Barriers to HIV testing services and care among older adults aged 50 and above in Nigeria: a mixed-methods study

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. 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. 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. 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.