Aging with HIV in Sub-Saharan Africa: Health and Psychosocial Perspectives

1. Foreword

Mark Brennan-Ing

2. Epidemiology of HIV in the older African population

F. Xavier Gmez-Oliv

The HIV epidemic has been associated with a younger population, but this no longer holds true. Before effective treatment was available, AIDS mortality in sub-Saharan Africa was rising, peaking in the early 2000s. Then, with the introduction of antiretroviral therapy, life expectancy of people living with HIV increased. Their survival resulted in a higher prevalence of HIV in the over-50 population, creating a double burden of diseases, where HIV coexists with noncommunicable conditions. This double burden places extra stress on an already weak primary health system, especially in rural settings. Older people are also acquiring HIV. Prevention campaigns mainly target young people. People over 50 may therefore engage in high-risk sexual behavior that exposes them to infection, resulting in higher than expected HIV incidence. It is crucial to understand how older people perceive their risk of contracting HIV in order to institute effective preventive measures.

3. Multiple chronicities: Aging bodies, wellbeing, and chronic HIV in Eastern Africa

Josien de Klerk

The concept of multiple chronicities is used to argue that living with chronic HIV is not a singular experience. Building on ethnographic work in two rural settings (Tanzania) and an urban setting (Kenya), this chapter frames older people's living with the virus as a social experience, blurring the distinction between being infected and being affected by loss and prolonged caregiving. In East African where HIV is endemic, older people's personal and family histories with the virus shape the multiplicity of chronic HIV. The embodied experience of chronic HIV for older people is not only about how the virus behaves in the older body but also about the management of traumatic memories of caregiving and loss. HIV interplays with other chronic conditions, such as noncommunicable diseases and economic conditions. The presentation of a senior service model that acknowledges HIV as multiple chronicity exemplifies how models of HIV care could be developed in endemic contexts.

4. Comorbid conditions occurring in older adults on antiretroviral therapy (ART) in Botswana: A retrospective cross-sectional cohort study of patient data

Kabo Matlho

Although people over the age of 50 account for more than 20% of those living with HIV in Botswana, they are largely underrepresented in HIV research and tailored interventions. Yet the interaction of aging and HIV may involve an increased risk for and exacerbation of chronic illnesses such as tuberculosis (TB)
cardiovascular, kidney, and liver diseases
diabetes
hypertension
and cancers, as well as cognitive decline. These comorbidities complicate treatment and potentially increase mortality. This study gauged the existence and magnitude of comorbidities within the aging HIV cohort in Botswana using data from patients age 35 and older who were on first-line antiretroviral therapy. The data show a higher rate of specific comorbidities in adults 50 and older compared with those age 35-49. TB was particularly prevalent in older men, and hypertension was most prevalent among older women. Multimorbidity is pronounced among those aging with HIV in Botswana. Guidelines and policies need to adapt to the changing demographics and evolving challenges.

5. Expectations of health and illness in older age through the lens of the HIV-epidemic i