The Foreseeable Face of HIV. 30/6/11

The anxiety I am now experiencing stems from some of the unavoidable stark realities of ageing with HIV

The Independant

By Winnie Ssanyu Sseruma
30 June 2011

I have written about many aspects of HIV but so far, I’ve managed to avoid the subject of ageing. I am usually a very forward looking and optimistic person but, having recently hit the ripe old age of 50, my happiness at being alive and leading a fairly normal life is tinged, not just with guilt, but also growing anxiety about the future.

My guilt stems from the many reflective articles and speeches that have been triggered by the 30-year anniversary since HIV was first identified in California back in 1981. The most sobering fact about the commemorations is the staggering number of people we have already lost to this one disease so far – between 25 to 30 million worldwide, with just under 34 million currently living with HIV. Around 10 million people should be receiving HIV treatment but instead they’re languishing on waiting lists across the globe as a result of the myriad of differing interpretations of access. The deteriorating health of the global finances is also playing a huge role in this.

The anxiety I am now experiencing stems from some of the unavoidable stark realities of ageing with HIV. Some of the statistics emerging indicate that by 2015 half of all people living with HIV will be over 50 – on the one hand this is amazing because we were never supposed to live so long, but on the other it’s hugely challenging because of what that means for our future health and whether our health facilities are ready for what is already unfolding. Just the other day I read a feature referring to anyone over 50 who is living with HIV as elderly and I immediately thought ‘give me a break’, but they may have a point. There is a phenomenon in HIV circles referred to as ‘accelerated ageing’ which scientists are still not sure is induced by certain HIV drugs, the premature ageing of immune cells, or both.

Such HIV drugs were the very first on the market and became available in the early 1980s. Many of these are no longer being used in developed countries but are still a real lifeline in developing countries across the world. In many clinics in places like Sub Saharan Africa, where HIV is still a big challenge and there are very few drug options, doctors report seeing patients who are doing very well on HIV treatments but look twice or three times their real age. Even though people might be feeling well and living longer, visible physical changes that are not exactly flattering, can have a much more negative emotional impact and can be doubly stigmatizing.

Over thirty years ago, researchers predicated that people living with HIV would be more prone to heart conditions, neurological disorders, and cancers that affect the elderly. And sure enough, whether it is HIV itself or the treatments, doctors are seeing an increased risk of illness and death from liver, lung,  kidney, bone and cardiovascular disease as well as many cancers not traditionally HIV-related. Many of these ailments – and some others which are currently being researched – are showing up in people living with HIV in their 30s, 40s & 50s; ailments that are usually seen in people who are 70-years of age and above in the general population.

Lighten up, I hear you telling me, reminding me that the only certainties in life are getting older, taxes and death! I agree to a point. However, I also believe that there is no harm in confronting life’s challenges as long as you are able to offer solutions, raise awareness and educate others in the process – all points I hope I am able to address through this forum.

Much more needs to be done where the elderly living with HIV are concerned. There is the unspoken view that people over fifty either should not be having unprotected sex or are not having sex at all. Since unprotected sex is one of the main modes of HIV transmission, it’s ridiculous that there are hardly any prevention messages targeted towards older people. Indeed, when people over 50 end up testing HIV positive it’s often a surprise to some health professionals, not to mention being quite traumatic and shameful for their patients. Organisations such as HelpAge International have seen the number of over 50s who are testing positive increasing over the last few years but there is still nowhere near enough support for this group.

I am also acutely aware that as a 50-year-old living with HIV, I am at risk of becoming invisible if research and monitoring organisations do not review their guidelines beyond the current cut off age of 49. HIV prevalence figures in many countries only take into account adults between 15 – 49 years of age; a figure which does not even consider older people living with HIV or their potential treatment and care needs.

In short, much more needs to be done for the over 50s living with HIV – not to just to highlight this uneasy interface but to invest financially, to carry out more research and analyse the impact of the disease medically, socially, and otherwise for this important but essentially sidelined population.

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