Older persons: missing link in HIV response

Conrad Gweru
Allocating resources for HIV and Aids treatment, care and support is a herculean task that health planners and policy-makers in most low and middle-income earning countries struggle with.The increasing demand for services due to increasing awareness of the virus has resulted in resources allocated failing to meet the demand created with regards to treatment of patients, care and support of both the infected and affected.

Health planners and policy-makers have, in the past years, received a series of advocacy messages and various policy statements and actions with a number of recommendations from organisations and stakeholders representing different population groups.

Key amongst those stakeholders and groups are older persons whose voice has unfortunately not received deserving attention by health planners and policy makers globally and more specifically in Zimbabwe.

Throughout the world, focus and attention has been given to the 15 to 49 age group who are said to be more vulnerable and sexual active more than any other persons outside the age group, but a recent report published by UNAIDS seems to be singing a different tune.

The “HIV and Ageing” report of November 2013 contains alarming statistics pointing to an increasingly significant trend in the global HIV epidemic as it confirms a growing number of people aged 50 and older who are living with the virus.

The report indicates that for the first time since the start of the HIV epidemic, 10 percent of the adult population living with HIV in low and middle-income countries is aged 50 or older.

Unaids, in its report, was concerned that very few HIV strategies in low and middle-income countries currently address this previously hidden dimension of the HIV epidemic, yet populations 50 years and older hold important implications for HIV responses today.

The proportion of adults living with HIV that is aged 50 years and older has increased in all regions, at varying rates, since 2007.
Currently an estimated 3.6 million people worldwide aged 50 years and older are living with HIV.

In 2012 alone the report notes that there were an estimated 2.9 million people aged 50 years and over living with HIV in low and middle-income countries.

According to the report this “ageing” of the HIV epidemic is mainly due to three factors: the success of anti-retroviral therapy in prolonging the lives of people living with HIV; decreasing HIV incidence among younger adults shifting the disease burden to older ages; and the often-unmeasured, and thus often overlooked, fact that people aged 50 years and older exhibit many of the risk behaviours also found among younger people.

The report notes that relatively few HIV surveys have been conducted specifically among individuals aged 50 years and older, but those which are available reveal high HIV prevalence. In a 2012 national HIV survey in South Africa, for example, HIV prevalence was 13 percent among people aged 50–54 years, and 12 percent among women and 6.9 percent among men aged 55–59 years (compared to 18 percent among men and women aged 15-49 years).

A 2006–2007 national population-based survey in Swaziland, found 13 percent of men and seven percent of women aged 60–64 years were living with HIV (compared to 27 percent among men and women aged 15-49 years). In Kenya, HIV prevalence was five percent among people aged 50-64 years (compared with 7.4 percent in people aged 15–49 years).

In Zimbabwe, while there has been a noted decrease in the positivity rate for all age groups, there has been a significant increase in positivity amongst the 50+ age group.

National Aids Council communications officer Mrs Tadiwa Pfupa-Nyatanga said, “Generally there has been a slight drop in the positivity rate for all the age groups except in the 50+ age group where there has been an increase from 13.8 percent to 14.3 percent.”

Based on the report there is need to address the growing numbers of older persons 50+ living positively. HelpAge Zimbabwe programmes manager Mr Adonis Faifi indicated that older persons face a number of challenges with regards to access to treatment, care and support.

He said, “Most HIV/Aids programmes target young people and I think there is need to design programmes that also target older persons. . .” he further indicated that there is also need to have age friendly desks within Ministry of Health and Child Care from the rural health centre to national health facilities where older persons can freely go to and access HIV and AIDS services amongst other health needs.

He noted with concern that the lack of priority of older persons on HIV and AIDS issues is mainly due to the assumption that “older persons are considered past the age of sexual activity, hence they have not been prioritised even by the very responsible authority, in this case National Aids Council, if you check in the current HIV and AIDS Strategic plan, the priority is the ages (15-49) cohort in policy planning and allocation of resources in response to HIV and AIDS”.

He further advised that Government needs to raise awareness of HIV and Aids amongst older persons. Co-ordinator of the Zimbabwe Ageing Network Mr Mark Chikanza noted that older persons had not been consulted on HIV and Aids issues affecting them.

The organisation is working on a new programme and policy change issues were data should be collected primarily for the 50+ age group.

He also noted that “There is a strong misconception that sexuality does not concern older persons.
“Access points for condoms and other services favour younger people especially anti-natal centres where there is a lot of information but unfortunately older people do not go there.

“Cleaning of the sick or even the dead is a role of older persons but they do not have information.  There are a lot of cultural issues still going on that with proper training they can also be broken,” he said.

Mr Chikanza advised that Government must collect and publicise data on all age groups.
“Government should collect and publicise data on all age groups. At the moment interventions are focused on the 15-49 age group since data is readily available on that age group.

“Data will then be used to allocate resources according to need for each group.”
He also noted that district hospitals must have age friendly desks.

“District hospitals should have age friendly desks where older people are comfortable to approach.  Access to medication should be improved. We have also realised that new infections among older people are going up.

“We are now main streaming it in all the activities.  When we talk of access to health, it includes access to HIV and medication.”