Abstract
The HIV epidemic has been considered a disease of young adults since it began. Epidemiological reports that focused on pregnant women up to 49 years of age created the false sense that HIV was not infecting the older population.
In Africa, AIDS mortality increased from the early 1990s to a peak in the early 2000s. The HIV epidemic has mainly affected the eastern and southern regions of Africa, and South Africa became the country with the highest number of HIV infections and AIDS-related deaths worldwide. Life expectancy of people living with HIV increased with the introduction of antiretroviral therapy, creating the first generation of older people infected with HIV. However, prevention campaigns ignored them, and older people, unaware of their risk for HIV infection, engaged in high-risk sexual behaviour and experienced higher-than-expected HIV incidence. This has brought the complication of a double burden of disease, where HIV coexists with noncommunicable diseases that are more common in older adults.
In this context, with older people experiencing new HIV infections and an increasing prevalence, it is crucial to understand their beliefs about HIV transmission and their risk of contracting HIV and their knowledge of measures that can prevent HIV infections and deaths.
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References
Abuelezam, N. N., McCormick, A. W., Surface, E. D., Fussell, T., Freedberg, K. A., Lipsitch, M., et al. (2019). Modelling the epidemiologic impact of achieving UNAIDS fast-track 90-90-90 and 95-95-95 targets in South Africa. Epidemiology and Infection, 147, e122. https://doi.org/10.1017/S0950268818003497
Angotti, N., Mojola, S. A., Schatz, E., Williams, J. R., & Gómez-Olivé, F. X. (2018). “Taking care” in the age of AIDS: Older rural South Africans’ strategies for surviving the HIV epidemic. Culture, Health & Sexuality, 20(3), 262–275. https://doi.org/10.1080/13691058.2017.1340670
Autenrieth, C. S., Beck, E. J., Stelzle, D., Mallouris, C., Mahy, M., & Ghys, P. (2018). Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000–2020. PLoS ONE, 13(11), e0207005. https://doi.org/10.1371/journal.pone.0207005
Bakanda, C., Birungi, J., Mwesigwa, R., Ford, N., Cooper, C. L., Au-Yeung, C., et al. (2011). Association of aging and survival in a large HIV-infected cohort on antiretroviral therapy. AIDS, 25(5), 701–705. https://doi.org/10.1097/QAD.0b013e3283437ed7
Baylies, C. (2002). HIV/AIDS and older women in Zambia: Concern for self, worry over daughters, towers of strength. Third World Quarterly, 23(2), 351–375.
Birnbaum, J. K., Murray, C. J., & Lozano, R. (2011). Exposing misclassified HIV/AIDS deaths in South Africa. Bulletin of the World Health Organization, 89(4), 278–285. https://doi.org/10.2471/BLT.11.086280
Bradshaw, D., Msemburi, W., Dorrington, R., Pillay-van Wyk, V., Laubscher, R., Groenewald, P., et al. (2016). HIV/AIDS in South Africa: How many people died from the disease between 1997 and 2010? AIDS, 30(5), 771–778. https://doi.org/10.1097/QAD.0000000000000947
Brandt, A. M. (1988). The syphilis epidemic and its relation to AIDS. Science, 239(4838), 375–380.
Chang, A. Y., Gómez-Olivé, F. X., Payne, C., Rohr, J. K., Manne-Goehler, J., Wade, A. N., et al. (2019). Chronic multimorbidity among older adults in rural South Africa. BMJ Global Health, 4(4), e001386. https://doi.org/10.1136/bmjgh-2018-001386
Clark, S. J., Gómez-Olivé, F. X., Houle, B., Thorogood, M., Klipstein-Grobusch, K., Angotti, N., et al. (2015). Cardiometabolic disease risk and HIV status in rural South Africa: Establishing a baseline. BMC Public Health, 15, 135. https://doi.org/10.1186/s12889-015-1467-1
de Klerk, J. (2012). The compassion of concealment: Silence between older caregivers and dying patients in the AIDS era, northwest Tanzania. Culture, Health & Sexuality, 14(Suppl 1), S27–S38. https://doi.org/10.1080/13691058.2011.631220
de Klerk, J. (2020). Monitoring the body: Grandmothers’ ability to provide “expert” care for grandchildren living with HIV in northwest Tanzania. Anthropology & Medicine, 27(1), 17–31. https://doi.org/10.1080/13648470.2019.1633112
