Psychosocial factors linked to HIV testing among older men in China

An explanatory sequential mixed-methods study conducted in Dehong Prefecture, China, found that threat perception, subjective norms and self-efficacy were positively associated with whether older men at elevated risk of HIV had ever been tested. Among 300 survey participants, 57.7% reported prior HIV testing. Structural equation modeling also identified negative total associations between HIV-related information, behavioral skills and ever-tested status, while interviews suggested that distrust of inconsistent information, limited perceived relevance and fear-oriented messaging may help explain those results.

The quantitative phase of the study was a cross-sectional survey conducted between 2024 and 2025 and included 300 participants with a mean age of 57.2 years. The researchers described risky sexual behaviors among the participants, particularly inconsistent condom use. Reduced sexual pleasure was the main reason participants gave for not using condoms.

The study context reported that more than 65% of HIV cases among older men at elevated risk in China had been diagnosed at an advanced stage, attributed largely to delayed testing. The survey therefore examined whether psychosocial characteristics were associated with prior testing rather than whether a new testing intervention changed behavior. Structural equation modeling was used to estimate direct, indirect and total associations between several psychosocial factors and ever-tested status.

Threat perception had the strongest positive total association, with a coefficient of 0.349 ( p = 0.001). Subjective norms were next, at 0.295 ( p = 0.003), followed by self-efficacy at 0.199 ( p < 0.001). Testing belief had a positive indirect association with ever-tested status, with a coefficient of 0.042 ( p < 0.001).

HIV-related information and behavioral skills showed negative total associations of −0.175 ( p = 0.009) and −0.211 ( p = 0.015), respectively. These coefficients describe modeled associations in the survey data; because the quantitative component was cross-sectional, they do not establish causal effects or changes in testing behavior over time. The researchers subsequently interviewed 30 participants, drawing on the survey results to explore and contextualize the quantitative patterns.

Thematic framework analysis identified distrust of conflicting information, the perception that available information was not personally relevant, and adverse reactions to fear-oriented messaging as possible explanations for the negative association involving HIV-related information. Participants also described insufficient knowledge of testing procedures, low confidence in accessing services and age-related perceptions of HIV risk. Overall, the study linked prior HIV testing among older men at elevated risk to threat perception, subjective norms, self-efficacy, testing beliefs, the interpretation of HIV-related information and practical barriers.

The authors proposed age-sensitive approaches involving credible and personally relevant information, stronger social support and self-efficacy, and clear guidance on how and where to obtain testing. Those suggestions are intervention priorities rather than evidence that such measures have already been shown to increase testing or advance diagnosis. The results are most directly applicable to the Dehong study population.

The mixed-methods design combined survey-based statistical estimates with interviews, but the cross-sectional survey could not determine causality, and the study did not test whether targeted interventions would improve uptake or lead to earlier diagnosis.

Subject of Research: Psychosocial correlates of prior HIV testing among older men at elevated risk in Dehong Prefecture, China

Article Title: Identifying factors influencing HIV testing behavior among high-risk elderly men: a mixed-methods study incorporating structural equation modeling and thematic framework

Article References: Wang, Y., Tang, R., Zhou, Q., Yang, Y., Duan, S., Yuan, Z., Wu, Q., Wang, J., & Shan, D. (2026). Identifying factors influencing HIV testing behavior among high-risk elderly men: a mixed-methods study incorporating structural equation modeling and thematic framework. BMC Infectious Diseases, 26(1), Article 1671. https://doi.org/10.1186/s12879-026-14305-3

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14305-3

Keywords: HIV testing, older men, Dehong Prefecture, structural equation modeling, mixed-methods research, threat perception, self-efficacy, subjective norms, condom use, testing barriers, Identifying, factors