in HIV testing among older women from a high prevalence community.

We conducted a cross-sectional study of women aged >or=50 seeking medical care. The main outcome measures were (1) interest in HIV testing and (2) reasons for women's interest or lack of interest assessed using open-ended questions. We compared the characteristics of women based on testing interest and fit two multivariable logistic regression models to identify factors associated with lack of testing interest among never tested women and women with moderate or high HIV risk factors. Responses to short answer questions were analyzed according to participants' HIV testing interest. Coding was performed by two independent reviewers using deductive application of themes identified in previously published literature on HIV testing interest.

Of 564 eligible women, 514 (91%) enrolled. Only 22% were interested in HIV testing. Those who lacked interest were more likely to be older (63.3 vs. 58.4, p < 0.001), African American (77% vs. 60%, p < 0.001), have poor HIV knowledge (68% vs. 57%, p = 0.02), and have low perceived HIV risk (82% vs. 69%, p = 0.01). Lack of interest in HIV testing was associated with increasing age and African American race among women with moderate or high-risk factors, whereas age, African American race and low perceived risk were important for never tested women. Common reasons for lacking interest in testing were perceived lack of need, perceived lack of risk, and a prior history of HIV testing.

Few of these older, high-risk women were interested in HIV testing despite the fact that more than half had risk factors for having been exposed to HIV during their life-time. Efforts to increase HIV testing interest should educate older women about HIV risk and transmission factors and promote accurate risk self-assessment.