HIV and Ageing: Understanding the Unique Needs of Older Adults

Dr.Udit Narayan Chhetri 20 May, 2024

HIV and Ageing: Understanding the Unique Needs of Older Adults

Introduction

Since the emergence of the first HIV case in Chennai in April 1986, India has made remarkable progress in combating the epidemic. The introduction of Antiretroviral Therapy (ART) has transformed the landscape, enabling countless individuals to lead healthy lives despite their HIV-positive status. With the availability of free ART under the National AIDS Control Programme (NACP), India has witnessed an 86% decline in AIDS-related deaths (ARDs) from 2005 to 2022. However, as the HIV scenario evolves, new challenges emerge, particularly concerning the ageing population living with HIV. The India HIV Estimates 2022 reveal a notable shift in the age-sex pattern of HIV infections. While only around 17% of total People Living with HIV (PLHIV) were aged 50 years or older in 2000, by 2022, the highest prevalence of HIV was observed in the 45-49 age group with a shift in increase in the older population more than 49 years.

Challenges Faced by Older People Living with HIV

People ageing with HIV encounter many of the same health concerns as the general population aged 50 and older. As individuals grow older, they become more susceptible to chronic diseases. Comorbidities such as diabetes, high blood pressure, and neurocognitive disorders may occur more frequently in older people living with HIV due to ageing. Additionally, they may develop HIV-Associated Neurocognitive Disorder (HAND) and other non-AIDS conditions, such as cardiovascular disease and cancer, often linked to chronic inflammation caused by HIV. While women living with HIV face an elevated likelihood of cervical cancer, men who have sex with men are at a greater risk of developing anal cancer. This risk increases with age, particularly for men who have sex with men and are HIV-positive. Further, Older people with HIV often face stigma and discrimination, leading to psychological distress and delayed access to healthcare services (1–3).

A study conducted in the United Kingdom reported that 22% of people living with HIV aged 50+ rated their current well-being as bad or very bad. More than one-third of the individuals aged 50 and over living with HIV were reliant on welfare benefits, 84% were concerned about their future financial difficulties, and 88% had not made any financial plans to fund future care needs. In addition, 82% of the survey respondents experienced moderate to high levels of loneliness, and 58% had moderate to high levels of HIV self-stigma. Women reported lower levels of well-being than men, highlighting gender disparities(4).

Closing the Gap

As the population of older individuals living with HIV continues to expand, so does the demand for appropriate services. Bridging the gap in HIV care for these populations requires tailored interventions that address their unique needs. It’s crucial for healthcare providers to receive training that equips them to effectively respond to the specific requirements of older adults with HIV. Efforts should prioritize tackling social determinants of health, such as poverty, lack of social support, social isolation, and feelings of loneliness. Furthermore, there’s a pressing need to address the spectrum of non-communicable diseases, including cervical and anal cancers, alongside HIV care. Services must be comprehensive, offering support for emotional and mental well-being, while also addressing the underlying causes of HIV-related self-stigma.

Conclusion

As India continues its fight against HIV, it is imperative to prioritise the needs of older adults living with the virus. By implementing interventions, improving access to healthcare, and addressing social determinants of health, we can ensure that all individuals, regardless of age, receive the support and care they need to live healthy and fulfilling lives.

References

1. New evidence on cervical cancer screening and treatment for women living with HIV [Internet]. [cited 2024 May 17]. Available from: https://www.who.int/news/item/12-12-2023-new-evidence-on-cervical-cancer-screening-and-treatment-for-women-with-hiv
2. Colón-López V, Shiels MS, Machin M, Ortiz AP, Strickler H, Castle PE, et al. Anal Cancer Risk Among People With HIV Infection in the United States. Journal of Clinical Oncology [Internet]. 2018 Jan 1 [cited 2024 May 17];36(1):68.
3. Aging with HIV | HIV.gov [Internet]. [cited 2024 May 8]. Available from: https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/aging-with-hiv
4. Uncharted Territory A report into the first generation growing older with HIV. 2017.