Older African Americans and the HIV Care Continuum: A Systematic Review of the Literature, 2003–2018


Evidence suggests that racial disparities in the HIV care continuum persist in older age groups, particularly among African Americans. The objective of this systematic review was to identify factors that facilitate or hinder older African Americans’ engagement in the HIV care continuum. For studies published between 2003 and 2018, we: (1) searched databases using keywords, (2) excluded non-peer-reviewed studies, (3) limited findings to older African Americans and the HIV care continuum, and (4) retrieved and summarized data focused on barriers and facilitators of the HIV care continuum. Among the 1023 studies extracted, 13 were included: diagnosis/testing (n = 1), engagement in care (n = 7), and antiretroviral adherence (n = 5). Barriers included lack of HIV risk awareness, routine testing, and healthcare access, stigma, and multimorbidities. Social support, health/medication literacy, and increased self-efficacy facilitated engagement. A targeted focus on older African Americans is needed to achieve national goals of improving HIV care and treatment outcomes.


La evidencia sugiere que disparidades raciales en el cuidado continuo del VIH persisten en los grupos de mayor edad, particularmente entre los afroamericanos. El objetivo de esta revisión sistemática fue identificar los factores que facilitan u obstaculizan la participación de afroamericanos mayores en el cuidado continuo del VIH. Con respecto a los estudios publicados entre el 2003 y el 2018, nosotros: (1) revisamos bases de datos usando palabras claves, (2) excluimos estudios no revisados por pares, (3) limitamos los resultados a afroamericanos mayores y el cuidado continuo del VIH, y (4) recuperamos y resumimos datos concentrados en las barreras y facilitadores al cuidado continuo del VIH. De los 1023 estudios extraídos, se incluyeron 13: diagnóstico/prueba (n = 1), participación en el cuidado (n = 7) y adhesión antirretroviral (n = 5). Algunas de las barreras incluidas fueron la falta de conciencia de riesgo del VIH, las pruebas rutinarias, y el acceso al cuidado médico, el estigma y las multi-morbosidades. El apoyo social, el conocimiento sobre la salud/medicamentos y una mayor auto-eficacia facilitaron la participación. Para lograr los objetivos nacionales de mejorar el cuidado del VIH y los resultados de tratamiento es necesario enfocarse en afroamericanos mayores.

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The authors wish to thank Emilia Guevara for her help in translating the abstract into Spanish.


The work was supported by a seed grant from the University of Maryland ADVANCE Program [PI: Sangaramoorthy and Dyer] and the US National Institutes of Health’s National Institute of Drug Abuse [Grant Number R03 DA03713101; PI: Dyer]. The findings and conclusions of this manuscript do not represent the official views or policies of the University of Maryland or the US National Institutes of Health.

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Correspondence to Thurka Sangaramoorthy.

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Sangaramoorthy, T., Jamison, A. & Dyer, T. Older African Americans and the HIV Care Continuum: A Systematic Review of the Literature, 2003–2018. AIDS Behav 23, 973–983 (2019). https://doi.org/10.1007/s10461-018-2354-4

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  • Aging
  • African Americans
  • Health disparities
  • HIV care continuum
  • Treatment