Are HIV services in England accessible and acceptable to adults diagnosed with HIV at age 50 years and over? A mixed-methods study

In the UK, new HIV diagnoses are increasing in adults aged 50 years and over, a group that also has a higher likelihood of testing at an advanced stage of disease than younger people. Despite this, limited research has examined the pathway to HIV diagnosis and treatment experienced by this age group, or looked more broadly at the impact of living with HIV after diagnosis at this age. Using a mixed-methods approach, this thesis explores the acceptability and accessibility of HIV services in England to adults diagnosed at age 50+ years, from the perspective of these service users and healthcare professionals (HCPs) working in sexual health/HIV services and involved in caring for this age group. This thesis draws on semi-structured interviews with service users; an online survey and semi-structured interviews with HCPs; as well as national data on sexual health/GUM clinic attendance, HIV test coverage, and new HIV diagnoses by age. Adults aged 50+ years are found to experience often complex and non-linear journeys to HIV testing, particularly if they do not belong to a ‘risk group’ targeted in HIV prevention and testing efforts. Barriers to prompt HIV diagnosis include (i) the non-specific nature of HIV symptoms and their misattribution as being age-related, (ii) an age-associated decline in risk perception, and (iii) the decreased likelihood of HIV test offer in advancing age. Both service users and HCPs perceive HIV treatment services to provide exceptional care, which is associated with the benefits of closer health monitoring, clinician expertise in HIV, and consistency in care. General practitioners (GPs) by contrast appear to be underutilised in the management of older people with HIV, which may be particularly detrimental as these service users often develop additional, age-related morbidities, which extend beyond the remit of HIV clinician knowledge. The thesis concludes by highlighting a need to reconsider the model of HIV care in England, especially with respect to the role of GPs in HIV service provision. It is likely that increased GP involvement would optimise care and encourage the normalisation of HIV, which would promote testing and reduce stigma.