You gotta walk the walk to talk the talk: protocol for a feasibility study of the Happy Older Latino Adults (HOLA) health promotion intervention for older HIV-positive Latino men
Pilot and Feasibility Studies volume 9, Article number: 32 (2023)
Older Latinos living with the human immunodeficiency virus (HIV) have been disproportionately affected by the epidemic and experience compounded health disparities that have deepened over time. These health disparities are largely related to lifestyle and are either preventable or amenable to early detection or intervention. Despite existing resources to deliver an intervention to reduce this compounded health disparity, there is little information on the effects of health promotion interventions on indices of cardiometabolic risk in midlife and older Latinos living with HIV. The Happy Older Latinos are Active (HOLA) intervention is an innovative health promotion program that is uniquely tailored to meet the diverse needs and circumstances of older Latinos with HIV. The goal of this manuscript is to describe the protocol of a feasibility study of the HOLA health promotion intervention for older HIV-positive Latino men.
HOLA, which is informed by Behavioral Activation and Social Learning theory is a community health worker (CHW)-led, multicomponent, health promotion intervention consisting of: (1) a social and physical activation session; (2) a moderately intense group walk led by a CHW for 45 min, 3×/week for 16 weeks; (3) pleasant events (e.g., going to brunch with friends) scheduling. Eighteen community dwelling Latinos living with HIV aged 50+ will be recruited for this feasibility study adapting the HOLA intervention. Participants will be assessed at three time points (baseline, post-intervention, and 3 months post-intervention) on measures of cardiometabolic risk factors (waist circumference, dyslipidemia, hypertension, and glucose), psychosocial functioning, and health-related quality of life.
If HOLA can be delivered successfully by CHWs, then the scalability, accessibility, and potential for dissemination is increased. Additionally, this study will inform feasibility and identify modifications needed in the design of a larger hypothesis testing study.
Clinicaltrials.gov Identifier: NCT 03839212. Date of Registration: 8 February, 2019.
Due to the changing landscape of the human immunodeficiency virus (HIV) epidemic, older adults are living with HIV at rates higher than ever before. In 2018, the prevalence of diagnosed HIV infection in the USA was 374.6 per 100,000 population with an increased number of estimated cases affecting older Americans over the age of 50 . Even though HIV is no longer a death sentence due to the development of effective antiretroviral therapy (ART) and other HIV focused therapeutics, significant disparities in treatment outcomes persist among certain demographics. In general, HIV continues to not only affect racial/ethnic minorities at higher rates, but also gay, bisexual, and men who have sex with men (MSM) compared to their cis-gender heterosexual white counterparts . Therefore, research must look to the intersections of age, race, ethnicity, and sexual identity in developing interventions that may best support those most at risk for poor HIV-related treatment outcomes.
Significantly more people living with HIV (PLWH) are living into older adulthood demonstrating a growing need for HIV-focused research and treatment examined through an aging lens. According to 2018 CDC data, more than half of PLWH in the USA are over the age of 50 years  with predictions that by the start of 2021 almost 70% of PLWH in the USA will be at least 50 years old . Older adults are often diagnosed with HIV much later (~ 4.5 years after infection) indicating more advanced disease progression associated with the epidemic among this age group . Additionally, for PLWH in the USA aged 55 and above, while 90% knew their HIV status, only 64% were virally suppressed and barely more than half (57%) were actively engaged in care, suggesting that the UNAIDS “90-90-90” goals toward ending the HIV epidemic by 2050  are currently out of reach among older adults living with HIV (OALWH) .
Latinos have been disproportionately affected by HIV since the origins of the epidemic, and that increased vulnerability has deepened over time. Despite representing less than 20% of the entire U.S. population, Latinos make up 27% of new HIV diagnoses and account for over 20% of the national prevalence . More specifically, Latino sexual minority men (LSMM) are responsible for almost 25% of new HIV infections among all gay, bisexual, and MSM identified individuals  despite Latino men making up less than 9% of the entire U.S. population . These disparities persist beyond just HIV incidence with Latino identified PLWH facing additional challenges with their HIV treatment care due to suboptimal rates of viral suppression [7, 8] and ART adherence  compared to their non-Latino SMM peers.
Unsurprisingly, these racial/ethnic disparities become significantly more observable among older adults. Older Latinos in the USA are slightly more than 5 times more likely to acquire HIV  and are more likely to have an AIDS diagnosis, detectable viral load, and poorer treatment adherence compared to their age-matched white non-Latino counterparts [11, 12]. Additionally, older Latinos seem to exhibit mild to moderate cognitive impairment in learning, memory, and processing speed compared to their non-Latino white peers [12, 13]. It is likely that these intersecting social determinants (i.e., age, race/ethnicity, sexual identity) will continue as the HIV population ages and that many of these poor health outcomes will be felt most intensely by older Latinos.
