HIV among older adults in sub-Saharan Africa : a neglected epidemic

Abstract

As the HIV epidemic enters into its fourth decade, the epidemiology continues to change and the response continues to adapt. One of the most significant trends in HIV in developed countries has been the ageing of the cohort as HIV-positive individuals infected while young survive longer with anti-retroviral treatment and due to ongoing sexual transmission among those aged 50 years and older. In the United States for example, recent estimates have noted that around 50% of people living with HIV will be older than 50 by 2015. Despite these clear trends and their significant implications for prevention, care and treatment – specifically with regard to co-morbidity with various chronic diseases – very little analysis has been conducted on the HIV and ageing phenomenon in developing countries. This thesis aims to address the shortage of evidence in this emerging area by focusing on HIV infection among older adults in sub-Saharan Africa – the region where the HIV burden is greatest – from a number of different quantitative angles. This thesis contains five published works. The University of Sydney’s Academic Board approved submission of published work as a thesis on 14 August 2002. The thesis adheres to the University of Sydney thesis by publication format. Chapter One highlights the high rates of AIDS-related mortality among older adults in a rural community in high prevalence western Kenya. This mortality underscores the need to better understand the issue of HIV among older adults in Africa. Chapter Two estimates the number of people aged 50 years and older living with HIV in sub-Saharan Africa using United Nations data. Chapter Three examines HIVrelated awareness, knowledge and testing behaviour among those aged 50 years and older in nine rural sites in seven African countries. Chapter Four examines HIV infection and treatment outcomes among older adults in Zomba District in Malawi. Chapter Five uses a large population-based survey among older adults in South Africa to develop a picture of HIV infection along with an examination of rates of diabetes, stroke, arthritis, depression and other conditions. Together, these papers and chapters explore the multi-faceted aspects of HIV among older adults in Africa. Mortality, epidemiology, awareness, treatment outcomes and co-morbidities are all addressed to develop a fuller quantitatively-driven picture of the issues and challenges facing older adults and the responses needed for this important emerging trend. Ethical Clearance Malawi’s National Health Sciences Research Committee provided ethical approval for Chapter Four. The research conducted for Chapters One and Three was approved by the ethical review committee at Columbia University, New York, USA, and by all governments of host countries – in the case of Chapter One specifically, the Kenya Medical Research Institute ethics board. Ethical review and clearance for Chapter Five was obtained through the World Health Organization and South Africa’s Human Sciences Research Council Research Ethics Committee. Ethical approval was not required for Chapter Two. Prior to receipt and analysis for this thesis, all data sets were anonymised.