HIV Infections Surge Among Older Adults in Sub-Saharan Africa

A concerning rise in HIV cases among people aged 50 and older in sub-Saharan Africa is prompting urgent calls for targeted interventions. This demographic’s vulnerability highlights gaps in current prevention strategies and the need for tailored healthcare approaches.

Rising Prevalence in Older Adults

Between 2000 and 2016, the number of adults over 50 living with HIV in sub-Saharan Africa doubled. Their HIV prevalence now surpasses that of younger adults. By 2040, a quarter of Africans with HIV could be in this older age group, necessitating awareness and treatment campaigns.

Dr. Luicer Olubayo, a researcher at the Sydney Brenner Institute for Molecular Bioscience (SBIMB) at Wits University, observed that HIV perceptions are limited. “We often think of HIV as a disease of younger people. It doesn’t help that intervention campaigns are mainly targeted at the youth.”

Older adults often disbelieve they can contract HIV. This widespread misconception hampers global efforts to meet UNAIDS’ 95-95-95 targets by 2030. These are that 95% of people with HIV know their status, 95% of those who know are on treatment, and 95% have a suppressed viral load.

Challenges and Barriers

Associate Professor F. Xavier Gómez-Olivé, at the MRC/Wits-Agincourt Research Unit, points out that HIV surveys frequently focus on younger individuals, leading to insufficient data on older populations. This creates significant gaps in understanding prevalence, incidence, and treatment outcomes.

Stigma remains a significant obstacle to treatment access. Poor HIV testing uptake among older adults delays diagnoses and limits care. This is due to pervasive stigma, which is why understanding it in older adults remains crucial.

Dr. Olubayo notes, “We know that there is significant social stigma related to HIV infection. This is why understanding HIV-related stigma in older adults remains crucial as a way to inform interventions to support older people’s mental health and overall well-being.”

These interventions include repeated testing, pre-exposure prophylaxis (PrEP), and campaigns to increase awareness. Gómez-Olivé adds that HIV can be managed alongside other chronic conditions.

Risk Factors and Complex Interplay

A complex interplay of factors shapes HIV risk. Age, education, gender, and location impact an individual’s risk. Although more people have access to treatment, older adults, particularly in rural areas, face challenges like lower education levels and gender inequality.

Widowed women experience the highest HIV rates (30.8%). This is potentially due to losing a partner to HIV, stigma, and greater risk of unsafe behaviors. People without formal education and those with low incomes also have higher rates of infection.

The CDC reports that in 2021, 22% of new HIV diagnoses in the U.S. were among individuals aged 55 and older (CDC 2021).

Longitudinal Data and Future Directions

Longitudinal data provides valuable insights into the HIV epidemic among older adults in sub-Saharan Africa. Gómez-Olivé says, “Our study is beneficial in that older populations are under-represented, and not much is known about them over time. What changes are occurring? We have to answer these kinds of questions. With longitudinal data, we can look at the effectiveness of antiretroviral therapy coverage in older people.”

The study used data from urban Kenya and urban and rural sites across South Africa from 2013-2016 and 2019-2022. The team is gaining a deeper understanding of this aging HIV epidemic.

Data for the study originated from the Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen), involving adults aged 40 and older. AWI-Gen is a long-term study at six research centers in four sub-Saharan African countries.