26 August 2011

HIV in old age

While the focus of HIV and Aids interventions has always been on the 20-40-year-olds most likely to be infected, experts warn that the elderly also have to be considered.


While the focus of HIV and Aids interventions has always been on the 20-40-year-olds most likely to be infected, African democracy institute Idasa warns that health workers and social planners have neglected to take into account the elderly who have contracted the virus – and their numbers are growing.

Successful ARV treatment is just one factor that has created a new group of HIV and Aids patients – the over 50s ‑ who face their own distinctive needs and challenges. Idasa's Governance and Aids programme (GAP) says its most recent research shows that "this age group is often left out in HIV care programmes and are not often targeted by prevention programmes. The older person falls into the cracks of screening in medical facilities".

 Old age disguise symptoms of HIV/Aids

The study, HIV and AIDS and the Older Adult, by Mwanja Ng'anjo & Christèle Diwouta, points out that old age could disguise the symptoms of HIV and Aids, leaving it undetected and untreated as health workers and social services focus their attention on the younger population. This could have serious consequences as older adults may fall through the treatment net.

Greater awareness of the prevalence of HIV and Aids in the older cohort is urgent, and the authors recognise that it points to a possible need for alternative treatment regimes. The study suggests that older people may be more sensitive to antiretroviral drug toxicity and therefore the body's reaction to antiretroviral agents may be different in the older person. The authors also warn that older people may be suffering from age-related conditions and using other non-HIV medications, which could introduce complications in the use of antiretrovirals.

Furthermore, the stigma and discrimination experienced by older people suffering from HIV and Aids is greater. The Idasa study used Grandmothers Against Poverty and Aids (GAPA), a Cape Town-based NGO, as a case study, describing it as "an inspirational movement that has changed the lives of many. It stands out as a forceful beacon in a society where ageing with HIV is taboo." The study quotes an older woman with HIV whose community ostracised her and called her a witch when her symptoms became apparent: "Thandi (not her real name) says the toughest challenge she has faced on her journey with HIV is the question she cannot seem to shake off since she contracted HIV: 'How could you get HIV at your age?'"

Elderly care for Aids orphans

What makes this study so important is that many of GAPA's members – and many more of South Africa's older generation countrywide ‑ have been left to care for Aids orphans. They have become the sole breadwinners and sources of income in many households, as well as the caretakers of those no longer able to serve as the economically active sector of the population. While government and other services have recognised that grandparents, especially grandmothers, have inherited the responsibility of providing an income for their households as well as performing a caretaker role, they have failed to take into account the fact that growing numbers of these senior citizens are HIV-positive or suffering from Aids themselves.

Belief that older people don't have sex

The authors say that HIV and Aids service providers and policy-makers make the fatal mistake of assuming older people are not sexually active. They cite other factors behind the rise in HIV and Aids in the50-and-above age group. "Heterosexual transmission in the older population can be correlated to behaviour change brought on by drugs in the last few decades that treat erectile dysfunction," the authors write. "Older people also use drugs and abuse alcohol which puts them at risk for HIV and STIs as they engage in risky behaviour such as having unprotected sex and multiple sex partners. The impact of violence on health and particularly HIV is undeniable. It is estimated that 16% of all HIV infections in women in South Africa result from domestic violence by their partners and in this respect, rape and domestic violence, particularly in the South African context, are also drivers of the epidemic that is not only being experienced amongst the younger population." - (Health24, August 2011)

- Source: Press statement by Idasa, an African Democracy Institute

Read more:
HIV infection increasing in SA

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Dr Sindisiwe van Zyl qualified at the University of Pretoria before working for an HIV/AIDS NPO in Soweto for many years. She was named one of the Mail & Guardian's Top 200 Young South Africans in 2012.

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