Psychometric validation of ERA-12 and aging expectations among PLHIV in Kazakhstan

With longer life expectancy due to antiretroviral therapy, people living with HIV (PLHIV) face age-related conditions and psychosocial challenges that influence their perceptions of aging. Yet, no study has examined aging expectations in Kazakhstan or the broader Central Asian region, particularly among PLHIV. This study aimed to assess the psychometric properties of the Russian version of the 12-item Expectations Regarding Aging (R-ERA-12) scale, a brief, internationally validated multidimensional instrument, and to examine aging expectations among PLHIV in Almaty.

Data were collected from 100 PLHIV aged 40 years and older enrolled in a follow-up pilot study at the Almaty Centre for AIDS Prevention and Control between 2023 and 2024. Sociodemographic information, R-ERA-12 responses, stigma, quality of life measures, and HIV-related laboratory data were collected. Confirmatory factor analysis (CFA) tested the three-factor structure representing physical, mental, and cognitive expectations. Model fit was evaluated using standard indices, and reliability and validity were examined through internal consistency and factor-based indicators. Linear regression models were applied to identify factors associated with total R-ERA-12 scores.

CFA confirmed that the three-factor model provided a good fit, and the scale demonstrated high internal consistency (α = 0.93). Subscale reliability was also strong (α = 0.84-0.87), with the average variance explained by each factor ranging from 57 to 64%, indicating good construct validity. Participants reported generally low expectations regarding aging, particularly in the physical health domain. In multivariable analysis, higher levels of internalized HIV stigma were significantly associated with more negative aging expectations (β = -1.91, p = 0.03).

The R-ERA-12 demonstrated robust psychometric properties and is a reliable instrument for assessing aging expectations among PLHIV. Findings highlight notably low aging expectations and suggest that addressing internalized stigma could help foster more positive beliefs about aging, supporting the integration of ERA-12 into clinical and psychosocial programmes for PLHIV in Kazakhstan and similar settings.