ArticleBMC public health2021
'Too old to test?': A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi.
Article in BMC public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 19 citations in OpenAlex.
- Qualitatively exploring opportunities and challenges for sexually transmitted infection prevention aimed at Canadian international retirement migrants wintering in the United States.BMC public health · 2026Article
- [Growing old with HIV in Senegal: an anthropological perspective for a public health policy].Medecine tropicale et sante internationale · 2026Article
- Strategies for implementing HIV self-testing in diverse populations: an integrative review.Revista brasileira de enfermagem · 2025Review
- Needs & networks: understanding the role and impact of social networks on HIV (self-)testing among GBMSM and trans people in England and Wales.BMC public health · 2024Article
- Knowledge, and utilization of HIV self-testing, and its associated factors among women in sub-Saharan Africa: evidence from 21 countries demographic and health survey.BMC public health · 2024Article
- The Social Construction of Aging Among a Clinic-Based Population and Their Healthcare Workers in Zambia.International journal of public health · 2024Article
- Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially- and ethnically-diverse women in Minnesota: A cross-sectional study.Preventive medicine reports · 2023Article
- Changing attitudes towards HIV testing and treatment among three generations of men in Cameroon: a qualitative analysis using the Fogg Behavior Model.BMC public health · 2023Article
- Article
- Progress towards the UNAIDS 90-90-90 targets among persons aged 50 and older living with HIV in 13 African countries.Journal of the International AIDS Society · 2022Article
- "You have a self-testing method that preserves privacy so how come you cannot give us treatment that does too?" Exploring the reasoning among young people about linkage to prevention, care and treatment after HIV self-testing in Southern Malawi.BMC infectious diseases · 2022Article
- "Deadly", "fierce", "shameful": notions of antiretroviral therapy, stigma and masculinities intersecting men's life-course in Blantyre, Malawi.BMC public health · 2021Article
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Authors and funding
11 authors at 6 institutions in 4 countries.
Funding
Abstract
backgroundDespite 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.
methodsWe 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.
resultsMidlife-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.
conclusionsCharacteristics 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.
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