Older adults

The existence of effective treatments for HIV means people are able to live with HIV to an increasingly older age. The proportion of people seen for HIV care who are black African and aged over 50 has steadily increased over the last decade: 4.4% of the total in 2000, 5.8% in 2004 and 10.6% in 2009.¹

More generally, the number of people diagnosed with HIV when they are 50 or older is increasing, although a large proportion of these new diagnoses are in people of white ethnicity. A proportion acquired their infection over the age of 50 (suggesting that prevention activities must reach this group). Nonetheless people diagnosed when they are older are even more likely to be diagnosed late, with a low CD4 count, than people diagnosed at younger ages.²

Of the surveyed African people in BASS Line 2008-09, those over 50 were the least sexually active, with fewer sexual partners, and were among the most confident in accessing, possessing and using condoms. They were the most knowledgeable about HIV and, unlike younger age groups in the BASS Line survey, each respondent was sure they did not want to pass on or get HIV.³ Nonetheless the survey’s recruitment methods may mean that those surveyed are not entirely representative of the wider African population.

The fact that the population of black African people living with HIV is getting steadily older means that greater attention should be paid to how ageing affects the natural history of HIV and the response to treatment. A project run by the Africa Advocacy Foundation in south London reported that those over the age of 50 lacked information about a range of health problems that they were experiencing, and were unsure whether they were medication side-effects, associated with HIV infection or were other conditions that are more common in older people. Older people are more likely to experience multiple health conditions, making medical management more complex.⁴

A recent investigation into the needs of older people with HIV found that the principal concerns of older black African women with HIV were financial difficulties, employment, difficulties with self-care, stigma and discrimination, access to health care, depression and mental health, and loneliness. The researchers commented that, in comparison to the other older adults studied, the needs of black African women were particularly acute.⁵

Given that some older black African people have weak support networks in the UK, there is probably a need for more psychosocial support, as well as better liaison between HIV services, other health services and other care providers. Moreover as more and more people are living longer with HIV, there will be an increase in the size of this population, demanding that research, services and information take age into account.