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

 描述(申请人提供)：南非是世界上感染艾滋病毒/艾滋病人数最多的国家，人口老龄化速度也很快。近年来，随着抗逆转录病毒治疗的普及，许多成年人都感染了艾滋病毒，而且越来越多的人在老年时感染了艾滋病毒。尽管有这些人口担忧，但关于艾滋病毒疫情对南非老年人影响的研究很少。40岁后艾滋病毒(HIV40)的总体目标是研究撒哈拉以南非洲农村人口中艾滋病毒风险和保护行为的生命过程和背景变化，这些人是艾滋病毒/艾滋病研究中基本上被忽视的人群：40-80岁的成年人。我们寻求资金来分析来自南非农村的纵向Agin Court健康和社会人口监测系统(AHDSS)的数据，以及嵌套在AHDSS中的关于艾滋病毒和中老年人性行为的定量和定性数据，并由我们的研究团队收集。我们创新和新颖的综合多方法数据集借鉴了五个数据来源，包括：(1)AHDSS数据收集了从1992-2014年跟踪的27个村庄90,000人的年度人口普查；(2)5080人(其中2080人40岁以上)的嵌套横断面调查数据(2010-2011年)；(3)对40-80岁艾滋病毒阳性和阴性成年人的60次嵌套生活史访谈(2013年)；(4)来自77名受访者的社区焦点组数据(2013年)；以及(5)来自当地3家医疗诊所卫生工作者的关键信息访谈数据(2013年)。在一种创新的生命过程方法的指导下，我们使用这些数据来检查从中老年过渡到老年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。HIV40的重要意义在于它关注生命过程的变化以及艾滋病毒风险的背景和向老年过渡期间的保护。它提供了艾滋病毒和老年学文献中的尖端科学进展，将为老年人预防艾滋病毒的方法提供信息。它还在使用独特的多方法纵向和横截面嵌套数据集方面具有创新性。我们的研究将由一支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，我们预计我们的工作将通过利用阿金库尔二十多年的社区关系，为南非农村地区的艾滋病毒预防规划做出贡献并直接影响。

 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.