HIV prevention must include older people

In the effort to stem the spread of HIV in South Africa, the focus of prevention campaigns is usually on the young. But HIV among young people is unlikely to be controlled unless older people (aged 50 and older), and males in particular, are included in prevention campaigns.

The results of the study were presented at a poster session at the XVI International AIDS Conference in Toronto, Canada on 14 August.

The findings form part of a larger study, the 2005 South African national household survey on HIV Prevalence, Incidence, Behaviour and Communication in which more than 24 000 South Africans were tested for HIV and asked about their risk or protective behaviour for HIV infection.

The poster presentation by Dr Olive Shisana, principal investigator of the main study, focus on the results of a sub-sample of 2 787 randomly selected South Africans in the age group 50 years and older. The participants all agreed to be tested for HIV. Samples of dry blood spots were tested first (using Vironostika HIV-1 Uniform II PlusO assay) and all positive samples were retested with a second ELISA test. This was follow by questionnaire-based interviews, which included questions on knowledge of HIV transmission and sexual behaviour.

It was found that 5.7% of those tested were HIV positive, with the highest rates in the age group 50-54 (10.8%). Their knowledge of HIV transmission was high, for example, only 35% were unsure or disagreed that having multiple partners increases the risk of HIV; 11.2% were unsure or disagreed that HIV can be transmitted by having unprotected vaginal sex; and 21.3% were unsure or disagreed that HIV can be prevented by using condoms.

Males more at risk
Increased HIV infection in males was associated with having a partner five years their junior. The HIV tests showed that 16,2% in this category were HIV positive. Overall, males engaged in sexually risky behaviour, such as having multiple partners (9.8%) and were unlikely to use a condom with sexual partners (8.6% used a condom in the last sex act). And of those tested, 75% believed they were at low risk for HIV.

Shisana concludes that older people need to be included in HIV surveillance and in prevention programmes as HIV infection in young women, especially, is unlikely to be controlled unless older men are included in the prevention campaigns.

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