THE elderly tend to believe that HIV is a disease for young people and this tends to make them overlook or ignore prevention methods such as using condoms.
Some even view condoms as being necessary to prevent pregnancies and no longer relevant to them as they would have passed child bearing age.
This was revealed by Mpilo Hospital Centre of Excellence medical director Nkazimulo Tshuma, a medical practitioner in the field of HIV management when she presented on the topic: Ageing with HIV during a National Aids Council (NAC) media engagement seminar in Esigodini, Matabeleland South, on Tuesday.
On new infections in older people, she said there was low risk perception, with many adults believing HIV is a “young people’s disease”.
“Ageing with HIV presents unique social challenges. We have a small proportion of people who actually acquire HIV at an elderly age above 50 and some would wonder why people acquire HIV,” Tshuma said.
“We think above 50, you are wiser, you have more information, but at the same time, we have new infections in elderly people.
“Those are the reasons that we attribute towards that, there is low risk perception. Adults tend to think that HIV is for young people. In our culture, we do not talk about sex and sexual activities issues with adults.
“It’s only us (who get) called by adults (and) they sit us down. It’s not the other way round. Even if they come for general consultation, if an adult presents unwell, HIV test is not at the top of the list. If you take your grandmother to a doctor, will they say ‘top of the list, let’s have an HIV test?’”
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Tshuma said the older adults may underestimate their own vulnerability and do not see themselves as needing prevention.
She said there were very few prevention programmes targeting the elderly, adding that most HIV awareness campaigns, condom distribution and PrEP initiatives are aimed at youth and key populations.
She said older age groups were often overlooked in national and community-level prevention efforts, while there are 70 to 80 years old and above with HIV.
Tshuma said most of the prevention programmes that are there do not include the elderly.
She said the biological vulnerability, especially postmenopausal women, is high due to low condom use in later-life relationships.
“Older people may believe pregnancy is no longer a concern, so protection seems unnecessary. Cultural and social dynamics, we have practices such as remarriage, widow inheritance and intergenerational sex, which can expose older adults to risk,” Tshuma said.
“Men sometimes have relationships with younger women, who may have higher HIV prevalence. Sexuality in older age is rarely discussed openly and stigma prevents older adults from seeking information, testing or prevention tools like PrEP.
“Due to the decline in the immune system with ageing and late diagnosis, older people are likely to be diagnosed with advanced HIV at higher rates than the younger population.”
Tshuma said the complexities of ageing with HIV were that people living with HIV (PLWH) experience higher rates of multi-morbidity and polypharmacy, geriatric syndromes, including frailty and falls, tend to appear earlier than in the general population and accelerated aging is driven by chronic inflammation and long-term antiretroviral therapy (ART) exposure.
On multi-morbidity and polypharmacy, Tshuma said chronic inflammation puts older PLWH at increased risk of additional chronic diseases such as hypertension, diabetes and chronic kidney disease.
Tshuma said the effects of ageing with HIV were accelerated ageing and multimorbidity, which means higher risks of non-communicable diseases.
She noted that HIV is associated with three-fourfold risks of bone demineralisation disorders and fractures.
“The Veterans Aging Cohort Study (VACS) found that PLWH are 1.5 times more likely to have an acute myocardial infarction [heart attack] than the general population,” she said.
“Studies have shown that PLWH have higher rates of balance problems.”
On mental health, Tshuma said older PLWH were prone to mental health challenges with loss of spouses, family, employment, financial independence and health adding to the problems matrix.
She said some have still not come to terms with their HIV diagnosis, adding that mental health conditions such as depression and anxiety are common among older PLWH.
On frailty, Tshuma said in PLWH, it occurs at a younger age than in HIV negative people and it is associated with increasing age, longer duration of HIV infection, detectable viral load, lower CD4 count.
“Frailty is more severe in those with multimorbidity. Frailty is associated with poor health outcomes including mortality, falls and fractures,” she said.
“Zimbabwe’s HIV programmes have done well towards the UNAids 95-95-95 targets (quantity of life).
“Ageing introduces new co-morbidity and frailty challenges. Integrated HIV+ geriatric care is essential for quality of life. Targeted, inclusive interventions are needed to ensure healthy aging with HIV.”