Freeman, E., & Anglewicz, P. (2012). HIV prevalence and sexual behaviour at older ages in rural Malawi. International Journal of STD & AIDS, 23(7), 490–496. https://doi.org/10.1258/ijsa.2011.011340
Gómez-Olivé, F. X., Thorogood, M., Clark, B. D., Kahn, K., & Tollman, S. M. (2010). Assessing health and well-being among older people in rural South Africa. Global Health Action, 3. https://doi.org/10.3402/gha.v3i0.2126
Gómez-Olivé, F. X., Angotti, N., Houle, B., Klipstein-Grobusch, K., Kabudula, C., Menken, J., et al. (2013). Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care, 25(9), 1122–1128. https://doi.org/10.1080/09540121.2012.750710
Gómez-Olivé, F. X., Thorogood, M., Bocquier, P., Mee, P., Kahn, K., Berkman, L., et al. (2014). Social conditions and disability related to the mortality of older people in rural South Africa. International Journal of Epidemiology, 43(5), 1531–1541. https://doi.org/10.1093/ije/dyu093
Gómez-Olivé, F. X., Houle, B., Rosenberg, M., Kabudula, C., Mojola, S., Rohr, J. K., et al. (2020). Brief report: HIV incidence among older adults in a rural South African setting: 2010–2015. Journal of Acquired Immune Deficiency Syndromes, 85(1), 18–22. https://doi.org/10.1097/QAI.0000000000002404
Greig, J., Casas, E. C., O’Brien, D. P., Mills, E. J., & Ford, N. (2012). Association between older age and adverse outcomes on antiretroviral therapy: A cohort analysis of programme data from nine countries. AIDS, 26(Suppl 1), S31–S37. https://doi.org/10.1097/QAD.0b013e3283558446
Groenewald, P., Nannan, N., Bourne, D., Laubscher, R., & Bradshaw, D. (2005). Identifying deaths from AIDS in South Africa. AIDS, 19(2), 193–201. https://doi.org/10.1097/00002030-200501280-00012
Hallett, T. B., Stover, J., Mishra, V., Ghys, P. D., Gregson, S., & Boerma, T. (2010). Estimates of HIV incidence from household-based prevalence surveys. AIDS, 24(1), 147–152. https://doi.org/10.1097/QAD.0b013e32833062dc
Harling, G., Newell, M. L., Tanser, F., & Barnighausen, T. (2015). Partner age-disparity and HIV incidence risk for older women in rural South Africa. AIDS and Behavior, 19(7), 1317–1326. https://doi.org/10.1007/s10461-014-0952-3
Harris, T. G., Rabkin, M., & El-Sadr, W. M. (2018). Achieving the fourth 90: Healthy aging for people living with HIV. AIDS, 32(12), 1563–1569. https://doi.org/10.1097/QAD.0000000000001870
Hontelez, J. A., de Vlas, S. J., Baltussen, R., Newell, M. L., Bakker, R., Tanser, F., et al. (2012). The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS, 26(Suppl 1), S19–S30. https://doi.org/10.1097/QAD.0b013e3283558526
Houle, B., Mojola, S. A., Angotti, N., Schatz, E., Gómez-Olivé, F. X., Clark, S. J., et al. (2018). Sexual behavior and HIV risk across the life course in rural South Africa: Trends and comparisons. AIDS Care, 30(11), 1435–1443. https://doi.org/10.1080/09540121.2018.1468008
Houle, B., Yu, S. T., Angotti, N., Schatz, E., Kabudula, C. W., Gómez-Olivé, F. X., et al. (2020). Clusters of HIV risk and protective sexual behaviors in Agincourt, rural South Africa: Findings from the Ha Nakekela population-based study of ages 15 and older. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-020-01663-5
Johnson, L. F. (2012). Access to antiretroviral treatment in South Africa, 2004–2011. Southern African Journal of HIV Medicine, 13(1), 22–27. https://doi.org/10.4102/sajhivmed.v13i1.156
Johnson, C., Kumwenda, M., Meghji, J., Choko, A., Phiri, M., Hatzold, K., et al. (2021). “Too old to test?”: A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi. BMC Public Health, 21(650), 1–13. https://doi.org/10.1186/s12889-021-10573-7
Kabudula, C. W., Tollman, S., Mee, P., Ngobeni, S., Silaule, B., Gómez-Olivé, F. X., et al. (2014). Two decades of mortality change in rural northeast South Africa. Global Health Action, 7, 25596. https://doi.org/10.3402/gha.v7.25596
Kahn, K., Collinson, M. A., Gómez-Olivé, F. X., Mokoena, O., Twine, R., Mee, P., et al. (2012). Profile: Agincourt health and socio-demographic surveillance system. International Journal of Epidemiology, 41(4), 988–1001. https://doi.org/10.1093/ije/dys115