Older Latinos living with HIV experience various physical health disparities due to their intersecting minority status that must be considered. In general, OALWH face increased rates of age-related comorbidities due to a phenomenon called accelerated aging [14, 15]. Data from a large observational cohort study of OALWH reported that over 77% of participants reported suffering from two or more health comorbidities in addition to HIV  with the average number of physical comorbidities per participants landing at three . In particular, older HIV-positive Latino individuals are disproportionately affected with cardiometabolic diseases including metabolic syndrome (MetS), a precursor to diabetes, as well as cardiometabolic risk factors such as obesity and hypertension compared to their non-Latino older white peers [18,19,20]. Moreover, older Latinos living with HIV are more likely to be sedentary and not as actively engaged in pursuing changes in their physical activity compared to their non-Latino white counterparts . Despite evidence of the “Hispanic ParadoxFootnote 1” , this lack of physical activity in combination with possible issues connected to ART medication and Hepatitis-C co-infection make older Latino adults living with HIV more likely to suffer from other complicating physical conditions like nonalcoholic fatty liver disease [23, 24] and cardiovascular issues compared to their non-Latino white counterparts.
Older Latinos living with HIV face elevated rates of mental health concerns in addition to these physical comorbidities. More generally, OALWH have documented rates of major depressive episodes anywhere between 18 and 52% [17, 25, 26], significantly higher than the 1–8% documented rates of depression among older adults in the general population . Rates of social isolation in the general aging public (60 years or older) are estimated to be anywhere between 33% and 50%  with evidence suggesting that OALWH face social isolation more often than their age matched peers in the general population [29, 30]. Similarly, there is strong evidence to suggest that loneliness exponentially increases with age and one could predict OALWH bear even a greater amount of loneliness due to reduced social networks and ostracism [31, 32]. Additionally, loneliness and social isolation have been correlated with levels of morbidity and mortality comparable to more established biopsychosocial risk factors like obesity, sedentary behavior, smoking, and hypertension [28, 33, 34].
For OALWH, one of the biggest contributing factors to loneliness and social isolation is that of co-occurring stigma. While exact estimates of HIV stigma and age-related stigma in the USA are hard to calculate, OALWH must often navigate the dueling stigmas of HIV stigma, ageism, and stigma resulting from other possible marginalized identities [35,36,37]. It is possible that rates of stigma and loneliness seem to skyrocket in OALWH due to the increased likelihood that OALWH live alone and have limited and often inconsistent social networks [25, 37]. OALWH can face ostracism from the larger LGBTQ+ community and stigma due to the intersection of their age and HIV status compared to their non-infected peers which may in turn contribute to the increased levels of depression among this already vulnerable population . Additionally, since familism and social cohesion are strong hallmarks of Latino culture [39, 40], Latino OALWH may experience the harmful effects of co-morbid stigma and social isolation more intensely than their non-Latino HIV-positive peers due to societal expectation that they be more connected to family as they age; however, more research must be conducted to determine the veracity of such a hypothesis.
As outlined above, compounded health disparities place older Latinos living with HIV at particularly high risk for diminished quality of life due to physical and mental health morbidity. These data underscore the public health importance of increased efforts to address the multiplicative and unequal burden of HIV, MetS, and diabetes shouldered by older Latinos. Therefore, based on this gap in the literature, there is a compelling need to develop and disseminate interventions that promote healthy living, combat social isolation, and improve HIV-related health outcomes among older Latinos living with HIV. The goal of this manuscript is to describe the protocol of a feasibility study of the Happy Older Latinos are Active (HOLA) health promotion intervention for older HIV-positive Latino men. Since this is a feasibility study, researchers will be focused on evaluating the feasibility of recruitment, retention, assessment procedures, and acceptability of an innovative application of an already established health promotion intervention, HOLA, to a new population, older Latino men living with HIV . Also, in accordance with recommendations from biostatistical workgroups funded by NIH , this study will not powered to test a hypothesis. Rather, this study will serve as an initial step in establishing feasibility and acceptability of an approach that is intended to ultimately be used in a larger scale study. The specific aims of this study will be to:
Evaluate the feasibility of recruitment, assessment procedures, retention, acceptability, and implementation of HOLA in a sample of midlife and older Latinos with HIV.
Identify modifications needed in the design of a larger, confirmatory randomized controlled trial.
Explore changes in cardiometabolic risk factors (waist circumference, dyslipidemia, hypertension, and glucose), psychosocial functioning (depression and anxiety severity, social support), and health-related quality of life in a sample of midlife and older Latinos with HIV enrolled in the HOLA health promotion intervention.
All study methods, protocols, and participant incentive structures were approved by the university’s Internal Review Board (IRB ID: 20181032). In addition, a SPIRIT checklist has been completed to serve as a brief, structured summary of the trial. See Table 1.
This feasibility study will enroll 18 Latino older (aged 50+) men living with HIV who will then be assigned to three intervention groups composed of 6 participants each. Although small, this sample size is consistent with similar feasibility studies focused on physical activity among older adults [43, 44] and will be large enough to establish feasibility of the intervention in a population of older Latino men living with HIV. Additionally, informed consent will be obtained from each participant prior to enrollment and all enrollees will be provided with an initial verbal summary of the study. Payments will be graduated so participants received $15 on the first visit, $25 on the second visit, and $35 on the third visit (total of honoraria = $75). Financial incentives have the potential to serve as undue inducements by diminishing peoples’ sensitivity to research risks or unjust inducements by preferentially increasing enrollment among underserved individuals. However, results from two low-risk randomized clinical trials indicate that there is no evidence from studies of participation in hypothetical or real randomized clinical trials that incentivizing enrollment is undue or unjust, suggesting that studies that offer participation incentives are not unethical . For a detailed description of the inclusion/exclusion criteria, see Table 2.
