title: HIV sexual risk behavior in older black women: a systematic review.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) is a major public health concern in the United States, particularly among older Black women who comprise approximately 40% of the newly diagnosed cases among women. This systematic review sought to answer the research question: What are the sexual practices in older Black women associated with HIV risk?
  
  
  METHODS
  CINAHL, PubMed, MEDLINE, and Web of Knowledge electronic databases were searched for English-language research studies published between 2003 and 2013 that focused on the HIV sexual risk practices of Black women over the age of 50. Using PRISMA guidelines, two reviewers independently reviewed and appraised the quality of relevant articles; agreement of select studies was achieved by consensus.
  
  
  RESULTS
  Among the 3,167 articles surveyed, 9 met inclusion criteria. The majority (88%) were quantitative, observational studies. All nine articles addressed at least one of three factors that contribute to HIV sexual risk: Behavioral (inconsistent condom use and multiple sexual partners), psychological (risk perception, depression/stress, trauma, and self-esteem issues), and social factors (economics, education, and drugs/alcohol use). Outcome measures varied across studies.
  
  
  CONCLUSIONS
  Although this systematic review appraised few studies, findings suggest that many older Black women are engaged in HIV risk-taking practices. Clinicians and researchers need to be aware of the HIV risk practices of older Black women to improve health outcomes through education, effective communication and risk appraisal.
authors.affiliation: Columbia University School of Nursing, New York, NY. Electronic address: ts563@columbia.edu.
authors.forename: Tanyka K
authors.initials: TK
authors.lastname: Smith
authors.affiliation: Columbia University School of Nursing, New York, NY.
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D044383:Black People / Q000523:psychology*; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D006306:Health Surveys; D006801:Humans; D012309:Risk-Taking; D021841:Safe Sex; D012725:Sexual Behavior / Q000208:ethnology*; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult