by Jen Manne-Goehler, Francesc Xavier Gomez-Olive Casas, Julia Rohr, Kathleen Kahn, Nomsa Mahlalela and Till Bärnighausen, The Conversation
South Africa continues to have a high prevalence of HIV among all age groups. About 8.2 million people or 13.7% of the population live with HIV, one of the highest rates in the world.
The country also has one of the world’s most impressive antiretroviral therapy programs. Over 5 million people living with HIV are currently on chronic treatment. Widespread access to antiretroviral therapies since 2008 has led to millions of people aging with chronic HIV infection. Consequently, people with HIV are older on average than they were just a decade ago.
Most HIV prevention and treatment programs and policies in South Africa remain focused on adolescents and young adults. A growing group of middle-aged and older adults with HIV, or at high risk, are being left behind.
To date, there has been little research about sexual behavior, risk of HIV transmission, HIV stigma and HIV prevention for adults over 40 years old.
The Health and Aging in Africa: Longitudinal Studies in South Africa study—or Haalsa as it is commonly known—is an exception to this trend. It seeks to better understand both the risk of getting HIV and the health of aging adults with HIV in South Africa.
This project, a collaboration between the University of the Witwatersrand and Harvard University, has followed a cohort of over 5,000 adults older than 40 in the Agincourt region in north-east South Africa for more than 10 years.
Throughout this decade of research, the team has been gaining a deeper understanding of this “graying” HIV epidemic. Numerous important insights about HIV in older populations have already been achieved. Here we present some of the findings.
Sexual activity is common
Research conducted in 2017 uncovered a high prevalence of HIV in this older population. Nearly 1 in 4 people over 40 years old were living with HIV.
The study found that 56% of respondents, across all HIV status categories, had had sexual activity in the past 24 months. Condom use was low among HIV-negative adults (15%), higher among HIV-positive adults who were unaware of their HIV status (27%), and dramatically higher among HIV-positive adults who were aware of their status (75%).
Feeling the stigma
There are relatively few studies of HIV-related stigma among older adults, despite the increasing number of older adults living with HIV.
The majority of research excludes, or ignores, age as a variable. Understanding HIV-related stigma in older adults remains crucial and can inform interventions to support their mental health and overall well-being.
Our research suggests that social stigma poses a significant barrier to testing behavior among older adults. A quarter of our respondents reported social stigma related to HIV infection.
A recent pilot study examined home-based HIV testing options for older adults and showed a preference for self-testing. More privacy may encourage more adults to establish their HIV status.
In 2014-2015, 63% of older adults with HIV in the study were taking antiretroviral therapy and 72% of those on therapy were virally suppressed. More recent updates have suggested that as of 2018-2019, many more older adults with HIV were virally suppressed.
Here, they found large gaps in life expectancy based on viral suppression status: a 45-year-old man without HIV could expect to live about another 27 years; a man with virally suppressed HIV could expect to live 24 years. One with unsuppressed HIV could expect to live 17 years.
Similarly, a woman aged 45 without HIV could expect to live another 33.2 years compared with 31.6 years longer for a woman with virally suppressed HIV. A woman with unsuppressed HIV could expect to live a further 26.4 years.
Looking to the future
Taken together, these new insights are critically important to inform the design of interventions and policies to ensure healthy aging in South African society, and particularly among those with or at high risk of HIV.
Tailored strategies to prevent new HIV infections, awareness programs and support to ensure that more people living with HIV in older age groups achieve and maintain viral suppression are urgently needed to reduce HIV risk in this and similar communities in sub-Saharan Africa.
HIV among older South Africans in rural areas: Large study shows there’s a problem that’s being neglected (2024, February 19)
retrieved 19 February 2024
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