Participants will be recruited through two consent-to-contact databases with over 1200 participants each—one of people with HIV (recruited from the university-affiliated adult HIV clinic) and another focused on a community needs assessment (composed of HIV-negative and HIV-positive community dwelling adults). These databases include contact information, demographic information and data associated with HIV-related risk factors such as homelessness and psychological distress. Only participants who had indicated that they were HIV+ will be recruited from these databases. More information on how these consent to contact databases work can be found here .
The conceptual model which serves as the foundation for the intervention (Fig. 1) was crafted to address comorbid depression and anxiety symptoms as well as both physical and psychosocial functioning of older Latinos. HOLA, is informed by Behavioral Activation (BA)  and Social Learning Theory (SLT) . A major component of BA is scheduling activities into an individual’s day-to-day routine as a way of activating them out of a depressive episode. In HOLA, we incorporated components of BA in two ways. First, we encouraged participants to engage in a physical activity routine (i.e., an activity) and to schedule in pleasant events to their day-to-day (i.e., activity scheduling) to combat incident and recurrent episodes of depression and anxiety disorders as well as subdue symptom intensity . As a complement, SLT’s tenets of reinforcement, observational learning, and enhanced self-efficacy are utilized to bolster participant engagement and success in the intervention . The relationship between the participants and the community health worker (CHW) capitalizes on the personal relationship to motivate, model, and maintain health behavior change.
CHWs are an effective and culturally acceptable means of reaching the population with health information and motivating health behaviors [49, 50]. CHWs are lay community members who work almost exclusively in community settings and connect consumers to providers in order to promote health and prevent diseases among groups that have traditionally lacked access to adequate care . CHWs are assumed to be effective because they possess an intimate understanding of community social networks and health needs; communicate in a similar language; and recognize and incorporate culture to promote health [49, 50]. The use of CHWs has emerged as a strategy to reduce or eliminate health disparities and is an important means of task shifting to enable efficient utilization of scarce mental health resources (see footnote below)Footnote 2. Additionally, since engaging in health behavior change via physical activity is challenging, the HOLA intervention offers several opportunities for participants to be held accountable to their goals in the intervention. The CHW holds the individuals accountable, and individuals hold themselves accountable to the group, providing extra motivation to engage in the intervention. Accountability is an ideal way to help participants maintain their commitment, keep their energy and enthusiasm high and feel like they are not alone . CHWs in this study will be trained in the HOLA intervention protocol and supervised by the senior author.
Happy Older Latino Adults (HOLA) is a multi-component health promotion intervention for midlife and older Latinos . The first component consists of two manualized social and physical activation sessions. Prior to beginning the group walk phase, each participant will meet individually with a CHW for a 30-min physical and social activation session to (a) educate potential participants about the goals of the intervention; (b) provide information surrounding HIV/AIDS, cardiometabolic disorders such as diabetes and metabolic syndrome, how these physical conditions impact mental health, and ways they can improve their cardiometabolic health; (c) motivate participants to engage in physical activity; (d) increase participants’ social activities (e) identify potential obstacles that may interfere with meeting the demands of the intervention; and (f) brainstorm ways to overcome these obstacles. After week 8, participants will again meet one-on-one with the CHW for the second session so that they could discuss their own individual progress in relation to their physical and social activity goals.
The second component is centered around a group walk meant to facilitate both physical activity and social interaction between participants. This group walk will meet for 45 min, three times a week, for a total of 16 weeks. The group walk component was designed with interval training in mind and gradually increases in workload (defined by intensity, volume, and work/recovery cycle) over the course of the intervention. Each group walk will begin with 10 min of stretching and warm up, followed by 30 min of walking, and will end with 5 min of stretching/cool down. Each group walk will be led by the CHW and will be composed of six bilingual and monolingual Spanish-speaking participants.
The third component consists of scheduling pleasant events. During the cool down phase of each walking session, the CHW will ask each participant to identify a pleasant event that they intend to do with another person before the next meeting (e.g., going to brunch with friends). Individuals may choose to do this activity with another member of the group, with family, or with friends outside the group. Subsequent sessions will start with participants reporting on how effectively they implemented their pleasant event plan while the CHW and the group provide positive reinforcement and feedback. This component provides a means to generalize the intervention into the participants’ everyday lives and relationships. Participants will walk at a centrally located public park, which is owned and operated by the Miami-Dade County Parks and Recreation Department.
The fourth and final component of HOLA in the context of this feasibility study focuses on maintaining behavior change gleaned during intervention. Participants will engage in “booster” walking sessions, twice a month for 3 months post-intervention (starting the week after the 16-week program concluded) to capitalize on beneficial physical and mental health effects gained during the 16-week program. Encouraged by the prior literature, this maintenance phase was added to this feasibility study with the hopes of cultivating more sustained treatment effects over time . A more in-depth overview of the HOLA intervention can be reviewed in the main protocol paper published by Jimenez and colleagues . Adaptations made to the original HOLA intervention to make it specific to a sample of OALWH can be found in Table 3.
