Uganda recently joined the rest of the world to celebrate the International Day of Older Persons. Last week, we celebrated yet another event in honour of our senior citizens – the first National Gathering of Grandmothers in Uganda that has been organised by Reach Out Mbuya HIV/Aids Initiative and partners. For us involved in the fight against HIV/Aids, this presents an opportunity for reflection, especially in light of the fact that the number of people living with HIV who are 50 years and older continues to grow.
According the UNAIDS 2013 Aids by Numbers Report, out of the global total of about 35 million people living with HIV, an estimated 3.6 million are people aged 50 years or older. The majority (about 2.9 million) are in low-and middle income countries where the percentage of adults living with HIV who are 50 years or older is now above 10 per cent.
Closer to home, despite research successes and focused national attention, HIV infection rates among senior citizens is still a grey area. The National HIV/Aids and Aging Awareness Day may have gone unnoticed in Uganda. In fact, most sources of data will show prevalence rates only for those aged 15-49 years.
The good news is that with increased access to anti-retroviral treatment, more people living with HIV are now able to live as long as their HIV negative counterparts, though the physical and social issues that affect the elderly, particularly in developing countries, are more aggressive among the senior citizens living with HIV.
Living with HIV presents a number of challenges, no matter how old one is. However, in addition to these challenges, older people may face social isolation, loneliness, stigma, depression and financial constraints in addition to the waning physical capacity. They are also more likely to have heart, liver and kidney disease, osteoporosis and other chronic conditions.
And yet there is limited research and interventions targeting the elderly living with HIV. Many health care specialists will hesitate to ask older people about their sex lives because there is a tendency to assume that the older people are not sexually active, which is not necessarily the case. While some of the elderly patients may have been HIV positive for a long while, these tend to be diagnosed with very advanced stages of the disease due to a very low suspicion of HIV infection in this age group by health providers.
At the Makerere University Joint Aids Programme (MJAP) supported ISS clinic in Mulago 10 per cent of the over 12,000 clients receiving treatment at the clinic are 50 years or older. This suggests that there is a sizeable number of HIV infected individuals in this age bracket who may be missing appropriate care.
Older people are rarely targeted by HIV prevention campaigns and are less likely to be routinely tested for HIV. Even after more than 30 years since the first case of HIV/Aids was first diagnosed, the stories of stigma among people living with HIV are still common. For senior citizens who may already face isolation due to illness or loss of family and friends, stigma negatively affects their quality of life.
We must be more prepared for the ‘wave of older people living with HIV’. People living with HIV will need long-term care as they age, not just for HIV but for a host of other illnesses they are likely to develop. Ensuring that they have access to the care they need may require considering specialised care for older people living with HIV. HIV infection should not be ignored among older patients.
Dr Semitala is a care and treatment advisor, and head of research at the Makerere University Joint Aids Programme