It’s time to address the HIV/AIDS epidemic that is affecting older people in Africa, new research suggests.

Public health researcher Joel Negin writes:

The United Nations estimates that there are 33 million people worldwide living with the human immunodeficiency virus (HIV) including 22 million in sub-Saharan Africa.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) and other prominent global sources of data report prevalence rates only for those aged 15–49 years, and the indicators used by the United Nations General Assembly Special Session focus predominantly on the same age group.

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In developed countries, the HIV-positive population is aging.  A recent Australian report stated that the rate of HIV infection among over 55s is on the rise.  In the United States, by 2015, half of those living with HIV will be aged 50 years or older.

The aging of the HIV epidemic is driven by two main factors: longer survival through widespread provision of life-prolonging anti-retroviral medication and through transmission among adults older than 50.

Despite these trends in developed countries, the burden of HIV among those aged ≥ 50 years in developing countries is almost always ignored and this represents a significant blind spot in the global response to the epidemic.

In sub-Saharan Africa, 5.5 million people are now on anti-retroviral treatment, meaning that HIV-positive individuals are living longer and, as in Australia, sexual transmission of HIV among older adults is occurring.

In order to begin to address this gap, we analysed UNAIDS data and estimated that there are approximately 3 million people aged ≥ 50 years were living with HIV in sub-Saharan Africa. This represents 14.3% of the approximately 21 million people aged ≥ 15 years who are infected with HIV in Africa.

The estimated prevalence of HIV infection among the 74 million people aged ≥ 50 years in sub-Saharan Africa is 4.0%, compared with 5.0% among those aged 15–49 years.

Our study confirms that in Africa HIV infection does not affect younger people exclusively.

There are common misconceptions about sexual activity among older people.  These attitudes limit the development of appropriate responses tailored specifically to older adults.

Older adults’ access to HIV-related services and information in Africa is limited.  Data suggest that levels of condom use and knowledge about condoms are low among older adults.

The lack of targeted prevention services becomes even more important considering that many older people care for younger ones, since a lack of knowledge may prevent older people from effectively teaching the next generation about HIV.

The need to better understand the various HIV-related challenges faced by older adults will increase as the HIV+ population ages.

A significant percentage of the population – those aged ≥ 50 years – has been largely excluded from HIV prevention and testing services.

The high prevalence of HIV infection and the high rates of death from AIDS-related causes among older people in developing countries call for greater efforts to integrate the needs of older people into responses to the HIV epidemic and to strengthen targeted prevention, care and support programmes.

• Joel Negin is a lecturer in International Public Health, Sydney School of Public Health and a Research Fellow, Menzies Centre for Health Policy

This article is based upon research just published by Joel Negin, Bob Cumming and colleagues. This paper estimates that there are 3 million people aged 50 and older in Africa who are HIV+.

This paper confirms that AIDS-related mortality remains high among adults aged 50 and older in a project site in western Kenya. These publications are part of ongoing work on this neglected topic.

As a Crikey subscriber and someone who began working as a journalist in 1957, I am passionate about the importance of independent media like Crikey. I met a lot of Australians from many walks of life during my career and did my best to share their stories honestly and fairly with their fellow citizens.

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Liz
North Stradbroke Island, QLD

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