Grosso et al. AIDS Research and Therapy (2023) 20:10 AIDS Research and Therapy https://doi.org/10.1186/s12981-022-00488-7 RESEARCH Open Access Identifying the needs of older people living with HIV (≥ 50 years old) from multiple centres over the world: a descriptive analysis Tomás Martín Grosso1,2, Diana Hernández‑Sánchez3,4, Gordana Dragovic5, Marta Vasylyev6, María Saumoy7, José Ramón Blanco8, Diego García9, Tetiana Koval10, Cora Loste3,4, Tendayi Westerhof11, Bonaventura Clotet4,12,13, Omar Sued1, Pedro Cahn1 and Eugènia Negredo3,4,13* Abstract Background Older People Living with HIV (OPWH) combine both aging and HIV-infection features, resulting in age‑ ism, stigma, social isolation, and low quality of life. This context brings up new challenges for healthcare professionals, who now must aid patients with a significant comorbidity burden and polypharmacy treatments. OPWH opinion on their health management is hardly ever considered as a variable to study, though it would help to understand their needs on dissimilar settings. Methods We performed a cross-sectional, comparative study including patients living with HIV aged ≥50 years old from multiple centers worldwide and gave them a survey addressing their perception on overall health issues, psychological problems, social activities, geriatric conditions, and opinions on healthcare. Data was analyzed through Chisquared tests sorting by geographical regions, age groups, or both. Results We organized 680 participants data by location (Center and South America [CSA], Western Europe [WE], Africa, Eastern Europe and Israel [EEI]) and by age groups (50- 55, 56-65, 66-75, >75). In EEI, HIV serostatus socializ‑ ing and reaching undetectable viral load were the main problems. CSA participants are the least satisfied regarding their healthcare, and a great part of them are not retired. Africans show the best health perception, have financial problems, and fancy their HIV doctors. WE is the most developed region studied and their participants report the best scores. Moreover, older age groups tend to live alone, have a lower perception of psychological problems, and reduced social life. Conclusions Patients’ opinions outline region- and age-specific unmet needs. In EEI, socializing HIV and reaching undetectable viral load were the main concerns. CSA low satisfaction outcomes might reflect high expectations or profound inequities in the region. African participants results mirror a system where general health is hard to achieve, but HIV clinics are much more appealing to them. WE is the most satisfied region about their healthcare. In this con‑ text, age-specific information, education and counseling programs (i.e. Patient Reported Outcomes, Patient Centered Care, multidisciplinary teams) are needed to promote physical and mental health among older adults living with HIV/ AIDS. This is crucial for improving health-related quality of life and patient’s satisfaction. Keyword Older People Living with HIV, Aging, Health-Related Quality of Life, Patient satisfaction, Multicentre study *Correspondence: Eugènia Negredo enegredo@flsida.org Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. The Creative Commons Public Domain Dedication waiver (http://​creat​iveco​ mmons.​org/​publi​cdoma​in/​zero/1.​0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Grosso et al. AIDS Research and Therapy (2023) 20:10 Page 2 of 10 Background Methods During the last decades, remarkable improvements have Study design and population been seen on the treatment landscape of HIV infection. This is a cross-sectional, multicenter, comparative study Combined Antiretroviral Therapy (cART) has allowed including patients aged ≥50 years old or over living controlling HIV infection with high efficacy and rea- with HIV from multiple centers worldwide. A 15- min- sonably simple treatment schedules, in countries where ute - survey was administrated by the clinicians as part treatment is widely available [1–4]. Consequently, the of routine carequestionnaire was offered to participants profile of persons living with HIV (PLWH) has been of the study during between the years 2018–2020. Verbal shifted towards a tendency of increasing age [5, 6]. Since informed consent was obtained prior survey completion, the beginning of the twenty-first century, the number according to Hospital Universitari Germans Trias i Pujol of PLWH has been on the rise and is expected to keep Ethics Committee protocol approval. The investigator increasing [7]. informed the patient about the nature and purpose of the Aging is often defined as a decline of functional prop- study and all participants agreed. erties at the cellular, tissue and organismal level [8, 9], A total of 680 chronic HIV-infected patients were which increases the vulnerability to disease and mortal- enrolled through health care institutions in Africa (South ity [10]. This is of particularly higher concern in PLWH, Africa and Zimbabwe), Central America (Nicaragua, predisposing to a variety of well-recognized pathologies Honduras, Panama and Costa Rica), South America [11], for instance, atherosclerosis and cardiovascular (Argentina, Peru, Colombia, Ecuador and Uruguay), events [12], loss of renal function [13], osteopenia/oste- Western Europe (Spain and Italy), and Eastern Europe oporosis [14, 15], and non–AIDS-defining cancers [16, and Israel (Belarus, Israel, Serbia and Ukraine). 