Ageing faster with AIDS in Africa

Authors: J Mills, Edward; Rammohan, Anu; Awofeso,Niyi
The Lancet, Volume 377, Issue 9772, Pages 1131 – 1133, 2 April 2011


This paper, published by The Lancet, contends that as the AIDS epidemic matures, evidence is emerging that poorly managed HIV infection exacerbates ageing diseases, leading to increased morbidity and mortality, and that exacerbated chronic diseases should now be considered AIDS-related.

The authors note that for the vast majority of people living with HIV and AIDS in Africa, the focus of attention to date has been on the provision of emergency care for the most vulnerable, with children, mothers, and severely immuno-compromised patients at the forefront of services. To this end, few service providers have planned for an ageing African HIV-positive population because no one expected this group to survive to older age. The authors argue that the proportion of elderly people in Africa infected with HIV/AIDS is increasing.

The key findings of this paper are:

· older people are neglected in the AIDS response.

· little concern is attached to sexually active African older adults, for instance social marketing for prevention addresses crossgenerational sex and not within-population sex.

· although monitoring of the AIDS epidemic has been inconsistent, it has focused predominantly on country and UN reports of those aged 15–49 years with no reports addressing those aged 50 years and older.

· about 3 million elderly individuals (>50 years) in Africa are living with HIV infection, approximately 14% of all HIV infections.

Drawing from demographic and health surveys (DHS) conducted in Kenya, the only African nation with two full nationally representative DHS datasets for older adults, the authors note that whereas male HIV prevalence was 4.6% for the 15–49 year age group in 2003, it was 5.7% for the 50–54 year age-group in the same period. Also, the prevalence of HIV notification in men aged 50–54 years almost doubled between 2003 and 2008 (from 5.7% to 9.1%), while younger cohorts were generally static or declining in prevalence. Finally, using findings from a recent community mortality analysis from Kenya, the authors find that about 17% of mortality above the age of 50 years was attributable to AIDS as determined by verbal autopsy, with no ascertainment of AIDS-exacerbated deaths.

In conclusion, the authors argue that the perception that HIV is a problem only for young people and that older Africans are not at risk of HIV infection needs to be dispelled. Since older adults in Africa are important members of village and town economies as elders and caregivers, the authors argue that the provision of improved availability of AIDS care, that includes diseases of advanced age, and improving the social safety-net will make these people less vulnerable to AIDS complications and better able to perform their societal roles. To this end, the authors recommend awareness creation on HIV and ageing so as to help with prevention and treatment programmes and issues of stigma. Finally, as the AIDS epidemic matures, the authors recommend the need to understand the size of this ageing population and make available medical care that addresses their disease-specific needs.


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