U n i v e r s a l h e a l t h c o v e r a g e a n d c ommu n i c a b l e d i s e a s e s women and girls. The Gap Report also calls attention to a community rarely considered in programmes aimed at the vulnerable – people aged 50 and over. In this group we can find tangible examples of the issues and lessons we have discussed above. The ageing of the world’s population is one of the most significant demographic trends today. As the number of people living with HIV who are aged 50 or over continues to grow, the demand and need for long-term access to HIV and other health services will also grow. There are 4.2 million people aged 50 and over living with HIV today. They currently make up ten per cent of the adult population living with HIV in LMICs, but their needs are often underserved, overlooked or neglected. The ageing of the HIV epidemic is mainly due to three factors. First, antiretroviral therapy has been successful in prolonging the lives of people living with HIV in high-income countries. Second, the life expectancy of a person living with HIV who achieves and maintains viral suppression on antiretroviral therapy is now similar to that of a person who has not acquired HIV. Finally, the trend of decreasing HIV incidence among younger adults is shifting the proportion of disease burden to older age groups. However, few HIV strategies in LMICs have caught up with this trend and many countries are failing to address this increasingly significant dimension of the HIV epidemic. A large proportion of this group continues to be physically and sexually active. People aged 50 years and over exhibit many of the risk behaviours of younger people. There are indications that people 50 years and over may know less about HIV compared with younger people, as shown in surveys done in nine sites in West, East and Southern Africa. Awareness was especially low among older women. Data shows that the majority of people aged 50 and over with multiple partners do not use condoms. Sexually active women aged 50 and over are at high risk of acquiring HIV, owing to biological changes associated with menopause. People aged 50 and over need specialised care for HIV and other chronic conditions, and are more likely than their younger counterparts to remain on antiretroviral therapy, but treatment adherence can suffer if the person living with HIV is experiencing several chronic conditions simultaneously or facing poverty and food insecurity. In countries with a high HIV prevalence, the high figure of AIDS-related deaths tends to mask the nation’s potential burden of non-communicable diseases among older people since large proportions of this population do not survive long enough for non-AIDS-related illnesses to manifest. HIV testing and treatment services need to address the distinct needs and realities of people aged 50 and over who are living with HIV. The timely detection and initiation of antiretroviral therapy is especially important, since the immune systems of older people tend to recover more slowly compared with those of younger people. In order to respond to the varied needs of people aged 50 and over, knowledge about the efficacy of and modifications to treatment regimens in different age groups must improve. At the moment, research and data are sparse. A greater understanding is required around issues related to the body’s ageing process, and how the presence of other illnesses may affect HIV-related treatment. As far as possible, all health services should be integrated to facilitate easy access and be supported by linkages to the community. As we move forward and the absolute number of people who are aged 50 and over who are living with HIV continues to grow, data collection systems need to improve and services need to adapt and evolve. Further efforts are required to integrate antiretroviral therapy effectively within care systems for other chronic diseases. HIV services for older people should be managed alongside concurrent health considerations, such as diabetes, heart disease and hypertension. HIV responses need to account for the sexual rights and evolving family and economic contexts of older people and provide prevention, testing, treatment, care and support services that are accessible and that meet their specific needs. Increasingly, health and social services for older people should be informed by – and, in some cases, integrated with – broader initiatives to combat inequality and to end extreme poverty. Community-based services and, in particular, the provision of services and support through community- and faith-based organisations will be key to the scale up of social services for older people living with HIV. Health care providers must be trained to respond to the specific needs and challenges of this population. Special attention must be given to providing psychological and medical support as well as concrete social protection for people over 50. Social protection instruments, such as non-contributory pensions, and health and disability insurance, have been shown to dramatically improve the welfare of older people who are living with HIV or caring for children and grandchildren who are affected by HIV. For the urban and rural poor, even small, predictable payments enable them to buy food, pay transportation costs and contribute to their families’ expenses. The Gap Report demonstrates that closing the gaps and leaving no one behind will require research and innovation, combined with protective laws that promote freedom and equality for all people. It will also require increased commitment from the global community – alongside the countries most affected – to maximise the remarkable returns on AIDS investments we have witnessed over the last decade to improve health care and social protection for all. Endnotes 1 See www.unaids.org/en/resources/campaigns/2014/2014 gapreport/gapreport Accessed 15 April 2015. 52 Commonwealth Health Partnerships 2015 MICHEL SIDIBÉ was appointed Executive Director of UNAIDS and Under-Secretary-General of the United Nations in 2009. Under his leadership, UNAIDS works to ensure that no one is left behind in the response to HIV and that everyone in need has access to lifesaving HIV services. Sidibé has spent more than 30 years in public service. He has been awarded honorary doctorates from Tuskegee University and Clark University, as well as an honorary professorship by Stellenbosch University. In 2012 he was named one of the 50 most influential Africans by the Africa Report and on of 50 personalities of the year by the French newspaper Le Monde in 2009.
Commonwealth Health Partnerships 2015
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