Johnson, Cheryl, Kumwenda, Moses, Meghji, Jamilah, Choko, Augustine T, Phiri, Mackwellings, Hatzold, Karin, Baggaley, Rachel, Taegtmeyer, Miriam, Terris-Prestholt, Fern, Desmond, Nicola 
ORCID: 0000-0002-2874-8569 et al (show 1 more authors)
(2021)
'Too old to test?': A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi.
BMC PUBLIC HEALTH, 21 (1).
650-.
Abstract
<h4>Background</h4>Despite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults.<h4>Methods</h4>We conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations.<h4>Results</h4>Midlife-older adults (30-74 years of age) associated their age with respectability and identified HIV as "a disease of youth" that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying "lack of wisdom". These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults.<h4>Conclusions</h4>Characteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Life-course theory, Age stratification, Socioemotional selectivity, HIV, AIDS, HIV self-test |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 16 May 2022 07:55 |
| Last Modified: | 18 Jan 2023 21:02 |
| DOI: | 10.1186/s12889-021-10573-7 |
| Open Access URL: | https://doi.org/10.1186/s12889-021-10573-7 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3154852 |
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