HIV affects older people in two main ways. Large numbers of older people are themselves living with HIV. Many also take on vital caring responsibilities for loved ones living with HIV and the children orphaned by AIDS.

Living with HIV

In 2006, UNAIDS estimated that 2.8 million people aged 50 and over were living with HIV.[1]

According to the UNAIDS and WHO 2009 AIDS Epidemic Update, the largest share of new infections in many African countries are among older heterosexual couples.

But older people continue to be excluded from HIV prevention, care and treatment services. As UNAIDS highlights, few prevention programmes focus on older adults.[2]

Older people are sexually active

HIV programmes often discriminate against older people. They assume that older people are no longer sexually active and therefore not at risk of HIV.

In fact, they are very much at risk, through the same routes as any other population group: predominantly through heterosexual sexual contact.

Studies have shown that older people are less likely than younger people to practice safer sex.[3]

Excluding older people from prevention programmes and services means they do not have the information they need to protect themselves and others from infection.

Older people are also less likely to get voluntary counselling and testing. This means they are not tested and diagnosed until much later, often when they have full-blown AIDS. Late diagnosis means that anti-retroviral treatment, if available, is started later and is subsequently less effective.

Taking on caring roles

At a time in their lives when many older people might expect to be supported and cared for by their own children, a growing number are taking on caring roles for younger adults living with HIV, and for the orphans and vulnerable children they leave behind.

Sick adults

Sons and daughters often come home to their parents when they become ill, and older people find themselves caring for them and their children.

HelpAge International surveys in seven countries in sub-Saharan Africa revealed that around 40% of people living with HIV were being cared for by older people, with each older carer supporting an average of two people living with HIV.[4]

Vulnerable children

Many older people play a vital role in caring for children whose parents are sick or have died of AIDS.

UNICEF's State of the World's Children 2007 report refers to “the enormous burden that orphaning is exerting on the extended family in general and grandparents – often grandmothers – in particular”. [5]

The report found that in Tanzania, over 40% of orphaned children, and in Namibia and Zimbabwe over 60%, were being cared for by their grandmothers.

These new roles are having a huge impact on older people’s lives, adding to the challenges they already face, including health problems, low income and discrimination:

Economic impact 

Many older people affected by HIV have to meet extra expenses such as healthcare, school fees and burial costs despite having no regular income.

For example, in Mozambique in 2006, caring for an orphaned or vulnerable child cost an average of US$21 a month, while caring for someone with HIV cost US$30. However, older people had an average monthly income of just US$12.[6]

From these figures it is clear that most older people simply cannot meet all the costs of even one child in their care – let alone several children plus adults living with chronic diseases.

This economic burden comes at a time of life when people’s earning potential is much reduced – due partly to the physical impact of ageing, but also to age discrimination.

Older people with productive assets, such as land, are often forced to sell these to meet the costs of caring for a son or daughter with HIV. This leaves them with nothing to fall back on to support their own needs and those of their orphaned grandchildren.

Health and wellbeing

Older carers may already be trying to cope with declining health related to the ageing process, leaving them physically exhausted by caring and more susceptible to the opportunistic infections of those in their care.

The emotional distress of caring for one’s dying child also takes its toll.  Not only do older carers have to cope with the loss of their children, but also have to support their orphaned grandchildren through their grief.

Social isolation

Many older carers become socially isolated because they cannot afford the time or money to take part in social activities or they face stigma associated with HIV.

Older carers may also isolate themselves from their communities for fear of people's reactions and how they will be treated. This means older carers do not access the emotional support that may be available from family, friends and community members and organisations.

References

[1] Report on the global AIDS epidemic, New York, UNAIDS, 2006

[2] AIDS Epidemic Update 2009, Geneva, UNAIDS and WHO 2009

[3] The unexplored story of HIV and ageing, Geneva, Scmid G et al, WHO bulletin, 2008

[4] Baseline information form Africa regional HIV and AIDS project, London, HelpAge International 2006

[5] The state of the world’s children: the double dividend of gender equality, Geneva, UNICEF, 2007

[6] Stronger together, London, HelpAge International, 2007