Measures and analysis
This quasi-experimental feasibility study of an adapted health promotion intervention will examine feasibility of recruitment, assessment procedures, retention, acceptability, and implementation of HOLA in a sample of older Latinos living with HIV. In keeping with guidance from NIH funded biostatistical workgroups, this feasibility study was not designed to be powered to test a hypothesis . Additionally, the proposed analysis of feasibility data parallels a similar structure employed in the first HOLA trial and comparable feasibility trials [41, 53]. For this study, successful recruitment will be defined as 100% of the targeted sample (N = 18) be enrolled and less than 20% of eligible subjects refusing to participate. Additionally, adequate retention will be characterized as 85% or more of enrolled participants completing all post-intervention assessments while acceptability will be defined as participants attending at least 80% of sessions. Finally, with goals of scaling up the intervention in the future, an established project evaluation questionnaire developed by investigators at the University of Miami will be used to pinpoint any modifications needed for the design of a larger, confirmatory randomized control trial. The questionnaire is made up of a series of closed ended yes/no questions, rating scales, and open-ended questions that allow for more qualitative data regarding participants’ opinions of the specific components of the overall intervention. Study measures will be administered at baseline, end of intervention, and 3 months post-intervention. Trained research assistants (RA) will administer all of the assessments.
Study feasibility will be evaluated via participant recruitment, retention, and acceptability of the overall intervention. First, authors will measure study feasibility via recruitment and retention of eligible participants. For this study, successful recruitment will be defined as 100% of the targeted sample (N = 18) be enrolled and less than 20% of eligible subjects refusing to participate. Additionally, adequate retention will be characterized as 85% or more of enrolled participants completing all post-intervention assessments. Second, authors will assess participant acceptability of the intervention as another component of study feasibility. For this study, acceptability will be defined as participants attending at least 80% of sessions. Finally, to identify any specific challenges to scaling up the intervention in the future, an established project evaluation questionnaire developed by investigators at the University of Miami will be used to pinpoint any modifications needed for the design of a larger, confirmatory randomized control trial. The questionnaire is made up of a series of closed ended yes/no questions, rating scales, and open-ended questions allowing for more qualitative data on participants’ opinions of the specific components of the intervention to improve the overall feasibility of the study for future iterations of implementation.
Based on our exclusion criteria, participants will complete the Mini-Mental Status Exam (MMSE)  to recognize potential subjects with dementia or severe cognitive abnormalities. To establish baseline walking ability, eligible participants will be required to complete the 10-m walk test which has been shown to have not only excellent reliability when used in older adult populations, but also be comparable in validity with other longer measures . Participants’ viral load will be ascertained to determine viral suppression which is defined as < 200 copies/mL . Potential participants will self-confirm safe participation by not having an acute or severe medical illness.
Just prior to baseline, blood draws will be completed at the university affiliated adult HIV outpatient clinic from which participant recruitment will take place. These blood draws will yield baseline data on participants’ levels of HDL-C, LDL-C, triglycerides, insulin, and HbA1c. Fasting blood samples will be drawn via venipuncture and stored at 4 °C until analysis could be completed. Homeostatic model assessment (HOMA) will be calculated, providing a measure of insulin resistance. All the samples will be evaluated by commercial laboratory services using commercially available enzyme-linked immunosorbent assays. Simultaneously, participant physical characteristics such as blood pressure and hip-to-waist circumference will be collected to complement the measures of glucose, insulin resistance, and blood lipid profile mentioned previously. All of these measurements of cardiometabolic risk will be collected immediately post-intervention, and 3 months post-intervention as well.
Measures of psychosocial functioning will be collected at all three timepoints as well -baseline, post-intervention, and 3 months post-intervention. To measure depression symptom severity, participants will complete the Center for Epidemiologic Scale of Depression , 9-item Patient Health Questionnaire , the Perceived Stress Scale , and the 7-item Generalized Anxiety Disorder scale to ascertain anxiety symptom intensity . Finally, participants’ perceived social support will be measured by the frequently used and validated Multidimensional Scale of Perceived Social Support .
Additional measures will be administered to participants to gain more insight on factors of acculturation, physical activity, stigma, quality of life, and overall patient satisfaction. At baseline, participants will complete a demographics form, provide a list of current medications, and respond to the Bidimensional Acculturation Scale . Additionally, at all three time points-baseline, post-intervention, and 3 months post-intervention—subjects will be asked to complete the Global Physical Activity Questionnaire , the 12-item Short Form health survey , and the HIV Stigma Scale  to measure their overall physical activity levels, general health-related quality of life, and HIV-related stigma participants face on a day-to-day basis. Finally, participants will complete a project evaluation questionnaire developed by the investigators to indicate individual satisfaction in the intervention.
The total sample size for this pilot study will be 18 older Latino men living with HIV. A sample size of 18 will allow researchers to conduct three separate intervention groups of 6 people each. Prior work conducted by the authors indicated that 6 participants per intervention group was the optimum size to generate social interaction between participants, guard against attrition, while still being manageable for the CHW . Although small, this sample size is consistent with similar pilot studies focused on physical activity among older adults [43, 44] and will be large enough to establish feasibility of the intervention in a population of older Latino men living with HIV.
Anticipated statistical analysis plan
In keeping with guidance from NIH funded biostatistical workgroups, this pilot study was not designed to be powered to test a hypothesis . Therefore, since this study is designed to be a small pilot feasibility trial, best practices caution against using hypothesis testing in that they are likely to produce non-significant p values due to the study being underpowered. The CONSORT extension considers the use of descriptive statistics with 95% confidence intervals as more meaningful, an approach that parallels a similar structure employed in the first HOLA trial and comparable pilot trials [41, 53]. For variables continuous variables that are normally distributed, data will be analyzed and summarized using means and standard deviations. Alternatively, for continuous variables that are skewed, the median and range will be presented. Furthermore, data generated from categorical variables will be analyzed and summarized using counts and percentages (Fig. 2).
As the population of PLWH increasingly ages, high comorbidity between HIV and cardiometabolic diseases make older Latinos a high-risk population for whom innovative, scalable health promotion intervention could make a significant and lasting public health impact . Despite the fact that older Latinos with HIV experience high levels of cardiometabolic disease due to issues associated with accelerated aging or potential adverse effects of ART medication, there is still a considerable dearth of relevant information on the effects of positive health promotion interventions in older Latinos living with HIV and comorbid cardiometabolic illness. Currently in preparation for a n adequately powered randomized control trial (e.g., securing grant funding), this study will generate evidence as to whether an already established health promotion intervention, HOLA, can be adapted for older Latino men with HIV to improve physical health, psychosocial functioning, and health-related quality of life in the midst of a rapid demographic transition. Authors are optimistic that this pilot project will yield significant results because this study builds upon prior work by authors delivering a health promotion intervention to prevent anxiety and depression in Latino older adults, a population living with high exposure to risk factors (comorbid physical and mental health conditions) and disparities in access to and engagement in mental health services .
The HOLA intervention is a multifaceted, innovative health promotion program that is uniquely tailored to meet the diverse needs and circumstances of older Latinos with HIV. Since many older adults who identify as racial/ethnic minorities hold stigmatizing views of mental health services [66, 67], HOLA builds on prior research and incorporates culturally relevant strategies to health promotion/behavior change as way of reducing mental and physical health risk factors among older Latinos with HIV . Specifically, the use of a CHW to deliver a dual mental/physical health promotion intervention is an innovative approach to minimize disease burden in a population with high exposure to risk factors (in addition to HIV) and established disparities in both access to and engagement in beneficial mental and physical health services [69,70,71]. We believe that such an approach will appeal to older Latinos with HIV at risk for cardiometabolic disorders and psychological distress because of its non-stigmatizing presentation and the incorporation of cultural values/beliefs that promote the varying sociocultural influences contributing to the health of Latinos.
High prevalence of HIV  combined with comorbid cardiometabolic diseases  makes older Latinos a high-risk population for whom scalable health promotion interventions could have great public health impact. Despite the high prevalence of cardiometabolic diseases in this population, there is a dearth of information on the effects of health promotion interventions on indices of cardiometabolic risk in midlife and older Latinos living with HIV. Thus, the study will provide valuable insight to evaluate the feasibility and acceptability of HOLA among HIV-infected Latinos aged 50 years and older and identify modifications needed in the design of a larger, ensuing hypothesis testing study. For example, there may be some challenges with attributing changes in cardiometabolic risk (blood pressure, fasting glucose, waist circumference) to the HOLA intervention using only three measurements in total over the intervention and post-intervention/maintenance phase. Some of these outcome measures may require more frequent measurement and others may change a very small amount over the short time period of the feasibility study. In addition, potential sustainability might be best measured by the drop-off after the last payment to the participants. With the evidence collected as part of the feasibility and acceptability trial, the authors plan to generate hypotheses concerning the intervention’s effects on cardiometabolic risk factors, psychosocial functioning, and health-related quality of life in a sample of midlife and older Latinos living with HIV.
Availability of data and materials
The Hispanic Paradox is an epidemiological finding first described by Markides and Coreil (1986) to describe the puzzling fact that despite having lower average income and education, Latinos tend to have better health outcomes compared to their non-Latino White peers.
Task shifting involves the strategic redistribution of tasks among the healthcare team and personnel. Specific tasks are moved, shared or delegated, usually from highly trained health workers to those with shorter training or fewer qualifications, including lay people. This approach has been advocated as an important strategy to address healthcare resource shortages expand healthcare capacity.
Happy Older Latinos are Active
Human immunodeficiency virus
Community health worker
United States of America
Men who have sex with men
People with HIV
Older adults with HIV
Latino sexual minority men
Sexual minority men
National Institutes of Health
Internal Review Board
Social learning theory
Mini-Mental Status Exam
High-density lipoprotein cholesterol
Low-density lipoprotein cholesterol
Homeostatic Model Assessment
Statistical Package for the Social Sciences
Analysis of variance
CDC. HIV and older Americans. Centers for disease control and prevention. https://www.cdc.gov/hiv/group/age/olderamericans/index.html. Accessed 28 Jan 2021. Published September 14, 2020.
CDC. Hiv and gay and bisexual men. Centers for disease control and prevention. https://www.cdc.gov/hiv/group/msm/index.html. Accessed 7 Oct 2020. Published September 16, 2020.
Karpiak SE, Lunievicz JL. Age is not a condom: HIV and sexual health for older adults. Curr Sex Health Rep. 2017;9(3):109–15. https://doi.org/10.1007/s11930-017-0119-0.
90-90-90: treatment for all | UNAIDS. https://www.unaids.org/en/resources/909090. Accessed 27 Jan 2021.
Centers for Disease Control and Prevention. COVID-19 in racial and ethnic minority groups. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html. Accessed 18 June 2020. Published February 11, 2020.
U.S. Census Bureau. Hispanic or Latino Origin by Specific Origin; 2018. https://data.census.gov/cedsci/table?q=hispanic%20or%20latino%20miami&g=0500000US12086&hidePreview=true&tid=ACSDT1Y2018.B03001&t=Hispanic%20or%20Latino&vintage=2018. Accessed 28 April 2020.
Crepaz N, Tang T, Marks G, Hall HI. Viral suppression patterns among persons in the United States with diagnosed HIV infection in 2014. Ann Intern Med. 2017;167(6):446–7. https://doi.org/10.7326/L17-0278.
Hood JE, Golden MR, Hughes JP, et al. Projected demographic composition of the United States population of people living with diagnosed HIV. AIDS Care. 2017;29(12):1543–50. https://doi.org/10.1080/09540121.2017.130846669.
Hoots BE, Finlayson TJ, Wejnert C, Paz-Bailey G. Updated data on linkage to human immunodeficiency virus care and antiretroviral treatment among men who have sex with men—20 cities, United States. J Infect Dis. 2017;216(7):808–12. https://doi.org/10.1093/infdis/jix007.
Linley L, Prejean J, An Q, Chen M, Hall HI. Racial/ethnic disparities in HIV diagnoses among persons aged 50 years and older in 37 US States, 2005–2008. Am J Public Health. 2012;102(8):1527–34. https://doi.org/10.2105/AJPH.2011.300431.
Cruz JJD, Karpiak SE, Brennan-Ing M. Health outcomes for older hispanics with HIV in New York City using the oaxaca decomposition approach. Global J Health Sci. 2015;7(1):133–43. https://doi.org/10.5539/gjhs.v7n1p133.
Mindt MR, Miranda C, Arentoft A, et al. Aging and HIV/AIDS: neurocognitive implications for older HIV-positive Latina/o Adults. Behav Med. 2014;40(3):116–23. https://doi.org/10.1080/08964289.2014.914464.
Marquine MJ, Heaton A, Johnson N, et al. Differences in neurocognitive impairment among HIV-infected Latinos in the United States. J Int Neuropsychol Soc. 2018;24(2):163–75. https://doi.org/10.1017/S1355617717000832.
Guaraldi G, Zona S, Alexopoulos N, et al. Coronary aging in HIV-infected patients. Clin Infect Dis. 2009;49(11):1756–62. https://doi.org/10.1086/648080.
Kalayjian RC, Landay A, Pollard RB, et al. Age-related immune dysfunction in health and in human immunodeficiency virus (HIV) disease: association of age and HIV infection with naive CD8+ cell depletion, reduced expression of CD28 on CD8+ cells, and reduced thymic volumes. 2003;187(12):1924-33.
Brennan M, Karpiak SE, Shippy RA, Cantor MH. Older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science; 2009.
Havlik RJ, Brennan M, Karpiak SE. Comorbidities and depression in older adults with HIV. Sex Health. 2011;8(4):551–9. https://doi.org/10.1071/SH11017.
Frontini M, Chotalia J, Spizale L, Onya W, Ruiz M, Clark RA. Sex and race effects on risk for selected outcomes among elderly HIV-infected patients. J Int Assoc Phys AIDS Care. 2012;11(1):12–5. https://doi.org/10.1177/1545109711404947.
Lombo B, Alkhalil I, Golden MP, et al. Prevalence of metabolic syndrome in patients with HIV in the era of highly active antiretroviral therapy. Conn Med. 2015;79(5):277–81.
Ramírez-Marrero FA, De Jesús E, Santana-Bagur J, Hunter R, Frontera W, Joyner MJ. Prevalence of cardio-metabolic risk factors in Hispanics living with HIV. Ethn Dis. 2010;20(4):423–8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071519/. Accessed 10 Jul 2020.
Ramírez-Marrero FA, Rivera-Brown AM, Nazario CM, Rodríguez-Orengo JF, Smit E, Smith BA. Self-reported physical activity in hispanic adults living with HIV: comparison with accelerometer and pedometer. J Assoc Nurs AIDS Care. 2008;19(4):283–94. https://doi.org/10.1016/j.jana.2008.04.003.
Markides KS, Coreil J. The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep. 1986;101(3):253–65 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477704/. Accessed 10 Jul 2020.
Guaraldi G, Squillace N, Stentarelli C, et al. Nonalcoholic fatty liver disease in HIV-infected patients referred to a metabolic clinic: prevalence, characteristics, and predictors. Clin Infect Dis. 2008;47(2):250–7. https://doi.org/10.1086/589294.
