Associations between extreme weather events, mobility, and resource insecurities with HIV vulnerabilities among older adults in Moshi, Tanzania: Cross-sectional findings.

BackgroundEnvironmental and social hazards shape HIV vulnerabilities in Sub-Saharan Africa. Although older adults (>55) have an HIV prevalence higher than the national average in Tanzania, they are understudied in HIV research. To address this knowledge gap, we examined associations between extreme weather event exposure, mobility, resource insecurities, and HIV vulnerabilities among older adults in Moshi, Tanzania.MethodsWe conducted a cross-sectional survey in Moshi with adults aged ≥50 randomly sampled from the Prospective Urban Rural Epidemiology cohort. We conducted multivariable linear and logistic regression analyses to examine associations between environmental (past-year extreme weather events; recent [past 6- and 1-month] seasonal/weather-related mobility) and social (food, water, and/or sanitation insecurity) hazards, protective factors (social support, resilience), and HIV vulnerabilities (condom use self-efficacy; sexual relationship power; lifetime intimate partner violence). Models were adjusted for age, gender, education, and relationship status.ResultsAmong participants (n = 250; mean age: 60.6 years, SD = 11.1; 72.8% women), over half (56.0%) reported >1 past-year extreme weather. Past-year extreme weather exposure (adjusted beta [aβ] = -1.09, 95% Confidence Interval [CI]: -2.08 to -0.10), past-month mobility (aβ = -2.25, 95%CI: -3.45 to -1.06), past 6-month mobility (aβ = -1.83, 95% CI: -3.17 to -0.48), and low food security (vs high/marginal) (aβ = -0.94, 95% CI: -1.72 to -0.15) were associated with lower condom use self-efficacy. Social support (aβ = 0.11, 95% CI: 0.06- 0.16) and resilience (aβ = 0.28, 95% CI: 0.12-0.44) were associated with increased condom use self-efficacy. Past-month (aβ = -5.03, 95% CI: -7.04 to -3.02) and 6-month (β = -2.59, 95% CI: -4.72 to -0.48) mobility were associated with lower sexual relationship power. Past-month mobility (aOR = 12.31, 95% CI: 2.67-56.80) and sanitation insecurity (aOR = 1.20, 95% CI: 1.10-1.32) were associated with higher intimate partner violence odds.ConclusionsExtreme weather event exposure, seasonal/weather-related mobility, and resource insecurities were associated with HIV vulnerabilities among older adults in Moshi. HIV programs in climate-affected contexts can include older populations and integrate social and environmental hazards.