allAfrica.com: Namibia: Elderly and HIV/Aids in Country (Page 1 of 2)

Having entered the third decade of the seemingly unabating HIV epidemic, the lower than expected number of people that have voluntarily tested for HIV or who know their HIV status in Namibia, remains a cause for concern.

This is despite various implemented strategies including transition from predominantly client-initiated voluntary counselling and testing (VCT) to provider-initiated VCT; social marketing and mass media advertising; establishment of VCT centres offering free services and specific programmes targeted at perceived at-risk groups in the population (e.g. sex workers, truck drivers, etc.).

It is the backdrop of low HIV testing amongst Namibians that has prompted the Ministry of Health and Social Services (MoHSS) to inaugurate a national HIV testing day this year; to be subsequently commemorated annually as a way of mobilizing citizens to voluntarily test for HIV.

This year it will be on May 09, 2008 and various stakeholders are working hard on making this day a huge success. As a front line health worker in the field, I am afraid the same groups that are perceived to be at high risk of HIV will be targeted again this year. These are people in the 15- 49 age group, deemed to be the most sexually active and thus at higher risk of heterosexual HIV infection in our setting.

It is acceptable to re-focus on that group given the low testing rates. However, one group has been overlooked over the years. It is the elderly people, those over 50 years old and the pensioners. There are barriers that need to the exposed and explored. That is the subject of this discussion, as the landmark day approaches and as preparations for the day gather momentum.

Older people tested and infected with HIV

Literature is replete with data showing the number of the elderly people living with HIV/AIDS (EPLWHA) is increasing worldwide. UNAIDS estimates show that 7% of all HIV persons are aged 50 years and older globally.

In the USA, estimates put the prevalence at 15%. One author stated that data from low-income countries are few. However, in Uganda, 4.6% of clients tested for HIV between 1999 and 2002 were older than 50 years with an HIV prevalence of 20%.

The South African national household HIV survey found an HIV prevalence of about 20% in the elderly.

In Namibia, data from a VCT centre in a predominantly rural setting shows that 17% were 49 years and older and the HIV prevalence was 29%.

Geographical differences are expected given that in our society, most of the elderly or pensioners retire to or reside in rural villages.

HIV infection risk in older people

Heterosexual sex remains the predominant mode of HIV transmission in the older people. In our discussions in the clinical setting, including discussions with elderly men, it is prominently clear that older men receiving old age pensions are at particular risk since they engage in transactional intergenerational sex with younger women.

Condoms are not used by most, because, according to some old men conversed with, they do not know how to use them.

Old women would generally, but not exclusively, get exposed to HIV during care of the sick people at home, or during the conduct of home deliveries and other bloody traditional practices.

Barriers to HIV testing in the elderly

It is well documented that HIV testing rates in elderly people are much lower compared to younger people because communities in general and health workers in particular presume the elderly are at low risk of HIV.

This notion is spurred by the erroneous assumption that older people are no longer sexually active. As a result, the elderly fail to accrue the benefits of early diagnosis of HIV; and thus miss out on early treatment, care and support.

Making a clinical diagnosis of HIV in the elderly may indeed be a challenge. The signs and symptoms of HIV in the elderly resemble those associated with the normal process of aging.

Many researchers also note with despair that WHO guidelines on HIV testing in populations do not seem to accord HIV infection amongst the elderly the priority and prominence it now deserves.

Readers may have observed the stereotyping of the elderly people in advertorials regarding HIV in mass media. Most often they are portrayed as the carers, rarely, if ever, as the infected.

This approach has clouded the reality that the elderly also need HIV care for themselves. The perpetuation of the notion that the elderly do not have HIV only exposes them to the risk of stigma and death through missing out on available free HIV/AIDS care and treatment.

web allafrica.com	Enter your search terms	Submit search form
OR subscribers use AllAfrica's premium search engine


Use our pull-down menus to find more stories