In the 2006 Report on the Global AIDS Epidemic, UNAIDS and WHO reported that a ‘substantial proportion of people living with HIV are 50 years and older’. 

However most HIV prevalence data is collected and produced on 15-49 year olds. The report explains that the reason for the restricted 15-49 age group (the conventional reproductive years) being used to date has been for the purpose of comparability across countries.

This approach continues to convey an ambiguous and discriminatory message to programme implementers and policy makers.

UNAIDS estimate the number of invisible older people living with HIV/AIDS at 2.8 million. 

If older people remain invisible in the statistics it will not be possible for governments or other institutions to mount a proper response to the AIDS pandemic.

HelpAge International is addressing this deficit with programme partners in Africa and Asia. Through a three-year programme to support older people affected by HIV and AIDS, funded by Comic Relief, HelpAge International is developing data collection methods in seven countries.  Data will be used both to check that the programme is achieving its objectives, and to provide evidence for advocacy.

Caring role

In November 2006 project partners met in Kenya to hold a workshop to review data collected and the methods used to collect it.

The workshop provided the first opportunity get a multi-country view of how HIV and AIDS affect older people in Africa.

A number of points emerged. For example:

• The percentage of older people in the communities ranged from 3 per cent to 41 per cent. The exceptionally high figure of 41 per cent in Ahero, Kenya, was explained by the area’s propensity to floods, droughts and uncertain livelihoods, resulting in disproportionately high numbers of young people leaving the area.
  

• Some figures were much higher than national figures, reflecting the more severe impact of AIDS in the project areas. 
• The percentage of people living with HIV and/or other chronic illnesses was also high ranging from 10-88 percent.  In half of the communities older people cared for over 50 per cent of people living with HIV.

HIV tests

Some interesting findings also began to emerge from the more detailed data collection.

For instance, in the process of collecting data, partners found that the clinics record the sex and age of everyone who comes for testing. However, they do not forward data on over-49-year-olds to national statistics offices, because this data is not requested. Partners obtained data on ages of people visiting VCT clinics by asking health workers to go through their records.

Early findings, based on very small samples, showed that people aged over 50 do come forward for testing, although in much smaller numbers than younger people. However, a relatively high proportion of those over 50 tested positive.
 
When alerted to the exclusion of people over 50 from HIV prevalence data, the Kenya National AIDS Council representative suggested that it should change its information request forms to ask VCT clinics to include people over 50.

For partners from other countries, it was agreed that a key message for their own national AIDS bodies was to let them know that data on older people was available, and to ask them to request this information from VCT clinics.

Using the data

The Uganda Reach the Aged Association (URAA) has been working closely with government to press for older people’s inclusion in health, education and AIDS policies and programmes.

URAA worked to arrange a meeting at a time convenient for key contacts and then invited them personally to a presentation on the data.

Using their data, URAA was able to link the recently-identified reversal in the decline of HIV prevalence in Uganda to the neglect of older people’s role in responding to HIV – alerting government representatives to the fact that older people require HIV services for themselves and the children and adults in their care.