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HIV Infection in Elderly Rises Globally

By Edward Makuzva

The number of elderly people living with HIV is on the rise globally. This increase is attributed to the effectiveness of Antiretroviral Treatment (ART) that increases longevity of life.

Living with HIV at an advanced age is associated with a number of challenges in the range of physical, clinical, and immunological.

Since its discovery in 1980s, HIV has largely been considered as the disease of young people. However, recent reports indicate that the epidemiology of the infected population is fast changing, with significant increase in the number of elderly patients.

Speaking at a Media Science Cafe, on HIV and Aging, organised by Health Communicators Forum (HCF) facilitated by the Humanitarian Information Facilitation Centre (HIFC) funded by AVAC, World Health Organisation, Zimbabwe National Programmes for Family and Reproductive Health officer, Dr Trevor Kanyowa said that many of the medical problems now faced by People Living with HIV(PLWHIV) have more to do with aging than HIV related illness.

Dr Kanyowa highlighted that ageing with HIV infection also presents unique challenges for preventing other diseases because both age and HIV heighten the risk of cancers, bone loss and cardiovascular disease.

Dr Kanyowa said that some of the health problems experienced by older people appear to happen earlier and faster in People Living with HIV.

Worldwide, an estimated 3.6 million people aged 50 years and older are living with HIV. (UNAIDS)
For the first time since the start of the HIV epidemic, 10% of the adult population living with HIV in low- and middle-income countries is aged 50 or older.

“Even with successful ART, the difference in comorbidity-free years between PLHIV and the general population persists, comorbidities being higher in PLHIV.

“This excess morbidity suggests premature ageing in PLHIV, both caused by the HIV infection itself and complex interaction of ART effects, chronic viral co-infections and lifestyle/behavioural factors.

“Nonetheless, aging is highly variable and heterogeneous among individuals, and its underlying mechanisms are not completely clear yet, constituting a challenge for its characterization,” Dr Kanyowa explained.

The veteran doctor added that HIV response, especially in the ageing population, defies a single, universal approach and continues to demand solid knowledge and focused responses
People-centred, participatory HIV responses will therefore need to prioritise this critical demographic.

“HIV responses need to account for this important demographic by reflecting risks and trends and providing appropriate prevention, testing and treatment services. HIV services for people aged 50 or should ideally be integrated with non-communicable disease screening and treatment as well as other age-appropriate health services.

“Clinicians should be aware of the increasing need to manage HIV care and co-morbid conditions associated with aging simultaneously,” Dr Kanyowa added.

Speaking at the same occasion, Newlands Clinician Dr Cleopas Chimbetete said HIV prevention in elderly patients should be made a priority as they are at risk with the pandemic.

“When these elderly come to the clinic, we make sure they are tested so that we are sending a clear message to them that they are at risk.

“There is a realization that there is an emerging challenge of more elderly patients living with HIV in their old age.

“In terms of strategies to address this problem, we need to highlight HIV prevention even in elderly patients. So, for those who are involved with HIV prevention campaigns such as male circumcision, PrEP and whatever form of HIV campaigns let’s includes the elderly as well. We realise that they remain at risk with new infections.

“When we see elderly patients coming to our hospital facilities for whatever medical reason let’s offer HIV Testing because we have noticed a delay in HIV diagnosis and some of the symptoms of HIV infections in this age group they mimic old age and they just dismissed as part of the aging process and we don’t want late diagnosis of HIV in generation of people.

“We also realize that HIV is a risk factor in number of other conditions so people living HIV in old age are more likely to have other conditions such as hypertension, diabetes, mental health issues, cancers such as cervical cancer,” said Dr Chimbetete.

Dr Chimbetete added that as care providers we must now offer a holistic approach or comprehensive approach to the care of elderly patients.

He called for the stocking of all Opportunistic Infections(OIs) clinics to be equipped with BP machines and glucagon machines to test sugars.

“We don’t want health workers who only understand HIV management but do not understand our national guidelines in terms of how we manage hypertension, diabetes and how we screen common cancers. So we want a holistic approach,” Dr Chimbetete explained.

Speaking at the same forum, the Zimbabwe HIV and AIDS Activists Union Community Trust (ZHAAUCT), Secretary General, Angeline Chiwetani said her long life journey living with HIV has been made possible because of her strict adherence to medication.

Chiwetani who is 51 years old, living with HIV for 29 years has been on treatment for 15 years, since 2008.

She narrated that stigma and discrimination around PLHIV was very high and landlords chased away tenants if they suspected that they are HIV positive in decades gone by.

“Alot of people died and some the of the landlords chased away their tenants if they suspect that you are HIV positive and during those days being positive was like a death sentence in the communities or locations.

“We were living in Glen View in the 90s. I witnessed stigma and discrimination. We were given separate toilet outside.

“My husband passed away, but look at me now. I’m healthier through taking my medication regularly. You won’t go wrong if you took these ARVs,” Chiwetani explained.

Stigma refers to the process by which a group of individuals is labeled as socially undesirable, and these individuals are devalued due to attributes or behaviors that are societally deemed as “deeply discrediting”.

Stigma is a damaging social phenomenon. In the case of people living with HIV (PLHIV), stigma has negative effects on health outcomes, including non-optimal medication adherence, lower visit adherence, higher depression, and overall lower quality of life .

Statistics revealed that 4.2 million people aged 50 and older are living with HIV today globally.

More than 2 million people aged 50 and older live in Sub- Africa, which accounts for 60 % of all people with HIV over the age of 50.

13% of the adult population living with HIV is aged 50 or older.

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