Entry into HIV Testing among Newly Diagnosed Older African American Women
Background: The National HIV/AIDS Strategy highlights the need to increase access to care and improve health outcomes for people living with HIV. The first step in this strategy is to ensure timely testing. It is estimated that approximately 20% of individuals living with HIV are unaware of their HIV status. For older African American women, barriers to timely testing include a decreased perception of HIV risk and failure of healthcare providers to offer HIV tests.
Methods: Constructivist Grounded Theory (CGT) was used for this study. In taking the constructivist approach, analysis stemmed from shared experiences and relationships with participants. Semi-structured interviews were conducted, audio-recorded and transcribed. Women were eligible if they (a) received an HIV/AIDS diagnosis at the age of 50 or older, and (b) self-identified as African American and/or Black. A total of eleven interviews were used. The interview guide was created using community-based participatory research (CBPR) methods. Open-ended, non-leading questions and probes were developed from a literature review and community member’s suggestions. Coding, mapping, analytic strategy usage, and memoing all assisted in creation of the categories.
Results: A provisional grounded theory was constructed, which emphasized that delayed entry into HIV care was related to delayed HIV testing. Majority of the women reported receiving an AIDS diagnosis within months of being tested. Two categories that emerged from these interviews included: “missed opportunities” and “it was almost too late.” Both categories emerged from codes surrounding gaps in care.
Implications: The use of CBPR principles aided in gathering meaningful data from the participants. The data elicited from these categories have highlighted several common concerns among older African American women diagnosed with HIV/AIDS after the age of 50. The question that arose for many of the women was “why didn’t anyone test me before?” Nurses and other healthcare providers are in a prime position to assess risk behaviors and educate older women about their HIV risk earlier in their disease trajectory. Aligned with the principles of CBPR, implications for this research study include the dissemination of these findings to both healthcare providers and the African American community.