Kautz, T., Bendavid, E., Bhattacharya, J., & Miller, G. (2010). AIDS and declining support for dependent elderly people in Africa: Retrospective analysis using demographic and health surveys. BMJ, 340, c2841. https://doi.org/10.1136/bmj.c2841
Kyobutungi, C., Ezeh, A. C., Zulu, E., & Falkingham, J. (2009). HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: Results from a cross sectional survey. BMC Public Health, 9, 153. https://doi.org/10.1186/1471-2458-9-153
Lekalakala-Mokgele, E. (2011). A literature review of the impact of HIV and AIDS on the role of the elderly in the sub-Saharan African Community. Health SA Gesondheid, 16(1), 1–6. https://doi.org/10.4102/hsag.v16i1.564
Loewenson, R., Hadingham, J., & Whiteside, A. (2009). Household impacts of AIDS: Using a life course approach to identify effective, poverty-reducing interventions for prevention, treatment and care. AIDS Care, 21(8), 1032–1041. https://doi.org/10.1080/09540120802626170
Madhavan, S., Schatz, E., Gomes-Olive, F. X., & Collinson, M. (2017). Social positioning of older persons in rural South Africa: Change or stability? Journal of Southern African Studies, 43(6), 1293–1307. https://doi.org/10.1080/03057070.2017.1365522
Maina, W. K., Kim, A. A., Rutherford, G. W., Harper, M., K’Oyugi, B. O., Sharif, S., et al. (2014). Kenya AIDS Indicator Surveys 2007 and 2012: Implications for public health policies for HIV prevention and treatment. Journal of Acquired Immune Deficiency Syndromes, 66(Suppl 1), S130–S137. https://doi.org/10.1097/QAI.0000000000000123
Manne-Goehler, J., Montana, L., Gómez-Olivé, F. X., Rohr, J., Harling, G., Wagner, R. G., et al. (2017). The ART advantage: Health care utilization for diabetes and hypertension in rural South Africa. Journal of Acquired Immune Deficiency Syndromes, 75(5), 561–567. https://doi.org/10.1097/QAI.0000000000001445
Matanje Mwagomba, B. L., Ameh, S., Bongomin, P., Juma, P. A., MacKenzie, R. K., Kyobutungi, C., et al. (2018). Opportunities and challenges for evidence-informed HIV-noncommunicable disease integrated care policies and programs: Lessons from Malawi, South Africa, Swaziland and Kenya. AIDS, 32(Suppl 1), S21–S32. https://doi.org/10.1097/QAD.0000000000001885
Matlho, K., Randell, M., Lebelonyane, R., Kefas, J., Driscoll, T., & Negin, J. (2019). HIV prevalence and related behaviours of older people in Botswana: Secondary analysis of the Botswana AIDS Impact Survey (BAIS) IV. African Journal of AIDS Research, 18(1), 18–26. https://doi.org/10.2989/16085906.2018.1552162
Mills, E. J., Rammohan, A., & Awofeso, N. (2011). Ageing faster with AIDS in Africa. Lancet, 377(9772), 1131–1133. https://doi.org/10.1016/S0140-6736(10)62180-0
Mojola, S., & Angotti, N. (2019). “Sometimes it is not about men”: Gendered and generational discourses of caregiving HIV transmission in a rural South African setting. Global Public Health, 1–13. https://doi.org/10.1080/17441692.2019.1606265
Mojola, S. A., Williams, J., Angotti, N., & Gómez-Olivé, F. X. (2015). HIV after 40 in rural South Africa: A life course approach to HIV vulnerability among middle aged and older adults. Social Science & Medicine, 143, 204–212. https://doi.org/10.1016/j.socscimed.2015.08.023
Mojola, S. A., Angotti, N., Denardo, D., Schatz, E., & Gómez Olivé, F. X. (2020). The end of AIDS? HIV and the new landscape of illness in rural South Africa. Global Public Health, 1–13. https://doi.org/10.1080/17441692.2020.1851743
Moore, A. R. (2013). Older people living with HIV/AIDS (OPLWHA) in Lomẻ, Togo: Personal networks and disclosure of serostatus. Ageing International, 38, 218–232. https://doi.org/10.1007/s12126-012-9158-z
Mugisha, J. O., Schatz, E. J., Hansen, C., Leary, E., Negin, J., Kowal, P., et al. (2018). Social engagement and survival in people aged 50 years and over living with HIV and without HIV in Uganda: A prospective cohort study. African Journal of AIDS Research, 17(4), 333–340. https://doi.org/10.2989/16085906.2018.1542322
National AIDS and STI Control Programme. (2013). Kenya AIDS Indicator Survey 2012: Preliminary report. National AIDS and STI Control Programme, Ministry of Health, Kenya.
Negin, J., & Cumming, R. G. (2010). HIV infection in older adults in sub-Saharan Africa: Extrapolating prevalence from existing data. Bulletin of the World Health Organization, 88(11), 847–853. https://doi.org/10.2471/BLT.10.076349
Negin, J., Wariero, J., Cumming, R. G., Mutuo, P., & Pronyk, P. M. (2010). High rates of AIDS-related mortality among older adults in rural Kenya. Journal of Acquired Immune Deficiency Syndromes, 55(2), 239–244. https://doi.org/10.1097/QAI.0b013e3181e9b3f2
Negin, J., Martiniuk, A., Cumming, R. G., Naidoo, N., Phaswana-Mafuya, N., Madurai, L., et al. (2012). Prevalence of HIV and chronic comorbidities among older adults. AIDS, 26(Suppl 1), S55–S63. https://doi.org/10.1097/QAD.0b013e3283558459
Negin, J., Geddes, L., Brennan-Ing, M., Kuteesa, M., Karpiak, S., & Seeley, J. (2016a). Sexual behavior of older adults living with HIV in Uganda. Archives of Sexual Behavior, 45(2), 441–449. https://doi.org/10.1007/s10508-015-0582-5
Negin, J., Gregson, S., Eaton, J. W., Schur, N., Takaruza, A., Mason, P., et al. (2016b). Rising levels of HIV infection in older adults in eastern Zimbabwe. PLoS ONE, 11(11), e0162967. https://doi.org/10.1371/journal.pone.0162967
Nyblade, L., MacQuarrie, K., Phillip, F., Kwesigabo, G., Mbwambo, J., Ndega, J., et al. (2005). Working report: Measuring HIV stigma: Results of a field test in Tanzania. United States Agency for International Development.
Nyirenda, M., Newell, M. L., Mugisha, J., Mutevedzi, P. C., Seeley, J., Scholten, F., et al. (2013). Health, wellbeing, and disability among older people infected or affected by HIV in Uganda and South Africa. Global Health Action, 6, 19201. https://doi.org/10.3402/gha.v6i0.19201
Ogunmefun, C., Gilbert, L., & Schatz, E. (2011). Older female caregivers and HIV/AIDS-related secondary stigma in rural South Africa. Journal of Cross-Cultural Gerontology, 26(1), 85–102. https://doi.org/10.1007/s10823-010-9129-3
Payne, C. F., Wade, A., Kabudula, C. W., Davies, J. I., Chang, A. Y., Gómez-Olivé, F. X., et al. (2017). Prevalence and correlates of frailty in an older rural African population: Findings from the HAALSI cohort study. BMC Geriatrics, 17(1), 293. https://doi.org/10.1186/s12877-017-0694-y
Pillay-van Wyk, V., Msemburi, W., Dorrington, R. E., Laubscher, R., Groenewald, P., & Bradshaw, D. (2019). HIV/AIDS mortality trends pre and post ART for 1997–2012 in South Africa: Have we turned the tide? South African Medical Journal, 109(11b), 41–44. https://doi.org/10.7196/SAMJ.2019.v109i11b.14283
Rabkin, M., Kruk, M. E., & El-Sadr, W. M. (2012). HIV, aging and continuity care: Strengthening health systems to support services for noncommunicable diseases in low-income countries. AIDS, 26(Suppl 1), S77–S83. https://doi.org/10.1097/QAD.0b013e3283558430
Reniers, G., Araya, T., Davey, G., Nagelkerke, N., Berhane, Y., Coutinho, R., et al. (2009). Steep declines in population-level AIDS mortality following the introduction of antiretroviral therapy in Addis Ababa, Ethiopia. AIDS, 23(4), 511–518. https://doi.org/10.1097/QAD.0b013e32832403d0
Rosenberg, M. S., Gómez-Olivé, F. X., Rohr, J. K., Houle, B. C., Kabudula, C. W., Wagner, R. G., Salomon, J. A., Kahn, K., Berkman, L. F., Tollman, S. M., & Bärnighausen, T. (2017). Sexual behaviors and HIV status: A population-based study among older adults in rural South Africa. Journal of Acquired Immune Deficiency Syndromes, 1(74), e9–e17. https://doi.org/10.1097/QAI.0000000000001173
Rosenberg, M., Gómez-Olivé, F. X., Wagner, R. G., Rohr, J., Payne, C. F., Berkman, L., et al. (2020). The relationships between cognitive function, literacy and HIV status knowledge among older adults in rural South Africa. Journal of the International AIDS Society, 23(3), e25457. https://doi.org/10.1002/jia2.25457
Schafer, M. H., Upenieks, L., & DeMaria, J. (2021). Do older adults with HIV have distinctive personal networks? Stigma, network activation, and the role of disclosure in South Africa. AIDS and Behavior, 25(5), 1560–1572. https://doi.org/10.1007/s10461-020-02996-x