Merriman RB. Nonalcoholic fatty liver disease and HIV infection. Curr HIV/AIDS Rep. 2006;3(3):113–7. https://doi.org/10.1007/BF02696654.
Grov C, Golub SA, Parsons JT, Brennan M, Karpiak SE. Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care. 2010;22(5):630–9. https://doi.org/10.1080/09540120903280901.
Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008;47(3):384–90. https://doi.org/10.1097/QAI.0b013e318160d53e.
Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National epidemiologic survey on alcoholism and related conditions. Arch Gen Psychiatry. 2005;62(10):1097–106. https://doi.org/10.1001/archpsyc.62.10.1097.
Landeiro F, Leal J, Gray AM. The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporos Int. 2016;27(2) https://ora.ox.ac.uk/objects/uuid:77d7ac37-b6a1-498d-8368-47d9ea3c5fe0. Accessed 28 Jan 2021.
Brennan-Ing M, Seidel L, Karpiak SE. Social support systems and social network characteristics of older adults with HIV. HIV Aging. 2017;42:159–72. https://doi.org/10.1159/000448561.
Webel AR, Longenecker CT, Gripshover B, Hanson JE, Schmotzer BJ, Salata RA. Age, stress, and isolation in older adults living with HIV. AIDS Care. 2014;26(5):523–31. https://doi.org/10.1080/09540121.2013.845288.
Dykstra PA, van Tilburg TG, Gierveld JD. Changes in older adult loneliness: results from a seven-year longitudinal study. Res Aging. 2005;27(6):725–47. https://doi.org/10.1177/0164027505279712.
Cornwell EY, Waite LJ. Measuring social isolation among older adults using multiple indicators from the NSHAP study. J Gerontol B Psychol Sci Soc Sci. 2009;64B(suppl_1):i38–46. https://doi.org/10.1093/geronb/gbp037.
Luanaigh CO, Lawlor BA. Loneliness and the health of older people. Int J Geriatr Psychiatry. 2008;23(12):1213–21. https://doi.org/10.1002/gps.2054.
Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316. https://doi.org/10.1371/journal.pmed.1000316 J Infect Dis. 2003;187(12):1924-1933. doi:10.1086/375372.
Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10(5):473–82. https://doi.org/10.1007/s10461-006-9099-1.
Wilson DM, Errasti-Ibarrondo B, Low G. Where are we now in relation to determining the prevalence of ageism in this era of escalating population ageing? Ageing Res Rev. 2019;51:78–84. https://doi.org/10.1016/j.arr.2019.03.001.
Emlet CA. “You’re awfully old to have this disease”: experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. Gerontologist. 2006;46(6):781–90. https://doi.org/10.1093/geront/46.6.781.
Yoo-Jeong M, Hepburn K, Holstad M, Haardörfer R, Waldrop-Valverde D. Correlates of loneliness in older persons living with HIV. AIDS Care. 2019;0(0):1–8. https://doi.org/10.1080/09540121.2019.1659919.
Miyawaki CE. Association of social isolation and health across different racial and ethnic groups of older Americans. Ageing Soc. 2015;35(10):2201–28. https://doi.org/10.1017/S0144686X14000890.
Tomaka J, Thompson S, Palacios R. The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. J Aging Health. 2006;18(3):359–84. https://doi.org/10.1177/0898264305280993.
Jimenez DE, Reynolds CF, Alegría M, Harvey P, Bartels SJ. The Happy Older Latinos are Active (HOLA) health promotion and prevention study: study protocol for a pilot randomized controlled trial. Trials. 2015;16(1):579. https://doi.org/10.1186/s13063-015-1113-3.
Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45(5):626–9. https://doi.org/10.1016/j.jpsychires.2010.10.008.
Heckman TG, Sikkema KJ, Hansen N, et al. A randomized clinical trial of a coping improvement group intervention for HIV-infected older adults. J Behav Med. 2011;2(34):102–11. https://doi.org/10.1007/s10865-010-9292-6.
Rissel C, Passmore E, Mason C, Merom D. Two pilot studies of the effect of bicycling on balance and leg strength among older adults. J Environ Public Health. 2013. https://doi.org/10.1155/2013/686412.
Halpern SD, Chowdhury M, Bayes B, et al. Effectiveness and ethics of incentives for research participation: 2 randomized clinical trials. JAMA Intern Med. 2021;181(11):1479–88. https://doi.org/10.1001/jamainternmed.2021.5450.
Weinstein ER, Jimenez DE. Prioritizing recruitment: the benefits to using a disease registry to recruit older adults with HIV and intersecting identities. AIDS Care. 2022;8:1–5. https://doi.org/10.1080/09540121.2022.2085867 Epub ahead of print. PMID: 35676752.
Jacobson NS, Martell CR, Dimidjian S. Behavioral activation treatment for depression: returning to contextual roots. Clin Psychol Sci Pract. 2001;8(3):255–70. https://doi.org/10.1093/clipsy.8.3.255.
Bandura A. Social learning theory: Prentice-Hall; 1977.
Perez M, Findley SE, Mejia M, Martinez J. The impact of community health worker training and programs in NYC. J Health Care Poor Underserved. 2006;17(1):26–43. https://doi.org/10.1353/hpu.2006.0049.
