HIV/AIDS epidemiological profile and intervention evaluation of rural elderly in China

HIV infection among older adults in rural China has risen significantly in recent years, yet epidemiological characteristics and intervention effectiveness remain understudied.

We described the characteristics of 179 HIV/AIDS patients aged ≥ 50 years in rural Nantong, China, then conducted a community-based 1:1 case-control study of 179 HIV/AIDS patients aged ≥ 50 years and developed a predictive nomogram. Mediation analysis was applied to explore the role of HIV knowledge, and the effectiveness of a comprehensive community intervention was assessed among 1206 community individuals.

There were 179 elderly HIV/AIDS participants recruited, 55.9% of them were homosexual transmission, and 84.4% were identified through passive pathways. The case-control showed that the protective factors associated with HIV infection included higher Perceived Social Support Score (PSSS) (OR = 0.023) and knowledge awareness (OR = 0.055), while the risk factors included being unemployed (OR = 4.852), having extramarital sex (OR = 30.264), and the tolerant attitude to extramarital sex (OR = 7.124). The C-index is 0.9 and the Dxy is 0.913 with Spiegelhalter Z-test, indicating that the nomogram has good predictive accuracy. Mediation analysis indicated that knowledge mediated the impact of PSSS, extramarital sex, and attitude towards extramarital sex on HIV infection, accounting for 30.8%, 26.6% and 14.1%of the effects, respectively. Six months after implementation of the comprehensive intervention, there was a significant increase in HIV knowledge awareness (from 41.0% to 84.4%) and a decrease in extramarital sex(from 2.4% to 0.8%).

Appropriate interventions for the rural elderly with low education can also effectively reduce AIDS related risky behaviors. PSSS can be considered as a potential screening factor to predict the risk of HIV infection.