Schatz, E. J. (2007). “Taking care of my own blood”: Older women’s relationships to their households in rural South Africa. Scandinavian Journal of Public Health, 35(Suppl 69), 147–154. https://doi.org/10.1080/14034950701355676
Schatz, E., & Ogunmefun, C. (2007). Caring and contributing: The role of older women in rural South African multi-generational households in the HIV/AIDS era. World Development, 35(8), 1390–1403. https://doi.org/10.1016/j.worlddev.2007.04.004
Schatz, E., Madhavan, S., Collinson, M., Gómez-Olivé, F. X., & Ralston, M. (2015). Dependent or productive? A new approach to understanding the social positioning of older South Africans through living arrangements. Research on Aging, 37(6), 581–605. https://doi.org/10.1177/0164027514545976
Simbayi, L. C., Zuma, K., Zungu, N., Moyo, S., Marinda, E., Jooste, S., Mabaso, M., Ramlagan, S., North, A., Van Zyl, J., Mohlabane, N., Dietrich, C., Naidoo, I., & the SABSSM V Team. (2019). South African National HIV prevalence, incidence, behaviour and communication survey, 2017: Towards achieving the UNAIDS 90-90-90 targets. HSRC Press.
Sinunu, M., Yount, K. M., & El Afify, N. A. (2009). Informal and formal long-term care for frail older adults in Cairo, Egypt: Family caregiving decisions in a context of social change. Journal of Cross-Cultural Gerontology, 24(1), 63–76. https://doi.org/10.1007/s10823-008-9074-6
Tanyi, P. L., Pelser, A., & Okeibunor, J. (2018). HIV/AIDS and older adults in Cameroon: Emerging issues and implications for caregiving and policy-making. Sahara Journal, 15(1), 7–19. https://doi.org/10.1080/17290376.2018.1433059
UNAIDS. (2002). Summary of the Declaration of Commitment on HIV/AIDS. United Nations General Assembly, Special Session on HIV/AIDS. 25–27 June 2001, New York.
UNAIDS. (2006). UNAIDS 2006 report on the global AIDS epidemic. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org. https://data.unaids.org/pub/report/2006/2006_gr_en.pdf
UNAIDS. (2008). Report on the global HIV/AIDS epidemic 2008. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/en/resources/documents/2008/20081107_jc1510_2008globalreport_en.pdf
UNAIDS. (2013). HIV and aging: A special supplement to the UNAIDS report on the global AIDS epidemic. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/sites/default/files/media_asset/20131101_JC2563_hiv-and-aging_en_0.pdf
UNAIDS. (2014a). 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf
UNAIDS. (2014b). Fast-track: Ending the AIDS epidemic by 2030. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf
UNAIDS. (2014c). The gap report. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf
UNAIDS. (2019). UNAIDS data 2019. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/en/resources/documents/2019/2019-UNAIDS-data
UNAIDS. (2020). UNAIDS data 2020. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/en/resources/documents/2020/unaids-data
Vollmer, S., Harttgen, K., Alfven, T., Padayachy, J., Ghys, P., & Barnighausen, T. (2017). The HIV epidemic in sub-Saharan Africa is aging: Evidence from the Demographic and Health Surveys in sub-Saharan Africa. AIDS and Behavior, 21, S101–S113. https://doi.org/10.1007/s10461-016-1591-7
Wallrauch, C., Barnighausen, T., & Newell, M. L. (2010). HIV prevalence and incidence in people 50 years and older in rural South Africa. South African Medical Journal, 100(12), 812–814. https://doi.org/10.7196/samj.4181
World Health Organization. (2008). Report on the review of primary health care in the African region. https://www.afro.who.int/sites/default/files/2017-06/report_review_primary_health_care.pdf. Accessed 26 Aug 2021.
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Gómez-Olivé, F.X. (2022). The Epidemiology of HIV in the Older African Population. In: Brennan-Ing, M., Porter, K.E., Kaufman, J.E., MacPhail, C., Seeley, J. (eds) Aging with HIV in Sub-Saharan Africa. Springer, Cham. https://doi.org/10.1007/978-3-030-96368-2_1
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