From the Department of Medicine, Faculty of Medicine.
Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Sex Transm Dis. 2024 Dec 1;51(12):826-837. doi: 10.1097/OLQ.0000000000002053. Epub 2024 Jul 24.
Older adults newly diagnosed with HIV experience poorer prognosis and higher mortality compared with those diagnosed at younger ages. We explored the barriers and facilitators in HIV care linkage and retention among newly diagnosed older persons living with HIV (OPLWH) in Malaysia.
We conducted in-depth interviews with OPLWH and focus group discussions with health care providers (HCPs) from 5 specialties (primary care medicine, psychological medicine, gynecology, geriatrics, and infectious disease) at a tertiary hospital between September 2021 and April 2022. All sessions were audio-recorded, transcribed verbatim, and analyzed thematically.
We recruited 16 OPLWH and 7 HCPs. Thirteen OPLWH were male. Eight of them self-identified as men who have sex with men, and the rest were heterosexual. Diagnosis of HIV was between the ages of 50 and 61 years. Barriers and facilitators could be categorized into 3 levels: individual, interpersonal, and institutional. Individual barriers included misinformation about HIV treatment, unable to afford HIV-related services, and belief that life was futile. Interpersonal barriers were HIV-related stigma, poor social and family support, and social prejudice toward men who have sex with men. Lastly, institutional barriers were the need for frequent hospital visits, high cost for HIV-related services, a lack of guidance after diagnosis, and poor communication with HCPs. Facilitators included doctor or friend support and positive institutional reputation.
Multiple challenges hindered optimal care for OPLWH after HIV diagnosis. Issues like high costs, belief that treatment is futile, and a lack of family support need to be addressed as part of long-term support services for OPLWH.
与年轻患者相比，新诊断出 HIV 的老年患者预后更差，死亡率更高。我们探讨了马来西亚新诊断出 HIV 的老年感染者（OPLWH）在 HIV 护理衔接和保留方面的障碍和促进因素。
我们于 2021 年 9 月至 2022 年 4 月在一家三级医院，对 5 个专业的 OPLWH（包括初级保健医学、心理医学、妇科、老年医学和传染病学）进行了深入访谈，并与医疗保健提供者（HCP）进行了焦点小组讨论。所有会议都进行了录音，逐字记录，并进行了主题分析。
我们招募了 16 名 OPLWH 和 7 名 HCP。13 名 OPLWH 为男性，其中 8 人自我认同为男男性行为者，其余为异性恋者。HIV 诊断年龄在 50 至 61 岁之间。障碍和促进因素可以分为 3 个层次：个人、人际和机构。个人障碍包括对 HIV 治疗的误解、负担不起 HIV 相关服务的费用以及认为生命没有意义。人际障碍包括 HIV 相关污名、社会和家庭支持不足以及对男男性行为者的社会偏见。最后，机构障碍是需要频繁去医院就诊、HIV 相关服务费用高、诊断后缺乏指导以及与 HCP 沟通不畅。促进因素包括医生或朋友的支持和机构的良好声誉。
多种挑战阻碍了 OPLWH 艾滋病毒诊断后的最佳护理。需要解决高成本、治疗无效的信念和缺乏家庭支持等问题，作为 OPLWH 长期支持服务的一部分。
