Background: Ukraine''s volatile HIV epidemic has resulted in over 238,000 people with HIV. HIV incidence among young people is declining due to targeted programmatic strategies, however we have identified a new increase in advanced HIV diagnoses (CD4< 200) among individuals ≥50yo. Exploring the role of stigma as a barrier to HIV care among older adults will inform clinical practice and research agenda, enabling 50yo+ in Ukraine be diagnosed and treated sooner.
Methods: After informed consent, trained research staff conducted qualitative interviews with 30 adults ≥50yo newly diagnosed with HIV and reviewed 26 charts, in a private confidential location at a government HIV clinic in Kyiv, Ukraine. Interviews were transcribed verbatim, translated into English, imported into Dedoose software, and inductively analyzed for themes.
Results: Among 26 older individuals initiating HIV care, the mean age was 54.4 (SD=11.63) and 15 (57%) were women. Opportunistic infection was present at HIV diagnosis in 24 (92.1%) and 4 (16.0%) were positive by serology for Hepatitis C. The mean CD4 count was 180.1 cells/mm3 (SD=178.8) and 21 (81%) had recently started antiretroviral therapy (ART). Thematic analyses concurred that both men and women were affected by preconceptions of who acquires HIV, as well as comorbidities, but external (e.g. during HIV status disclosure) and internal stigma experiences differed. Men''s concerns around ART initiation were with own physical health and function, with the majority receiving family support, while women''s concerns were about being “safe” to continue providing support to family like child or eldercare. Also, women considered their HIV diagnosis incompatible with their identity as a "decent woman and mother", "ordinary person who leads a healthy lifestyle"(i.e. internal stigma) and feared family''s rejection.
Conclusions: This data demonstrates the gendering of HIV stigma among older adults newly diagnosed with HIV in Ukraine. While new HIV diagnoses challenged all older adults'' perceptions that HIV shouldn''t affect ''ordinary persons'', only older women felt pressured to prove themselves as deserving to maintain their family, work, and societal roles. Future longitudinal evaluation is needed to determine how internal and external stigma influences the HIV care cascade, particularly VL suppression, among ≥50yo group in gendered ways.