"I was referred from the other side": Gender and HIV testing among older South Africans living with HIV
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Date
2018
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Publisher
Public Library of Science
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 ªshockº 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.
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Keywords
Universal Test and Treat (UTT) policy, South Africa, HIV, Older persons, Testing for HIV
Citation
Schatz, E. & Knight, L. (2018) "I was referred from the other side": Gender and HIV testing among older South Africans living with HIV. PLoS ONE, 13(4): e0196158.