Older adults in sub-Saharan Africa face growing HIV epidemics

Older adults in sub-Saharan Africa face growing HIV epidemics

Prevention and treatment campaigns do not adequately address the specific needs of the age group over 50 years.

In fact, the number of adults aged 50 and older living with HIV in sub-Saharan Africa doubled. Currently, their HIV prevalence exceeds that of younger adults.

By 2040, a quarter of people living with HIV in Africa will be aged 50 and over. Tailored awareness and treatment campaigns are urgent.

Dr. Luicer Olubayo, a researcher at the Sydney Brenner Institute for Molecular Bioscience (SBIMB) at Wits University and the lead author of a study published inLancet's healthy longevityThe journal, which studied HIV among older people in Kenya and South Africa, found that awareness of HIV acquisition is limited. "We often think of HIV as a disease of younger people. It doesn't help that intervention campaigns are primarily aimed at youth."

Additionally, older adults are less likely to believe they can get HIV. This misunderstanding is pervasive and has consequences for achieving global goals to achieve UNAIDS' 95-95-95 targets by 2030 (95% of people with HIV know their status, 95% of those who know their status are on treatment and 95% have a suppressed viral load).

While HIV prevalence among individuals over 50 years of age is similar to or exceeds that of younger adults, HIV surveys focus on younger individuals, leaving significant gaps in understanding HIV prevalence, incidence, and treatment outcomes in older populations. “

F. Xavier Gómez-Olivé, Associate Professor, MRC/Wits Agincourt Research Unit

Stigma remains a barrier to treatment

Uptake of HIV testing among older adults is poor, delaying diagnosis and limiting access to care. This is, in fact, one of the signifiers of the spread of the stigma that surrounds the disease.

"We know that there is significant social stigma surrounding HIV infection. For this reason, understanding HIV-related stigma among older adults remains critical to inform interventions to support the mental health and overall well-being of older people," says Olubayo.

Interventions could focus on repeated testing, use of pre-existing prophylaxis (PREP), and campaigns to increase awareness and reduce infections among older people.

“HIV can also be managed alongside other chronic diseases because HIV is managed as a long-term disease,” says Gómez-Olivé.

Non-communicable diseases such as hypertension, diabetes and obesity have increased dramatically in sub-Saharan Africa, particularly among older people. HIV treatment and intervention can be integrated into the long-term disease health ecosystem.

Aside from stigma, a complex interplay of factors shapes the risk of HIV

The study shows that age, education, gender and where people live influence their risk of HIV. Although more people now have access to HIV treatment, older adults, particularly in rural areas, silently face significant challenges in preventing HIV, such as: B. low levels of education and gender inequality.

Widow women had the highest HIV rate (30.8%). This may be due to having a partner against HIV, stigma, and a higher risk of unsafe behaviors such as transactional sex and limited power to negotiate condom use. People without formal education and those with low incomes also had higher HIV infection rates.

The advantage of longitudinal data for making decisions

An important added value of this study is the provision of longitudinal insights into the HIV epidemic among older adults in sub-Saharan Africa. "Our study is advantageous in that older populations are underrepresented, and not much is known about them over time. What changes occur? We need to answer these types of questions. With longitudinal data, we can study the effectiveness of antiretroviral therapy in older people," says Gómez-Oltivé.

The study used data collected in urban Kenya and in urban and rural locations across South Africa during two data collection waves: 2013-2016 and 2019-2022.

During a decade of research, the team has gained a deeper understanding of this aging HIV epidemic. Many important findings have been made about HIV in older populations and research gaps are being addressed.

Data for the study comes from the Africa-Wits-un Independent Partnership for Genomic Research (AWI-Gen) of adults aged 40 and over. AWI-Gen is a multicenter study with longitudinal cohorts in six research centers in four sub-Saharan African countries (South Africa, Kenya, Burkina Faso and Ghana) to investigate various determinants of health.

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