Assessing evidence and proposing a conceptual framework to enhance HIV testing and mental health awareness among middle-aged and older men who have sex with men : insights from social work perspective on practical interventions

Abstract

Introduction: HIV testing rates among middle-aged and older men who have sex with men (MSM) in the broader Chinese population remain low, despite their heightened vulnerability to HIV and mental health challenges. This study proposes a conceptual framework that integrates the Social Ecological Model (SEM) and the Theory of Planned Behavior (TPB) to enhance HIV testing and mental health awareness among this population, while offering social work insights on effective interventions. Methods: The study applies SEM and TPB to examine the factors influencing HIV testing behaviors in older MSM. SEM highlights the need for multi-level interventions, including personalized health communication and social support networks, while TPB identifies psychological barriers such as stigma, attitudes, and perceived behavioral control. Results: Key barriers to HIV testing include lack of tailored healthcare services, fear, and stigma. These psychological and structural barriers contribute to persistently low testing rates in this group. Conclusions: Integrating mental health support into HIV testing services is essential for improving outcomes. Addressing stigma and creating a supportive environment for testing can improve well-being among middle-aged and older MSM. Social workers play a critical role in providing psychological support, advocating for inclusive healthcare, and promoting systemic changes. Policy Implications: Public health initiatives should leverage technology, such as social media, and invest in outreach programs while training healthcare providers on MSM-specific needs. Campaigns must normalize HIV testing, challenge stereotypes, and promote mental health support to increase testing rates and improve overall health outcomes.