Abstract
Background: The roll out of antiretroviral therapy in Botswana, as in many countries with near universal access to treatment, has transformed HIV into a complex yet manageable chronic condition and has led to the emergence of a population aging with HIV. Although there has been some realization of this development at international level, no clear defined intervention strategy has been established in many highly affected countries. Therefore we explored attitudes of policy-makers and service providers towards HIV among older adults (50 years or older) in Botswana. Methods: We conducted qualitative face-to-face interviews with 15 consenting personnel from the Ministry of Health, medical practitioners and non-governmental organizations involved in the administration of medical services, planning, strategies and policies that govern social, physical and medical intervention aimed at people living with HIV and health in general. The Shiffman and Smith Framework of how health issues become a priority was used as a guide for our analysis. Results: Amidst an HIV prevalence of 25% among those aged 50–64 years, the respondents passively recognized the predicament posed by a population aging with HIV but exhibited a lack of comprehension and acknowledgement of the extent of the issue. An underlying persistent ageist stigma regarding sexual behaviour existed among a number of interviewees. Respondents also noted the lack of defined geriatric care within the provision of the national health care system. There seemed, however, to be a debate among the policy strategists and care providers as to whether the appropriate response should be specifically towards older adults living with HIV or rather to improve health services for older adults more generally. Respondents acknowledged that health systems in Botswana are still configured for individual diseases rather than coexisting chronic diseases even though it has become increasingly common for patients, particularly the aged, to have two or more medical conditions at the same time. Conclusions: HIV among older adults remains a low priority among policy-makers in Botswana but is at least now on the agenda. Action will require more concerted efforts to recognize HIV as a lifelong infection and putting greater emphasis on targeted care for older adults, focussing on multimorbidity.
Highlights
Le deploiement de la therapie antiretrovirale auBotswana, comme dans nombreux pays avec pres de l’accesuniversel au traitement, a transformele VIH une maladiechronique complexe mais facile agerer et a conduit al’emergence d’un vieillissement de la population avec le VIH.Bien qu’il y a eu quelques realisation de cette evolution auniveau international, aucune strategie d’intervention definisclairement n’etabli dans de nombreux pays fortement touches.C’est pourquoi nous avons exploreles attitudes des decideurset des fournisseurs de services pour le VIH chez les personnesagees (50 ans ou plus) au Botswana
We conducted 15 one hour, face-to-face, semi-structured, indepth interviews with consenting personnel from government and non-governmental organizations involved in the administration of medical services, care, strategies, planning and policies that govern social, physical and medical intervention aimed at people living with HIV (PLWH) and health in general in Botswana
The group consisted of six high-ranking civil servants directly involved with policy implementation from various departments within the government including the Ministry of Health and the National AIDS Coordinating Agency; four senior medical and nursing practitioners charged with HIV care at the HIV referral clinics in urban and rural areas; and four high ranking civil society representatives from three different non-governmental organizations directly involved with HIV care and management
Summary
Le deploiement de la therapie antiretrovirale auBotswana, comme dans nombreux pays avec pres de l’accesuniversel au traitement, a transformele VIH une maladiechronique complexe mais facile agerer et a conduit al’emergence d’un vieillissement de la population avec le VIH.Bien qu’il y a eu quelques realisation de cette evolution auniveau international, aucune strategie d’intervention definisclairement n’etabli dans de nombreux pays fortement touches.C’est pourquoi nous avons exploreles attitudes des decideurset des fournisseurs de services pour le VIH chez les personnesagees (50 ans ou plus) au Botswana. The advances of antiretroviral therapy (ART), in industrialized nations and many low- and middle-income nations, has transformed HIV into a manageable chronic condition leading to the emergence of a large population aging with the disease (Mills, Barnighausen, & Negin, 2012; Negin, Martiniuk, et al, 2012). This development has ushered in a new challenge of co-managing a broad spectrum of morbidities associated with ageing in light of HIV. Action will require more concerted efforts to recognize HIV as a lifelong infection and putting greater emphasis on targeted care for older adults, focussing on multimorbidity
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