17]. Increased life expectancy together with HIV-related chronic inflammation and long exposure to some antiret- Study variables and statistical analysis roviral drugs are the main reasons of the accelerated Enrolled patients were given an in-house, self-completing aging in PLWH [18]. survey developed by several experts in the HIV field from However, besides having physical implications, aging the participating centers. The questionnaire was divided also includes psychological and social changes [19–21], into two main parts. conditions that have an evident impact on health-related The first section was about self-perceived current quality of life (HRQOL). On top of that, PLWH have sig- patient’s situation. It consisted of 24 questions organized nificantly poorer HRQOL than the general population, as four domains, including general information (health despite having a normalized immunological status [22]. perception, undetectable viral load, serostatus sharing, Thus, elder people living with HIV (EPWH) combine financial problems, etc), psychological sphere (weari- both aging and HIV-infection features, resulting in age- ness, depression, loneliness, memory problems), social ism, stigma, social isolation and low HRQOL scores [23, sphere (having friends and family, active sexual and social 24]. This context brings up new challenges for healthcare life), and specific conditions/geriatric syndromes (sleep- professionals, who now have to provide assistance to ing, hearing, visual, mobility and sexual). Affirmative and patients with a significant comorbidity burden and poly- negative answers were valid. Percentages of affirmative pharmacy treatments. answers were then averaged in order toto get a score for While significant resources have been expended on each category, except for the general information section. understanding HIV/AIDS pathogenesis and treatment, The second section addressed the patient’s satisfaction as well as its impact on individuals, groups, societies about the attention received regarding general medical and healthcare delivery, so far little research has exam- care, psychological, functional, social, and sexual prob- ined how HIV/AIDS affects the ability of older adults to lems. These questions had either a five-level scale indi- maintain their daily needs [25, 26]. Opinion of PLWH on cating satisfaction, or an open field for the patient to the aging process and healthcare attention are not often complete. Multiple-choice data were arranged in percent considered as a variable to study, though this knowledge stacked column charts to show satisfaction levels. would help to direct health responses on dissimilar set- Patients were identified in the records by the cor- tings. With all this in mind, we attempted to assess the responding code number only. The statistical software region- and age-specific needs of EPWHOPWH, and used were SPSS 25 for categorical analysis and Graph- their opinion regarding healthcare attention. and com- Pad Prism 8 to develop our graphs. A general descriptive pare the differences amongst HIV patients’ needs from analysis of all the variables of the study, overall and sep- different parts of the world. arately by 4 regions [Africa, Center and South America (CSA), Western Europe (WE) and South East and East- ern Europe and Israel (SEEEI)] and age groups (50-55, Grosso et al. AIDS Research and Therapy (2023) 20:10 Page 3 of 10 Table 1 Summary of patients’ general characteristics problems in comparison to others (30.2%). SEEE patients Category N % have the lowest percentage of undetectable viral load (49.1%), status sharing (41.9%), and the highest score on Region Africa 25 3.7 living alone (40.2%). South & Centre America 72 10.6 Regarding psychological problems, weariness had Western Europe 226 33.2 a relatively high and consistent prevalence across South East and Eastern Europe 357 52.5 all regions (from 37.1% to 45.8%). African patients Gender Men 436 65.5 reported the highest on depression (52.6%), loneliness Women 230 34.5 (45.0%), and a