Why the elderly are less likely to receive AIDS prevention and treatment advice

Close to forty years into the AIDS pandemic, people infected with HIV can now live much longer due to Anti Retroviral Therapy (ART) drugs, a positive development that has converted AIDS into a chronic and manageable condition from a life-limiting infection. A Lancet HIV journal study suggests that people living with HIV on ART treatment have a “near normal” life expectancy.

This also means, however, that more people with HIV are living longer and getting older, hence the number of older people living with HIV is likely to increase. In 2014, about 13% of people living with HIV globally were over 50 years old. Many of these older people are assumed to be older women with greater vulnerabilities.

Moreover, nearly 17% of new HIV infections are reported in people over 50. Old age is not a safety net against new infections, or against any Sexually Transmitted Diseases (STDs), including HIV and AIDS. The threats and implications of HIV infection for older people are as serious as they are for younger age groups.

Not surprisingly, a larger proportion of older people living with HIV are based in lower and middle-income countries, particularly in Sub-Saharan Africa and in Asia. These numbers are likely to rise further. Poverty and overall poor health conditions, including comorbidities, worsen the situation further for older people in these regions.

In the last couple of years, as the COVID-19 pandemic shook global health systems, the impacts were seen on equitable access to prevention and treatment for HIV. It is feared that the pandemic may jeopardise the hard-won gains made in the global response to HIV.

In India, according to the estimates of the National AIDS Control Organization (NACO), the prevalence rate of AIDS was 0.22 in 2019, which is on the lower side on a global comparison. Yet, because of its overall population size of over 1.3 billion, India still has a large number of people living with HIV, an estimated 2.34 million.

Although little data is available on the number of older people living with HIV in India, it is estimated that a sizeable proportion of people living with HIV in India is comprised of older people. The two reasons that would support this assumption are: firstly, India has relatively good availability and coverage of ART, increasing life expectancy significantly; and, secondly, there has been a significant reduction in the incidence of new HIV infections in the country.

India also has one of the largest populations of older people in the world. Particularly in rural areas, many older people live in deprivation and poverty and there is a significant lack of healthcare services. Large numbers of older people suffer from communicable and non-communicable diseases. Amidst many other challenges faced by older people in rural India, they must bear the misery of being neglected and forgotten in HIV prevention and management efforts.

Ageing with HIV clearly is a significant global health challenge, yet public health strategies have been inadequate in recognising and addressing this critical reality.

World AIDS Day 2022 - to be observed on December 1 - has a theme of 'equalise.' It calls for action to address inequalities in the global response to HIV and AIDS. Hence, older people with their sizable proportion of HIV-affected people and, due to their special needs, must be an important priority and must get equitable access to prevention and treatment.

Several civil society organizations and community-based groups around the world, particularly in Africa and Asia, have focused on mainstreaming older people’s needs within their HIV response and programmes. The emphasis has been on strengthening older people’s groups within the communities (older people’s associations, self-help groups and inter-generational learning groups; on including HIV in health education curriculums (such as self-care and long-term care training); and, on reducing the stigma that isolates older people, especially older women. In addition, the thrust has been on training caregivers within communities and on providing psycho-social support to older people living with HIV.

GRAVIS, an NGO based in India, is running a comprehensive age-friendly healthcare programme that includes HIV and AIDS interventions. In the Thar Desert region and other states of India where GRAVIS works, older people live in deep poverty and are often missed by traditional health programmes. Specialised outreach sessions to people above 50 years of age provide education and counselling on HIV transmission and prevention. Those living with HIV are encouraged to access government-provided ART on a regular basis. Special focus is given to older women’s education on HIV, as they may be less informed and are more vulnerable. GRAVIS also facilitates intergenerational dialogues on HIV to reduce the stigma associated with it. It has so far reached out to over 100,000 older people to increase their understanding of HIV.

HIV in old age should be one of the most important future priorities and is a serious challenge in the battle against the virus. Moving forward, an inclusive approach that takes older people’s needs into account is required. It may have three important components: firstly, forming and strengthening older people’s groups within the communities; secondly, reducing and eliminating stigma leading to greater access for older people to testing and treatment; and thirdly, making HIV and AIDS an integral part of community-based health education initiatives.

Addressing older people’s needs and concerns will make the global response to HIV truly equitable and will facilitate progress on SDG3, which envisions the end of AIDS by 2030.