The foreseeable face of HIV

Winnie Ssanyu Sseruma
Untitled 184 220x300 The foreseeable face of HIV

Credit Christian Aid/Sarah Filbey

I have written about many aspects of HIV but so far, I’ve managed to avoid the subject of ageing. I am usually a very forward looking and optimistic person but, having recently hit the ripe old age of 50, my happiness at being alive and leading a fairly normal life is tinged, not just with guilt, but also growing anxiety about the future.

My guilt stems from the many reflective articles and speeches that have been triggered by the 30-year anniversary since HIV was first identified in California back in 1981. The most sobering fact about the commemorations is the staggering number of people we have already lost to this one disease so far – between 25 to 30 million worldwide, with just under 34 million currently living with HIV. Around 10 million people should be receiving HIV treatment but instead they’re languishing on waiting lists across the globe as a result of the myriad of differing interpretations of access. The deteriorating health of the global finances is also playing a huge role in this.

The anxiety I am now experiencing stems from some of the unavoidable stark realities of ageing with HIV. Some of the statistics emerging indicate that by 2015 half of all people living with HIV will be over 50 – on the one hand this is amazing because we were never supposed to live so long, but on the other it’s hugely challenging because of what that means for our future health and whether our health facilities are ready for what is already unfolding. Just the other day I read a feature referring to anyone over 50 who is living with HIV as elderly and I immediately thought ‘give me a break’, but they may have a point. There is a phenomenon in HIV circles referred to as ‘accelerated ageing’ which scientists are still not sure is induced by certain HIV drugs, the premature ageing of immune cells, or both.

Such HIV drugs were the very first on the market and became available in the early 1980s. Many of these are no longer being used in developed countries but are still a real lifeline in developing countries across the world. In many clinics in places like Sub Saharan Africa, where HIV is still a big challenge and there are very few drug options, doctors report seeing patients who are doing very well on HIV treatments but look twice or three times their real age. Even though people might be feeling well and living longer, visible physical changes that are not exactly flattering, can have a much more negative emotional impact and can be doubly stigmatizing.

Over thirty years ago, researchers predicated that people living with HIV would be more prone to heart conditions, neurological disorders, and cancers that affect the elderly. And sure enough, whether it is HIV itself or the treatments, doctors are seeing an increased risk of illness and death from liver, lung,  kidney, bone and cardiovascular disease as well as many cancers not traditionally HIV-related. Many of these ailments – and some others which are currently being researched – are showing up in people living with HIV in their 30s, 40s & 50s; ailments that are usually seen in people who are 70-years of age and above in the general population.

Lighten up, I hear you telling me, reminding me that the only certainties in life are getting older, taxes and death! I agree to a point. However, I also believe that there is no harm in confronting life’s challenges as long as you are able to offer solutions, raise awareness and educate others in the process – all points I hope I am able to address through this forum.

Much more needs to be done where the elderly living with HIV are concerned. There is the unspoken view that people over fifty either should not be having unprotected sex or are not having sex at all. Since unprotected sex is one of the main modes of HIV transmission, it’s ridiculous that there are hardly any prevention messages targeted towards older people. Indeed, when people over 50 end up testing HIV positive it’s often a surprise to some health professionals, not to mention being quite traumatic and shameful for their patients. Organisations such as HelpAge International have seen the number of over 50s who are testing positive increasing over the last few years but there is still nowhere near enough support for this group.

I am also acutely aware that as a 50-year-old living with HIV, I am at risk of becoming invisible if research and monitoring organisations do not review their guidelines beyond the current cut off age of 49. HIV prevalence figures in many countries only take into account adults between 15 – 49 years of age; a figure which does not even consider older people living with HIV or their potential treatment and care needs.

In short, much more needs to be done for the over 50s living with HIV – not to just to highlight this uneasy interface but to invest financially, to carry out more research and analyse the impact of the disease medically, socially, and otherwise for this important but essentially sidelined population.

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  • juliarix

    There are 33,300,000 of HIV positive single people worldwide. If you are one of them and you are prepared to become a little brave then You may find that POZmingle. com is just for you. For you will come across new individuals who will certainly become life long friends or Love of life and achieve a degree of self-belief you never would have believed possible. 

  • Spirulina Tablets

    Very sad

  • ralbone

    It is great to see the issue of HIV and ageing being discussed. Having worked on this issue for the last three years I know only too well, how rare discussions like this are, so thank you to Winnie for highlighting an increasingly important issue and one that will become even more significant in the future. As Winnie rightly points out, the numbers of older people living with HIV are increasing yet the attention this issue receives is not. People aged 50 and over currently constitute 14% of all people living with HIV in sub-Saharan Africa and recent increases in prevalence suggest this number will rise. In Botswana there was a rise in prevalence from 23.3% among men aged 50-54 in 2004 to 28.8% in 2008 and from 19.3% to 22.2% for women in the same age group. Despite statistics like this, older people are continually neglected in the HIV response with very few prevention interventions directly addressing their specific needs. As a result many studies have shown that older people are less likely to engage in safer sex than younger people. In South Africa condom use stands at 39.9% among men aged 50 and over in comparison with 58.1% for men aged 25-49 and 87.4% for those 15-24 years old. The lack of prevention work with older people is clearly putting them at risk. And older people face particular challenges when they are living with HIV, as Winnie points out. Recent studies have suggested older people with HIV have 3 times the number of health conditions of people the same age who are HIV negative. Despite all of these issues, ageing and HIV is still being ignored. At the recent High Level Meeting on HIV at the United Nations in New York – a meeting convened to discuss progress in responding to the epidemic and to plan for the future – ageing was not discussed and is not even mentioned in the outcome document, the document that now provides the framework for the world’s response to HIV! Organisations like HelpAge International continue to respond to the needs of older people living with and affected by HIV, in the face of the evidence surely it’s time others followed suit?

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