very high score on memory problems Age 50–55 243 37.4 (33.3%), having a mean score of 42.5%. On the other 56–65 303 46.6 hand, CSA participants showed the smallest psycholog- 66–75 91 14.0 ical problems mean score (26.6%). > 75 13 2.0 Moving onto the social sphere, patients in Africa and Marital status Married 278 40.9 CSA reported a similar level of active social life (71.4% Separated/Divorced 131 19.3 and 71.8% respectively), WE the highest (80.1%) and Single 177 26.0 SEEE the lowest by far (49.4%). Above half of patients Widowed 77 11.3 in WE and CSA reported active sexual life (55.4% and 54.2% respectively). Finally, almost every patient in CSA (98.6%) and WE (91.6%) reported having friends and family, and SEEE scored the least (73.7%). Overall, 56-65, 66-75, >75) was assessed by using a Chi-squared the highest social scores were found in WE (75.5%) and test. Finally, by averaging the percentage of affirmative CSA (74.9%). answers in the different sections, we developed three About a third of all patients reported at least one geriat- kinds of scores: psychological, social and specific condi- ric condition (troubles in sleep, hearing, vision, mobility, tions. We sorted these scores by both location and age or sexual). Sleep and visual problems were relatively high group and graphed them to visualize tendencies. across all regions (over 35%). People in Africa reported the most of visual (73.7%) and mobility problems (30.0%). Results Patients in SEEE reported the highest on sleep (42.7%) Cohort description and sexual (30.3%) problems. CSA was the region where A total of 680 patients took part in the study, coming the least problems were reported in overall (31.8%). from centers across the world in Africa (n = 25; 3.7%), When we look at the data by age (Table 3), older CSA (n = 72; 10.6%), WE (n = 226; 33.2%), and SEEE patients report a better health perception. In this sense, (n = 357; 52.5%). The majority of participants were male and the oldest EPWH have fewer financial problems (65.3%), between 56–65 years old (46.6%), and mar- (23.1%), more struggles to remember taking ART (23.1%), ried (40.9%). All these characteristics are summarized in tend to live alone (69.2%) and share less their HIV status Table 1. (30.8%). To remark, 39.0% and 46.2% of patients reported financial problems in the 50–55 and 56–65 age groups, Patient’s situation respectively. Focusing on the current situation of the patient, at first, a A pattern of increasing perception of psychological few general aspects on health and habits were recorded. problems is observed since the 66–75 and > 75 groups Then, self-perceived psychological, social life and geriat- have the lowest scores on every category. Participants ric problems were assessed. Data, sorted by geographical feel less lonely, less depressed and less wearied with region, are described in detail in Table 2. increasing age. The 50–55 and 56–65 age categories show To remark, Africans ranked best on good overall health the highest score on psychological problems (32.0% and (90,0%), albeit struggling to remember taking cART 35.0%, respectively), being weariness its major driver (19.0%), being retired (61.9%), and reporting the high- (39.7% and 47.4%, respectively). When we look at the est levels of financial problems (90.5%). People in CSA social sphere, we see a pattern of slow decay in social ranked the lowest on being retired (35.2%) and displayed life according to age (from 70.7% to 46.2%, p = 0,005), high values on health perception (86.8%) and HIV sta- and an abrupt decay in sexual life (from 58.3% to 7.7%, tus sharing (76.4%). Europeans displayed similar levels p < 0.001). In terms of geriatric problems, sleep (50.0%), of health perception, assuming the worst scores (73.6% hearing (46.2%) and visual (69.2%) conditions become and 72.5% in the WE and SEEE regions, respectively). worse as the patient ages, but mobility and sexual prob- WE is the region where subjects describe less financial lems display their peak at ages 66–75 (38.2% and 32.9% Grosso et al. AIDS Research and Therapy (2023) 20:10 Page 4 of 10 Table 2 Patient’s situation data sorted by location, expressed as the percentage of affirmative answers Section Parameter assessed Africa CSA WE SEEE Sig General information Median age 54.6 57.4 57.5 60.3 – Good Overall health perception 90.0 86.8 73.6 72.5 0.034 Retired 61.9 35.2 43.8 56.7 0.001 Exercise Minimum 65.3 66.5 64.8 69.4 0.500 Regular 54.3 46.7 40.2 50.8 0.040 Regular eating habit 90.5 80.9 93.8 92.1 0.010 Struggles to remember taking ART​ 19.0 15.3 9.8 10.7 0.384 Undetectable viral load 95.2 90.1 96.9 49.1 < 0.001 Living alone 23.8 31.9 26.5 40.2 0.005 HIV status sharing 90.5 76.4 63.7 41.9 < 0.001 Financial