Sub-Saharan Africa has been hit the hardest by the HIV/AIDS epidemic. According to The Joint United Nations Programme on HIV/AIDS (UNAIDS), in 2015 there were 36.7 million people living with HIV globally, 70% of who live in sub Saharan Africa.
Furthermore in this region, HIV affects older persons in two main ways. Firstly, the onus of taking care of and supporting both orphaned grandchild and sick family members falls on older people. It was found that grand parents – particularly poor grandmothers – care for around 40 % of all orphans in the United Republic of Tanzania, 45% in Uganda, more than 50% in Kenya and around 60% in both Namibia and Zimbabwe.
As carers of terminally ill HIV infected family members, older people have to bathe the sick, wash their clothes, feed them, turn them in bed and assist them to use the toilet. Therefore, they are increasingly exposed to AIDS-related illnesses through their caring role, which further jeopardizes their own health and that of children in their household. Additionally, older people and their dependents suffer tremendous strain, largely due to the trauma resulting from the loss of family members and the stigma of being affected by HIV/AIDS. This often leads to older people feeling they are failing in their role as carers.
Secondly, older persons are affected by HIV as people living with HIV. In recent years, more people living with HIV in sub-Saharan Africa are living into older age. UNAIDS estimates show that there were over 3.7 million people aged 50 and over living with HIV in sub-Saharan Africa in 2016, an increase from an estimated 2.5 million in 2011. This increase is attributed to availability of antiretroviral therapy (ARTs). According to the 2017 statistics from UNAIDS, 60% of all people living with HIV in East and Southern Africa (totaling up to 11.7 million people) were accessing ARTs.
However with increased age, HIV infection gets exacerbated by other age-related and/or chronic conditions that may further lessen the quality of life of older persons living with HIV. For example, they face increased risk of non-communicable diseases (NCDs) which may worsen HIV disease progression. Older people living with HIV are also more susceptible to frailty, a condition associated with increased comorbidity and loss of autonomy.
Further, as older people living with HIV/AIDS become progressively sicker and more dependent on others, they are more susceptible to neglect, abuse and violation of their rights at all levels. HIV positive status thus magnifies the already existing prejudices against older people and heightens the discrimination they are already facing. In particular women ageing with HIV and older persons with HIV and disabilities, face multiple discrimination including harmful gender norms and violence, HIV-related stigma, ageism and exclusion because of disabilities.
Despite the important role older persons play as caregivers and the changes in the age profile of people living with HIV, most HIV/AIDS strategies and programmes however still target the younger age groups. Older persons are largely invisible and their challenges are not adequately addressed. For example, research done by HelpAge International showed that older persons caring for orphans in Zimbabwe, Tanzania and Mozambique lack access to subsidised services available to them and their dependents.
This is largely because they were unclear about administration and disbursement and they do not have the necessary documentation (such as birth certificates or identity cards) required to get these services. The research also showed that older people in Kenya, Zimbabwe, Uganda, Tanzania, Mozambique, Ethiopia and South Africa identified the lack of right forums for them to learn more about HIV/AIDS.
Their preference was to be taught by their peers and by people whom they respect for their knowledge of sexual matters and traditions and customs. Since these forums do not exist older men and women are often denied access to accurate information and leading them to believe that HIV/AIDS only affects younger people. As a result many of the older people still draw on spiritual and traditional interventions, spending their meagre resources trying to ‘cure’ themselves and their children and grandchildren of AIDS.
However there are existing global and regional strategies that governments in sub Saharan Africa can adopt to improve the lives of both older caregivers and older persons living with HIV. More specifically, governments can adopt the United Nation’s Global Strategy and Plan of Action on ageing and health as well as ratify the African Union Protocol on the Rights of Older Persons, all of which offer adaptable pathways for healthy ageing.
Additionally, HelpAge International’s experiences show that strengthening the health system, especially by increasing the skills of health workers and the age friendliness of health services is critical in early diagnosis, management, treatment and/or referral of chronic diseases including HIV, which in older age need a more holistic, patient centere approach less focused on the specific disease and more on the maintenance of the individual wellbeing.
Moreover, community based systems, such as Home Based Care, showed the critical importance of providing support to the older patients, including older HIV patients and patients with disabilities, directly in their homes, to slow the progression of chronic diseases and provide palliative care.
HelpAge International recommends that people-centred, age friendly HIV care services be developed, implemented and monitored to support everyone infected and affected by HIV, including older persons. It is also suggested that social protection programmes be extended to older men and women to lessen the burden on older persons. It is clear that the needs of older persons, both as older caregiver and people living with HIV, can no longer be ignored, especially if the 90:90:90 UNAIDS strategy is to be achieved by 2020.
1 October 2017 was the International Day of Older Persons
About HelpAge International
HelpAge International is a global network of 127 organisations in 77 countries that works to help older people claim their rights, challenge discrimination and overcome poverty, so that they can lead dignified, secure, active and healthy lives. HelpAge is a member of the RIATT-ESA network.
For more information, contact
Dr. Luca Saraceno, MSc, PhD
Regional Health Program Manager – Technical Team Leader, HelpAge International, Mobile: +254 731 004 015 Email: firstname.lastname@example.org Skype: lucasaraceno