‘Too old to test?’: A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi

Johnson, Cheryl, Kumwenda, Moses, Meghji, Jamilah ORCID: https://orcid.org/0000-0002-4693-8884, Choko, Augustine T., Phiri, Mackwellings, Hatzold, Karin, Baggaley, Rachel, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Terris-Prestholt, Fern, Desmond, Nicola ORCID: https://orcid.org/0000-0002-2874-8569 and Corbett, Elizabeth L. (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, Vol 21, Issue 1.

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Abstract

Background
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.

Methods
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.

Results
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.

Conclusions
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
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12889-021-10573-7
Depositing User:	Stacy Murtagh
Date Deposited:	15 Apr 2021 15:40
Last Modified:	15 Apr 2021 15:40
URI:	https://archive.lstmed.ac.uk/id/eprint/17601

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