problems 90.5 46.4 30.2 45.6 < 0.001 Psychological problems Weariness 38.9 37.1 45.8 41.3 0.554 Depression 52.6 25.4 24.5 37.2 < 0.001 Loneliness 45.0 23.2 22.3 33.1 0.010 Memory problems 33.3 20.6 36.7 20.4 < 0.001 Mean score 42.5 26.6 32.3 33.0 – Social sphere Active social life 71.4 71.8 80.1 49.4 < 0.001 Active sexual life 35.0 54.2 55.4 46.0 0.069 Has Friends and Family 85.7 98.6 91.6 73.7 < 0.001 Mean score 64.0 74.9 75.7 56.4 – Specific/geriatric conditions Sleep 35.0 38.9 38.5 42.7- 0.702 Hearing 15.0 21.4 25.2 24.5 0.715 Visual 73.7 58.3 58.7 48.1 0.017 Mobility 30.0 16.7 21.3 28.5 0.077 Sexual 15.0 23.5 21.4 30.3 0.079 Mean score 33.7 31.8 33.0 34.8 – CSA Center and South America, WE Western Europe, SEEE South Eastern and Eastern Europe respectively). Eldest patients scored the highest on this asked if they are well managed in this matter, and only Sect. (41.7%). few Europeans (~ 15%) felt the same (Fig. 2B). Lastly, we developed a psychological, social and specific Over 30% of African and CSA reported nonsatis- conditions score by averaging the percentage of affirma- faction regarding care of functional problems, while tive answers in the different sections. We then sorted WE showed the best satisfaction scores in this aspect them scores by both location and age group (Fig. 1). The (> 60%) (Fig. 2C). Younger age groups reported higher graph shows a pattern of decay in social sphere and a rise nonsatisfaction than elder ones across all regions (data in conditions as people get older. not shown). A similar pattern is shared when consult- ants were asked about needs arising from social prob- lems: ~ 35% of Africans and > 50% of CSA said that Patients’ satisfaction these needs were not given enough attention, while less The last seven items of the questionnaire addressed the than 20% of Europeans were unsatisfied on this matter patients’ satisfaction regarding different aspects of their (Fig. 2D). Most of nonsatisfied Europeans accounted healthcare. Overall, patients were happy with the care for > 75-year-old SEEE group (data not shown). received at their medical center – more than 85% of peo- Although nonsatisfaction scores regarding sexual ple in Africa and Europe reported so. However, nonsatis- problems are similar to the other aspects, this category faction (i.e., unsatisfied and very unsatisfied) in this item shows the worst satisfaction reports (Fig. 2E). In line accounted for ~ 30% of CSA answers (Fig. 2A). with this, greater nonsatisfaction scores are seen as the Regarding psychological problems, over 25% of Afri- age group is older (data not shown). can and CSA participants report nonsatisfaction when We then asked our participants two questions regard- ing their practitioner’s labor. Most Africans and CSA Grosso et al. AIDS Research and Therapy (2023) 20:10 Page 5 of 10 Table 3 Patient’s situation data sorted by age group, expressed as the percentage of affirmative answers Section Parameter assessed 50–55 56–65 66–75 > 75 Sig. General information Good Overall health perception 81.5 69.9 69.4 91.7 0.008 Retired 26.9 53.8 98.9 100 < 0.001 Exercise Minimum 62.9 66.8 68.1 84.6 0.350 Regular 43.1 43.0 45.6 53.8 0.858 Regular eating habit 89.5 91.3 97.7 92.3 0.129 Struggles to remember taking ART​ 13.0 9.9 7.1 23.1 0.207 Undetectable viral load 78.8 73.0 60.8 63.6 0.020 Living alone 29.8 34.4 45.1 69.2 0.003 HIV status sharing 62.0 53.1 40.0 30.8 0.001 Financial problems 39.0 46.2 34.5 23.1 0.082 Psychological problems Weariness 39.7 47.4 39.5 30.8 0.207 Depression 32.7 33.6 27.3 0.0 0.097 Loneliness 27.7 29.7 31.8 15.4 0.619 Memory problems 28.0 29.1 16.7 23.1 0.143 Mean score 32.0 35.0 28.8 17.3 – Social sphere Active social life 70.7 58.4 54.4 46.2 0.005 Active sexual life 58.3 49.7 30.3 7.7 < 0.001 Has Friends and Family 88.0 80.3 71.4 83.3 0.004 Mean score 72.3 62.8 52.0 45.7 – Specific/geriatric conditions Sleep 38.1 42.8 42.2 50.0 0.638 Hearing 21.1 24.2 29.7 46.2 0.106 Visual 59.4 50.7 43.3 69.2 0.025 Mobility 21.2 24.1 38.2 23.1 0.016 Sexual 23.0 26.3 32.9 20.0 0.359 Mean score 32.6 33.6 37.3 41.7 – CSA Center and South America, WE Western Europe, SEEE South Eastern and Eastern Europe believe their doctor should see them > 3 times a year, from patients from different countries. Briefly, our data while most Europeans said that 1–2 times would be show relevant differences in the self-perceived patient’s enough (Fig. 3). Interestingly, when asked about man- situation and satisfaction with healthcare between agement of other conditions, most Africans and nearly regions. 