‘Too old to test?’: A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi
Cheryl Johnson1, Cheryl Johnson2, Moses Kumwenda3, Jamilah Meghji4, Augustine T. Choko3, Augustine T. Choko1, Mackwellings Phiri3, Karin Hatzold5, Rachel Baggaley2, Miriam Taegtmeyer6, Miriam Taegtmeyer4, Fern Terris-Prestholt1, Nicola Desmond3, Nicola Desmond4, Elizabeth L. Corbett1, Elizabeth L. Corbett3 •
TL;DR: In this article, the authors 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.
Abstract: 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. 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. 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. 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.
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Shannon M. Farley, Chunhui Wang, Rachel Bray, Andrea Low, Stephen Delgado, David Hoos, Angela N Kakishozi, Tiffany G. Harris, Rose Nyirenda, N Wadonda, Michelle S. Li, Mbaraka Amuri, James M Juma, Nzali Kancheya, Ismela Pietersen, Nicholus Mutenda, Salomo Natanael, Appolonia Aoko, Evelyn Ngugi, Fred Asiimwe, Shirley Lee Lecher, Jennifer Ward, Prisca Chikwanda, Owen Mugurungi, Brian Moyo, Peter Nkurunziza, Dorothy Aibo, Andrew Kabala, Samuel Biraro, Felix Ndagije, Godfrey Musuka, Clement B. Ndongmo, Judith Shang, E. Kainne Dokubo, Laura Dimite, Rachel McCullough-Sanden, Anne-Cécile Zoung-Kanyi Bissek, Yimam Getaneh, Frehywot Eshetu, Tepa Nkumbula, Lyson Tenthani, Felix R. Kayigamba, Wilford Kirungi, Joshua Musinguzi, Shirish Balachandra, Eugenie Kayirangwa, Ayiyi Ayite, Christine West, Stephane Bodika, Katrina Sleeman, Hetal Patel, Kristin Brown, Andrew C. Voetsch, Wafaa El-Sadr, Jessica Justman
TL;DR: In this paper , the authors examined 90-90-90 progress by age, 15-49 (as a comparison) and 50+ years, with further analyses among 50+ (55-59, 60-64, 65+ vs. 50-54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe).
Abstract: Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe).
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TL;DR: In this article, the authors determined the description of the uti cation of health facilities for HIV testing, which is an important indicator to record and track the spread and infection of HIV in Indonesia.
Abstract: Utilization of health facilities for HIV testing is an important indicator to record and track the spread and infection of HIV in Indonesia. This study aimed to determine the description of the uti...
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TL;DR: In this paper , the authors explored the barriers and facilitators to linkage for HIV prevention and care following uptake of HIV self-testing among young Malawians, and found that the social consequences associated with inadvertent disclosure of HIV sero-status were a significant deterrent to linkage.
Abstract: Young people, aged 16-24, in southern Malawi have high uptake of HIV self-testing (HIVST) but low rates of linking to services following HIVST, especially in comparison, to older generations. The study aim is to explore the barriers and facilitators to linkage for HIV prevention and care following uptake of HIV self-testing among young Malawians.We used qualitative methods. Young people aged 16-24 who had received HIVST; community-based distribution agents (CBDAs) and health care workers from the linked facilities were purposively sampled from two villages in rural southern Malawi.We conducted in-depth interviews with thirteen young people (9 female) and held four focus groups with 28 healthcare workers and CBDAs. Young people strongly felt the social consequences associated with inadvertent disclosure of HIV sero-status were a significant deterrent to linkage at their stage in life. They also felt communication on testing benefits and the referral process after testing was poor. In contrast, they valued encouragement from those they trusted, other's positive treatment experiences and having a "strength of mind". CBDAs were important facilitators for young people as they are able to foster a trusting relationship and had more understanding of the factors which prevented young people from linking following HIVST than the healthcare workers. Young people noted contextual barriers to linkage, for example, being seen on the road to the healthcare centre, but also societal gendered barriers. For example, young females and younger adolescents were less likely to have the financial independence to link to services whilst young males (aged 19-24) had the finances but lacked a supportive network to encourage linkage following testing. Overall, it was felt that the primary "responsibility" for linking to formal healthcare following self-testing is shouldered by the young person and not the healthcare system.Young people are happy to self-test for HIV but faced barriers to link to services following a self-test. Potential interventions for improving linkage suggested by this analysis include the establishment of youth-friendly linkage services, enhanced lines of communication between young people and healthcare providers and prioritising linkage for future interventions when targeting young people following HIVST.