Kenya S, Jones J, Arheart K, et al. Using community health workers to improve clinical outcomes among people living with HIV: a randomized controlled trial. AIDS Behav. 2013;17(9):2927–34. https://doi.org/10.1007/s10461-013-0440-1.
Barrera M Jr, Toobert DJ, Angell KL, Glasgow RE, Mackinnon DP. Social support and social-ecological resources as mediators of lifestyle intervention effects for type 2 diabetes. J Health Psychol. 2006;11(3):483–95. https://doi.org/10.1177/1359105306063321.
Martinson BC, Crain AL, Sherwood NE, Hayes M, Pronk NP, O’Connor PJ. Maintaining physical activity among older adults: six-month outcomes of the Keep Active Minnesota randomized controlled trial. Prev Med. 2008;46(2):111–9. https://doi.org/10.1016/j.ypmed.2007.08.007.
Jimenez D, Reynolds CF, Alegria M, Harvey PS, Bartels SJ. Preventing anxiety in depression in older latinos: the Happy Older Latinos are Active (HOLA) health promotion study. Am J Geriatr Psychiatry. 2017;25(3):S124. https://doi.org/10.1016/j.jagp.2017.01.156.
Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98. https://doi.org/10.1016/0022-3956(75)90026-6.
Peters DM, Fritz SL, Krotish DE. Assessing the reliability and validity of a shorter walk test compared with the 10-Meter Walk Test for measurements of gait speed in healthy, older adults. J Geriatr Phys Ther. 2013;36(1):24–30. https://doi.org/10.1519/JPT.0b013e318248e20d.
About #UequalsU | United States | Prevention Access Campaign. prevention. https://www.preventionaccess.org/about. Accessed 28 Jan 2021.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401. https://doi.org/10.1177/014662167700100306.
Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96. https://doi.org/10.2307/2136404.
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/archinte.166.10.1092.
Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the multidimensional scale of perceived social support. J Pers Assess. 1990;55(3-4):610–7 http://www.tandfonline.com/doi/abs/10.1080/00223891.1990.9674095. Accessed 17 Dec 2015.
Marin G, Gamba RJ. A new measurement of acculturation for hispanics: the Bidimensional Acculturation Scale for Hispanics (BAS). Hisp J Behav Sci. 1996;18(3):297–316. https://doi.org/10.1177/07399863960183002.
Bull FC, Maslin TS, Armstrong T. Global Physical Activity Questionnaire (GPAQ): nine Country reliability and validity study. J Phys Act Health. 2009;6(6):790–804. https://doi.org/10.1123/jpah.6.6.790.
Ware J, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33. https://doi.org/10.1097/00005650-199603000-00003.
Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29. https://doi.org/10.1002/nur.10011.
Conner KO, Copeland VC, Grote NK, et al. Mental health treatment seeking among older adults with depression: the impact of stigma and race. Am J Geriatr Psychiatry. 2010;18(6):531–43. https://doi.org/10.1097/JGP.0b013e3181cc0366.
Jimenez DE, Bartels SJ, Cardenas V, Alegría M. Stigmatizing attitudes toward mental illness among racial/ethnic older adults in primary care. Int J Geriatr Psychiatry. 2013;28(10):1061–8. https://doi.org/10.1002/gps.3928.
Jimenez DE, Begley A, Bartels SJ, et al. Improving health-related quality of life in older African American and Non-Latino White patients. Am J Geriatr Psychiatry. 2015;23(6):548–58. https://doi.org/10.1016/j.jagp.2014.08.001.
Tobias CR, Cunningham W, Cabral HD, et al. Living with HIV but without medical care: barriers to engagement. AIDS Patient Care STDs. 2007;21(6):426–34. https://doi.org/10.1089/apc.2006.0138.
Warren-Jeanpiere L, Dillaway H, Hamilton P, Young M, Goparaju L. Taking it one day at a time: African American women aging with HIV and co-morbidities. AIDS Patient Care STDs. 2014;28(7):372–80. https://doi.org/10.1089/apc.2014.0024.
Sangaramoorthy T, Jamison AM, Dyer TV. HIV stigma, retention in care, and adherence among older Black women living with HIV. J Assoc Nurs AIDS Care. 2017;28(4):518–31. https://doi.org/10.1016/j.jana.2017.03.003.
This research was supported by grants R01 MD012610 and U54 MD002266 from the National Institute on Minority Health and Health Disparities and RO1 AG053163 from the National Institute on Aging. Dr. Batsis is supported by K23-AG051681 from the National Institute on Aging.
This research was supported by grants R01 MD012610 and U54 MD002266 from the National Institute on Minority Health and Health Disparities and RO1 AG053163 from the National Institute on Aging. Dr. Batsis is supported by K23-AG051681 from the National Institute on Aging.
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Jimenez, D.E., Weinstein, E.R. & Batsis, J. You gotta walk the walk to talk the talk: protocol for a feasibility study of the Happy Older Latino Adults (HOLA) health promotion intervention for older HIV-positive Latino men. Pilot Feasibility Stud 9, 32 (2023). https://doi.org/10.1186/s40814-023-01262-w
- Older adults
- Health promotion
- Cardiometabolic risk