50% of Western and Eastern Europeans preferred their The aging process among PLWH is particular. Together HIV specialist (86%, 46%, and 53% respectively). Over a with HIV infection, social circumstances, relationship half of patients in CSA preferred other specialist (54%) issues, comorbidities and stigma may have an impact on (Fig. 3). their HRQOL [23, 28, 29]. For example, according to the Healthy Aging Score criteria developed by the Rotter- Discussion dam group (an aging score accounting for mental health, Given the efficacy of cART, HIV infection is no longer cognitive function, physical, social support, and quality a life-limiting condition. Nowadays, a special focus of life in general population) [30], a study carried out in needs to be made in addressing the quality of life of the OPWH at a tertiary HIV care clinic in Toronto found that extended life expectancy. Health needs in the elderly only 39% of participants matched the healthy aging range are different from that of other age groups, posing clini- scoring [21]. Following this line, another study found that cians to the additional challenges associated with aging. socio-economic status was significantly correlated to Patient-generated health data, albeit presenting limita- mental and physical HRQOL after adjusting for disease tions, is a useful tool to gain insight and improve the care severity in a German cohort of over 700 OPWH [19]. The provided by physicians in the aging population world- first stage of our questionnaire consisted of a self-per- wide, and thus increase the efficiency of the healthcare ceived evaluation of the current patient’s situation. Sur- system [27]. Here, we assessed the needs of the PLWH prisingly, we found that the eldest group (>75 years old) aged 50 years or over using a questionnaire collected showed the best health perception, despite scoring the Grosso et al. AIDS Research and Therapy (2023) 20:10 Page 6 of 10 Fig. 1 Average section scores sorted by both location and age group. CSA: Center and South America; WE: Western Europe; EEI: Eastern Europe and Israel highest on geriatric problems and the lowest in the social them live alone, very low HIV disclosure (41,9%) and, an sphere. This could be explained by considering that these alarming piece of information, less than 50% show unde- people report a high score in close friends and family and tectable viral load. Social factors might be associated to the lowest score in psychological problems and financial HIV being a highly stigmatizing, taboo topic, leading to problems. In addition, this group reported higher levels poor ART adherence thus affecting viral load. WE, CSA of exercise, and that all of them are retired. Of note, this and Africa show higher sharing scores (63.7%; 76.4% group consisted of only 13 people. Future studies should and 90.5%, respectively) and over 90% of them report collect data in OPWH over 65 years old, especially within undetectable viral load. Other remarkable result is that Africa and CSA to be able to appropriately assess their up to a fifth of African participants admitted forgetting situation. taking ART. This could probably be explained by a lack It is remarkable that patients in Africa report a great of consciousness about the importance of good adher- health perception despite a high score in depression, ence, considering other unmet needs. Similarly to others, financial problems and loneliness. A similar pattern is our results show high rates of poor adherence. A recent seen in CSA, where social problems seem to be central. meta-analysis of ART adherence on Sub-Saharian Africa On the other hand, EEI participants reported the lowest yielded that only three fourths of OPWH (>50 years old) health perception score, probably associated with worse are adherent to cART [34]. These are relevant region- social and loneliness scores. WE show better scores in specific starting points that highlight where we should social and financial problems, but lower scores in health strengthen our efforts to. perception. OPWH are at high risk of geriatric syndromes such as HRQOL is an essential component of health in PLWH, frailty, polypharmacy, and falls [8]. Pre-frailty and frailty plus it contributes to other medical outcomes such as affect more than 50% of effectively treated OPWH and is HIV infection progression [31]. In line with this, HIV associated with an increased risk of adverse health out- status sharing is a personal decision and has been related comes that contribute to the overall reduced survival and to cART adherence, viral load suppression and preven- HRQOL of PLWH [35]. In line with this, as expected, tion of HIV infection, particularly disclosure to sexual our results show a tendency to develop geriatric condi- partners [32, 33]. Supporting previous data, people in tions as patients are older, with no significant differences EEI report a relatively low social score (56.4%), 40,2% of among regions. Africa and CSA are the regions with Grosso et al. AIDS Research and Therapy (2023) 20:10 Page 7 of 10 Fig. 2 A: Patients’ satisfaction about their attention received. CSA: Center and South America; WE: Western Europe; EEI: Eastern Europe and Israel. B: Patients’ satisfaction about the management of psychological needs. CSA: Center and South America; WE: Western Europe; EEI: Eastern Europe and Israel. C: Patients’ satisfaction about tracking of geriatric conditions. CSA: Center and South America; WE: Western Europe; EEI: Eastern Europe and Israel. D: Patients’ satisfaction about social problems assessment. CSA: Center and South America; WE: Western Europe; EEI: Eastern Europe and Israel. E: Patients’ satisfaction about sexual problems management. CSA: Center and South America; WE: Western Europe; EEI: Eastern Europe and Israel more unsatisfied OPWH, a phenomenon that intensifies perspective. A suitable strategy to this would be consid- in older age groups, although general health perception ering sexual sphere while interviewing our patients. is better in overall than in Europe. This stands out the General care of OPWH should consider both HIV- needs of these patients for a more comprehensive care. related and age-related conditions. A Patient-Centered Additionally, sexual activity plays a significant role in the Care [41] approach should be considered as the main individual’s satisfaction and has often been ignored when strategy, since it attends access to care, emotional sup- analyzing health of older people [36–38]. HIV diagnosis port, physical comfort, and respect for patient’s prefer- and the fear of transmission have a big impact on sex- ences, among other principles. Patient-Centered Care ual life [39, 40], despite the efforts of campaigns such as is accomplished by collaborative work between the “Undetectable equals Untransmissible” (U=U). Our find- patient and an interdisciplinary team, which facilitates ings are in line with literature and highlight the impor- active patient involvement in decision making [42]. To tance of discussing the sexuality of OPWH from an open offer appropriate management, care providers should Grosso et al. AIDS Research and Therapy (2023) 20:10 Page 8 of 10 Fig. 3 Patients’ opinions on practitioner’s role. CSA: Center and South America; WE: Western Europe; EEI: Eastern Europe and Israel predict the demands of aging population and change HIV specialist. On the other hand, people in CSA mostly both approach and goals of their offered care [5]. Our answered that other specialists should do it. In WE and results highlight the importance of this matter by show- EEI, half of them prefer their HIV physician, and the ing how the patient needs vary by region and age group. other half would think that either their general practi- However, needs change from patient to patient, so it is tioner or other specialist should do it. important the implementation of Patient Reported Out- In line with this, people from Africa and CSA are the comes (PROs) and the multidisciplinary geriatric assess- least satisfied with the healthcare attention they receive ment of these subjects. Although our study is a screening, for functional, psychological and social problems. Over it could be considered by care providers to better under- a half of patients in Africa and CSA would prefer to stand OPWH demands and direct their efforts towards see their doctor with a higher frequency than every 6 them. months, whereas most Europeans are content with their The second part, which addressed for patients’ satis- situation, and would consider reducing their medical faction about their healthcare, reflected how different visits to one annually. Again, essential unmet and met healthcare systems are structured. For instance, in Africa, needs may be the key to understanding this outcome Our HIV checkpoints are often more accessible than conven- study had several limitations. First, we did not know for tional healthcare. Patients may not need to travel as far, how long patients had been living with HIV, which could or wait as much as they would in a public hospital. This determine health perception and other psychological might be why there was an overwhelming response in and social matters addressed in our study. With only 25 African patients when they were asked who should man- people addressed, Africa is much underrepresented. On age their other conditions – 81% of them answered their top of that, none of those patients was over 65 years old, Grosso et al. AIDS Research and Therapy (2023) 20:10 Page 9 of 10 which means that the needs of African OPWH were not Author contributions Conceptualization: EN, BC, PC; Methodology: GD, MV, MS, JRB, DG, TK, CL, TW; fully measured. Similarly, in CSA there was no data col- Formal analysis and investigation: TMG; Writing—original draft preparation: lected for the age group of >75 years old. In fact, only 2% TMG; Writing—review and editing: EN, DH-S, OS; Resources: EN; Supervision: of our participants were over 75 years old, making it diffi- BC, OS, PC, EN. All authors read and approved the final manuscript. cult to draw strong conclusions on this age group. As this Funding study relies on declarative data, we cannot rule out that No funding was required to carry out this research. some participants may have provided inaccurate details. Availability of data and materials Finally, these results were collected in 2018, which means All data and materials support our published claims and comply with field that current situation of OPWH may have changed after standards. the COVID-19 burden and the Russian massive invasion on Ukraine, especially in EEI. Indeed, a recent meta-anal- Declarations ysis highlighted the effect that the COVID-19 pandemic Ethics approval and consent to participate had in sexual heath, including disruptions in HIV/STI This work was approved by the corresponding ethic committees. Verbal testing, and changes in sexual behaviors [43]. Prospec- informed consent was obtained prior to the interview. tive studies should be carried out since they allow us to Consent for publication understand a wider scope of needs among HIV aging Not applicable. population, as well as the determining factors to improve treatment results based on patients’ needs. Competing interests Authors declare no conflict of interest nor competing interest regarding this work. Conclusions Targeting care and services for the HIV aging population Author details 1 Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina. should be based on individual patients’ needs. OPWH 2 Laboratorio de Inmunología, Universidad Nacional de Luján, Buenos Aires, needs differ depending on both geographical location Argentina. 3 Lluita contra les Infeccions, Hospital Universitari Germans Trias i and age. In EEI, we found that socializing HIV and reach- Pujol, Badalona, Spain. 4 Universitat Autònoma de Barcelona, Barcelona, Spain. 5 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty ing undetectable viral load would be the main goals. of Medicine, University of Belgrade, Belgrade, Serbia. 6 Lviv Regional Public CSA participants are the least satisfied regarding their Health Center, Lviv, Ukraine. 7 HIV and STD Unit, Hospital de Bellvitge, Barce‑ healthcare, which could be due to higher expectations lona, Spain. 8 Infectious Disease Department, Hospital Universitario San Pedro - CIBIR, Logroño, Spain. 9 Adhara HIV/AIDS Association, Sevilla Checkpoint, or profound inequities in the region. Africans show the Seville, Spain. 10 Department of Infectious Diseases, Poltava State Medical Uni‑ best health perception, and their satisfaction reports mir- versity, Poltava, Ukraine. 11 AIDS Research Institute‑IRSICAIXA, Hospital Universi‑ ror a system where general health is hard to achieve, but tari Germans Trias i Pujol, Badalona, Spain. 12 AIDS Research Institute‑IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, international aid on HIV-related problems is much more Badalona, Spain. 13 Universitat de Vic - Universidad Central de Catalunya (UVIC- appealing to them. WE is the most developed region UCC), Vic, Spain. studied and their participants report the best satisfaction Received: 7 September 2022 Accepted: 1 December 2022 scores. On top of that, our study data emphasizes that this population requires functional, psychological, and emotional support overall. 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More Than 20 Years of Research into • rapid publication on acceptance the Quality of Life of People with HIV and AIDS— A Descriptive Review • support for research data, including large and complex data types of Study Characteristics and Methodological Approaches of Published Empirical Studies. J Int AssocProvid AIDS Care. 2012;12(1):18–22. • gold Open Access which fosters wider collaboration and increased citations 29. Hsieh E, Polo R, Qian HZ, Fuster-RuizdeApodaca MJ, del Amo J. Intersec‑ • maximum visibility for your research: over 100M website views per year tionality of stigmas and health-related quality of life in people ageing with HIV in China, Europe, and Latin America. Lancet Healthy Longev. At BMC, research is always in progress. 2022;3(3):e206–15.. 30. Jaspers L, Schoufour JD, Erler NS, Darweesh SKL, Portegies MLP, Sedaghat Learn more biomedcentral.com/submissions S, et al. Development of a Healthy AgingScore in the Population-Based