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TL;DR: For example, the authors found that women aged 30-65 years old were recruited across Minnesota to complete an online survey to assess five outcome measures related to human papillomavirus self-sampling: awareness of test; self-efficacy to conduct test; location preference of test (clinic vs. home); collector preference (self vs. clinician); and preference of CCS strategy (HPV self sampling vs. Pap test).
Abstract: Pap tests are still underutilized by minority women due to limited awareness of cervical cancer screening (CCS), inadequate health care access, and cultural or religious beliefs. Human papillomavirus (HPV) self-sampling, a new CCS tool, has demonstrated potential to overcome some of these barriers. In 2021, women aged 30–65 years old were recruited across Minnesota to complete an online survey. The survey assessed five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference (self vs. clinician); and (5) preference of CCS strategy (HPV self-sampling vs. Pap test). Modified Poisson regressions tested associations between sociodemographic variables and outcomes. A total of 420 women completed the survey, of which 32.4% identified as Non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African-American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. Few women had heard of HPV self-sampling (6.5%), but a majority reported high self-efficacy to perform self-sampling (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%), yet would choose a traditional Pap test over HPV self-sampling (56.0%). The low level of HPV self-sampling awareness, across all racial/ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. Future HPV self-sampling research efforts should examine educational interventions targeted at healthcare providers to educate and encourage women on the importance of self-collection options.
References
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01 Jan 1959TL;DR: For instance, in the case of an individual in the presence of others, it can be seen as a form of involuntary expressive behavior as discussed by the authors, where the individual will have to act so that he intentionally or unintentionally expresses himself, and the others will in turn have to be impressed in some way by him.
Abstract: hen an individual enters the presence of oth ers, they commonly seek to acquire information about him or to bring into play information about him already possessed. They will be interested in his general socio-economic status, his concep tion of self, his attitude toward them, his compe tence, his trustworthiness, etc. Although some of this information seems to be sought almost as an end in itself, there are usually quite practical reasons for acquiring it. Information about the individual helps to define the situation, enabling others to know in advance what he will expect of them and what they may expect of him. Informed in these ways, the others will know how best to act in order to call forth a desired response from him. For those present, many sources of information become accessible and many carriers (or “signvehicles”) become available for conveying this information. If unacquainted with the individual, observers can glean clues from his conduct and appearance which allow them to apply their previ ous experience with individuals roughly similar to the one before them or, more important, to apply untested stereotypes to him. They can also assume from past experience that only individuals of a par ticular kind are likely to be found in a given social setting. They can rely on what the individual says about himself or on documentary evidence he provides as to who and what he is. If they know, or know of, the individual by virtue of experience prior to the interaction, they can rely on assumptions as to the persistence and generality of psychological traits as a means of predicting his present and future behavior. However, during the period in which the indi vidual is in the immediate presence of the others, few events may occur which directly provide the others with the conclusive information they will need if they are to direct wisely their own activity . Many crucial facts lie beyond the time and place of interaction or lie concealed within it. For example, the “true” or “real” attitudes, beliefs, and emotions of the individual can be ascertained only indirectly , through his avowals or through what appears to be involuntary expressive behavior. Similarly , if the individual offers the others a product or service, they will often find that during the interaction there will be no time and place immediately available for eating the pudding that the proof can be found in. They will be forced to accept some events as con ventional or natural signs of something not directly available to the senses. In Ichheiser ’s terms, 1 the individual will have to act so that he intentionally or unintentionally expresses himself, and the others will in turn have to be impressed in some way by him.…
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TL;DR: The life histories and future trajectories of individuals and groups were largely neglected by early sociological research as discussed by the authors, and the life course perspective is perhaps the pre-eminent theoretical orientation in the study of lives.
Abstract: Today, the life course perspective is perhaps the pre-eminent theoretical orientation in the study of lives, but this has not always been the case. The life histories and future trajectories of individuals and groups were largely neglected by early sociological research. In the pioneering study, The Polish Peasant in Europe and America (1918-1920), W. I. Thomas (with Florian Znaniecki) first made use of such histories and trajectories and argued strongly that they be investigated more fully by sociologists. By the mid-1920s, Thomas was emphasizing the vital need for a “longitudinal approach to life history” using life record data (Volkart, 1951, p. 593). He advocated that studies investigate “many types of individuals with regard to their experiences and various past periods of life in different situations” and follow “groups of individuals into the future, getting a continuous record of experiences as they occur.” Though this advice went unheeded for decades, Thomas’s early recommendations anticipated study of the life course and longitudinal research that has become such a central part of modern sociology and other disciplines.
