“I was referred from the other side”: Gender and HIV testing among older South Africans living with HIV

Abstract

South Africa has a Universal Test and Treat (UTT) policy in place to ensure that everyone tests for HIV and can access treatment if they test positive. The aim of this study is to document the pathways that older South Africans who are living with HIV take to access testing and treatment in this context. Despite the aging of the HIV epidemic in South Africa and clear evidence that testing older persons (over age 50) is necessary, very little is known about the circumstances under which older persons test for HIV or their motivations for doing so. In this study, we analyze 21 qualitative, in-depth interviews with women and men aged 50 and over who are living with HIV from two townships outside of Cape Town. Using grounded theory to specify emerging themes, we find similarities and differences between older men and women in their pathways to testing. Men primarily test for HIV when their spouse is diagnosed or in connection with TB testing and treatment. Older women, who are more likely to be widowed or divorced, often test for HIV only when they are symptomatic or not responding appropriately to care for non-communicable diseases. Most importantly, we find that older South Africans do not seek testing as a response to risk. Instead, older men and women test only once they are symptomatic and referred by a provider, or as a result of a partner’s status. Our respondents, particularly the women, expressed “shock” and confusion at learning they were HIV-positive because they do not see themselves as at risk of acquiring HIV. Because the benefits of UTT are greatest with early detection and treatment, older persons’ tendency to test at such a late stage of illness decreases the individual and population level advantages of UTT. More research is needed to understand older persons’ risk and testing behavior so that policy and programs include HIV testing messages that reach this population.

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

“…This trend among older men may also contribute to new infections in younger women in southern Africa where intergenerational relationships have been considered a key driver of the HIV epidemic (8). For older women, who no longer need antenatal or family planning services, access to and uptake of HIV testing declines considerably (9). Declining concerns about unwanted pregnancy, together with minimal public awareness of changes in the demographics of the HIV epidemic (10,11), may lead to greater willingness to engage in condomless sex with existing or new partners of unknown HIV status (12)(13)(14).…”

“…Despite increasing HIV prevalence and incidence, risk perception and perceived susceptibility to HIV is believed to be low in older age groups (9,15,16). Age-targeted health education and behaviour change campaigns in southern Africa remain focused on adolescents and young people (15-24 years) and have yet to be adapted for older groups.…”

Assessing the feasibility of a life history calendar to measure HIV risk and health in older South Africans

“…Urban site. Because previous qualitative research suggested it would be challenging to find older people living with HIV, especially over aged 65 years and male [41], we used snowball sampling starting with individuals connected to social and health service organizations in which we had connections. We selected 18 respondents aged 48-73, including 5 men and 13 women.…”

“…Qualitative studies have examined testing norms and barriers and facilitators of testing. However, except for our own previous work [41,42], the studies primarily have been with younger populations [43,44].…”

Putting women in the centre of the global HIV response is key to achieving epidemic control!

“…Women in polygamous marriages may lose stature and resources as they age. Around the world, women over 50 who do not have HIV are often not considered “at risk” to acquire HIV, are tested less frequently than men, and are less likely to seek PrEP . Yet, 22,000 women over 50 newly acquired HIV in southern and eastern Africa in 2018 alone .…”