Background: The number of newly registered HIV infections among people older than 50 in Ukraine has been increasing over the last six years: from 1198 in 2011 to 1761 in 2016. Data demonstrates that those ≥50 years constitute the only group where HIV incidence has significantly increased (from 8% to 12% between 2014 - 2016). This study qualitatively explored HIV care providers'' perspectives on what facilitates and hinders linking to care of people living with HIV who are older than 50 (PLWH50+).
Methods: We purposively sampled and anonymously interviewed 12 HIV care providers (Infectious Disease physicians and psychologists) in 6 regions of Ukraine. Data were coded using Dedoose qualitative data management software and inductively analyzed for themes using grounded theory.
Results: We found four main themes in providers'' accounts. First, older patients newly diagnosed with HIV were perceived by providers as more socially excluded, stigmatized and vulnerable than younger patients, requiring additional efforts to engage in HIV services. Second, providers thought PLWH50+ were largely ignorant regarding HIV, although many newly diagnosed older patients were infected 5-10 years ago according to their medical history and CD4 level. Third, a challenge unique to newly HIV diagnosed individuals ≥50 years was poly-pharmacy. Fourth, providers believed that PLWH50+ got HIV infection predominantly through unprotected heterosexual intercourse (including sex with injection drug users). Providers didn''t perceive their clients as MSMs, as clients didn''t disclose it.
Conclusions: Our results address the paucity of data in the literature about access to HIV care among older adults in global settings, synergy between HIV stigma and ageing, and continued exclusion of older adults from medical and policy agendas related to sexual health. While Ukrainian Ministry of Health HIV prevention programs prioritize youth, findings suggest that there is awareness among HIV care providers'' about increasing role of older adults in HIV epidemic and the need for development of new clinical HIV care and HIV prevention guidelines focused on this group. These guidelines need to pay particular attention to the problem of late case detection and delayed linkage to care.

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