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TL;DR: The authors argue that age is associated with increasing motivation to derive emotional meaning from life and decreasing motivation to expand one's horizons, which leads to age differences in social and environmental choices (consistent with antecedent emotion regulation), coping, and cognitive processing of positive and negative information.
Abstract: Far more attention has been paid to emotion regulation in childhood than in adulthood and old age. However, a growing body of empirical research suggests that the emotion domain is largely spared from deleterious processes associated with aging and points instead to developmental gains in later life. By applying tenets from socioemotional selectivity theory, we attempt to explain the observed gains in terms of motivation. We argue that age is associated with increasing motivation to derive emotional meaning from life and decreasing motivation to expand one's horizons. These changes lead to age differences in social and environmental choices (consistent with antecedent emotion regulation), coping (consistent with response-focused regulation), and cognitive processing of positive and negative information (consistent with goal-directed attention and memory). Broader implications for life-span development are discussed.
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01 Jan 2017TL;DR: In this paper, the authors focus on the creation of the Joint United Nations Programme on HIV/AIDS (UNAIDS), and how this new formation set about institutionalizing a global AIDS perspective.
Abstract: This chapter focuses on the creation of the Joint United Nations Programme on HIV/AIDS (UNAIDS), and how this new formation set about institutionalizing a global AIDS perspective. The chapter considers the main motivations behind this creation, which included the need to create a coherent and shared understanding of HIV, together with a coordinated policy framework to bring together different technical and political capacities for coherent policy intervention in multiple country contexts. The chapter argues that this process of creating a shared understanding of expected outcomes led to a shared understanding of the disease laying the foundations for the politics of Global AIDS.
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TL;DR: The profile of patients in the Netherlands infected with HIV is changing, with increasing numbers of older patients with multiple morbidities, which means that, in the near future, HIV care will increasingly need to draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure continued high-quality care.
Abstract: Summary Background The population infected with HIV is getting older and these people will increasingly develop age-related non-communicable diseases (NCDs). We aimed to quantify the scale of the change and the implications for HIV care in the Netherlands in the future. Methods We constructed an individual-based model of the ageing HIV-infected population, which followed patients on HIV treatment as they age, develop NCDs—including cardiovascular disease (hypertension, hypercholesterolaemia, myocardial infarctions, and strokes), diabetes, chronic kidney disease, osteoporosis, and non-AIDS malignancies—and start co-medication for these diseases. The model was parameterised by use of data for 10 278 patients from the national Dutch ATHENA cohort between 1996 and 2010. We made projections up to 2030. Findings Our model suggests that the median age of HIV-infected patients on combination antiretroviral therapy (ART) will increase from 43·9 years in 2010 to 56·6 in 2030, with the proportion of HIV-infected patients aged 50 years or older increasing from 28% in 2010 to 73% in 2030. In 2030, we predict that 84% of HIV-infected patients will have at least one NCD, up from 29% in 2010, with 28% of HIV-infected patients in 2030 having three or more NCDs. 54% of HIV-infected patients will be prescribed co-medications in 2030, compared with 13% in 2010, with 20% taking three or more co-medications. Most of this change will be driven by increasing prevalence of cardiovascular disease and associated drugs. Because of contraindications and drug–drug interactions, in 2030, 40% of patients could have complications with the currently recommended first-line HIV regimens. Interpretation The profile of patients in the Netherlands infected with HIV is changing, with increasing numbers of older patients with multiple morbidities. These changes mean that, in the near future, HIV care will increasingly need to draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure continued high-quality care. These findings are based on a large dataset of HIV-infected patients in the Netherlands, but we believe that the overall patterns will be repeated elsewhere in Europe and North America. The implications of such a trend for care of HIV-infected patients in high-burden countries in Africa could present a particular challenge. Funding Medical Research Council, Bill & Melinda Gates Foundation, Rush Foundation, and Netherlands Ministry of Health, Welfare and Sport.
602 citations
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