Abstract
Background
Adults aged 50 and above living with HIV in Nigeria are a growing but underserved group,
accounting for approximately 280,000 of the country’s 1.9 million people living with HIV.
Although the national adult HIV prevalence is 1.3%, it rises to 2.1% in this older group, driven by
late diagnoses and extended life expectancies from antiretroviral therapy (ART). Despite higher
risk, older adults are often left out of HIV testing services (HTS), age-appropriate care, and
national public health programmes.
Methods
A convergent parallel mixed-methods study combined an interviewer-administered digital
questionnaire for 200 HIV-positive older adults across six Nigerian states with eight in-depth
interviews. Quantitative data were analysed using SPSS v28, utilising descriptive statistics, chi-square tests, and t-tests
to evaluate urban-rural variations. Qualitative data were analysed
thematically. Findings were integrated using a joint matrix based on the Social-Ecological and
Health Belief Model.
Results
Fear (63.5%), limited HIV knowledge (71.5%), and low perceived risk (not sure: 34.5%, none:
27.5%) were the main individual barriers. HIV-related stigma affected 72.0% of respondents’
testing decisions, worsened by cultural taboos around older sexuality. Structural barriers were
high: 64.8% struggled with access in rural areas, and 80.5% experienced ageism from providers.
Urban-rural testing gaps were significant (χ², p<0.001), and rural residents had lower HIV
knowledge (p<0.05). Four qualitative themes emerged: (1) age-related invisibility from HIV
campaigns; (2) compounded stigma at the intersection of HIV status and ageing; (3) cultural
silence and religious ambivalence; and (4) systemic healthcare failures including systemic provider
ageism.
Conclusions
Barriers to HTS for older Nigerians are complex and overlapping. Nigeria’s National HIV
Strategic Framework (2021–2025) has historically overlooked this group. To meet UNAIDS 95
95 targets, policies must become age-inclusive, with local outreach, provider training in geriatric
HIV care, and integrated HTS into senior healthcare services.