HIV after 40 in Rural South Africa: Aging in the Context of and HIV/AIDS Epidemic

 描述（由申请人提供）：南非是世界上艾滋病毒/艾滋病感染者人数最多的国家，人口迅速老龄化。近年来，随着抗逆转录病毒疗法的普及，许多成年人携带艾滋病毒进入老年，而且越来越多的人在老年时感染艾滋病毒。尽管存在这些人口问题，但关于艾滋病毒流行对南非老年人影响的研究很少。40岁后的艾滋病毒（HIV 40）的总体目标是研究生活过程和艾滋病毒的风险和保护行为在撒哈拉以南非洲农村人口的背景变化在很大程度上被忽视的人口在艾滋病毒/艾滋病研究：40-80岁的成年人。 我们寻求资金来分析来自南非农村纵向阿金库尔健康和社会人口监测系统（AHDSS）的数据，以及我们的研究团队收集的AHDSS中中年和老年人艾滋病毒和性行为的定量和定性数据。我们的创新和新颖的综合多方法数据集利用了五个数据源，包括：（1）AHDSS数据收集了1992-2014年27个村庄的90，000人的年度人口普查数据;（2）5080人的巢式横断面调查数据（其中2080人年龄在40岁以上）与艾滋病毒和慢性疾病生物标志物的性行为（3）对40-80岁艾滋病毒阳性和阴性成年人进行的60次巢式生活史访谈（2013年）;（4）77名受访者的社区焦点小组数据（2013年）;和（5）来自3个当地卫生诊所的卫生工作者的关键知情人访谈数据（2013年）。在创新的生命过程方法的指导下，我们利用这些数据来研究从中年到老年过渡期间的艾滋病毒风险和保护行为，以及社会背景在塑造个人行为中的作用。 艾滋病毒40的重要性在于其重点是生命过程的变化和艾滋病毒风险的背景以及向老年过渡时的保护。它提供了艾滋病毒和老年学文献的前沿科学进展，将为老年人预防艾滋病毒的方法提供信息。它还创新地使用了独特的多方法纵向和横截面嵌套数据集。我们的研究将由一个强大的调查团队进行，他们在这里提出的实质性领域和方法方面具有互补的优势和合作经验。最后，我们希望我们的工作能够通过利用阿金库尔二十多年的社区关系，为南非农村的艾滋病毒预防规划做出贡献并直接产生影响。

 DESCRIPTION (provided by applicant): South Africa has the largest number of people living with HIV/AIDS in the world and a rapidly aging population. In recent years, with expanded availability of ART, many adults are aging with HIV, and further, increasing numbers are acquiring HIV at older ages. Despite these population concerns, research on the impact of the HIV epidemic on older South Africans is scarce. The overall goal of HIV after 40 (HIV40) is to examine life course and contextual variation in HIV risk and protective behaviors in a rural sub-Saharan African population among a largely neglected demographic in HIV/AIDS research: adults aged 40-80. We seek funding to analyze data from the longitudinal Agincourt Health and Socio-Demographic Surveillance System (AHDSS) in rural South Africa and quantitative and qualitative data on HIV and sexual behavior among middle-aged and older adults nested within the AHDSS and collected by our research team. Our innovative and novel integrated multi-method dataset draws on five data sources including: (1) AHDSS data collecting annual censuses of 90,000 people in 27 villages followed from 1992-2014; (2) nested cross- sectional survey data of 5080 individuals (of whom 2080 are aged 40+) on sexual behavior with HIV and chronic disease biomarkers (2010-2011); (3) 60 nested life history interviews with HIV positive and negative adults aged 40-80 (2013); (4) community focus group data from 77 respondents (2013); and (5) key informant interview data from health workers in 3 local health clinics (2013). Guided by an innovative life course approach, we use these data to examine HIV risk and protective behavior in the transition from middle to older ages and the role of social context in shaping individual behavior. HIV40 is significant in its focus on life course variation and contex in HIV risk and protection in the transition to older ages. It offers cutting edge scientific advancement in the HIV and gerontology literature that will inform approaches to HIV prevention for older adults. It is also innovative in its use of a unique multi-method longitudinal and cross-sectional nested dataset. Our research will be conducted by a strong team of investigators with complementary strengths and collaborative experience working on the substantive areas and methods proposed here. Finally, we expect our work to contribute to and directly impact HIV prevention programming in rural South Africa by leveraging over twenty years of community relationships in Agincourt.