Inequality in Health Status Among Older Adults in Africa: The Surprising Impact of Anti-Retroviral Treatment

Abstract

It is well known that the large-scale roll-out of antiretroviral therapy (ART) has reduced mortality and improved the health status of millions of people living with HIV (PLWH) in resource-limited settings (UNAIDS 2011). Although most common prevalence and epidemiological measures neglect measuring older people in these settings, estimates reveal that there are at least 3 million PLWH aged 50 years and above in sub-Saharan Africa (Hontelez et al. 2012; Negin and Cumming 2010). Though not specifically targeted by most treatment programs, increasing numbers of older adults in Africa have accessed ART services. There has been an ongoing debate in the literature about how the large scale roll-out of HIV services in Africa has affected wider health systems (Biesma et al. 2009; Brugha et al. 2010). Yet, to date, none of this literature examines the impact on older adults in particular. Studies from South Africa and Uganda reveal that the huge investments in strengthening HIV services and system responsiveness have led to older HIV-positive individuals having greater access to clinical care and support than if they were HIV-negative. These studies focused on the health of HIV-infected older adults aged 50 years and above and surveyed same-age HIV-negative counterparts as a comparator. What they found was surprising. In the South Africa study, HIV-infected older adult participants reported better functional ability (77.8 vs 69.4 on 100 point scales; p<0.001), quality of life (62.5 vs 59.4; J Cross Cult Gerontol (2013) 28:491–493 DOI 10.1007/s10823-013-9215-4