1. HIV AND AGING Carol Nawina NYIRENDA PAN AFRICAN POSITIVE WOMENS COALITION (PAPWC) COALITION OF ZAMBIAN WOMEN LIVING WITH HIV

2. INTRODUCTION People aged 50 years and over are a growing part of the HIV epidemic and this requires new responses. Many people with HIV are living longer, more active lives thanks to the expansion of effective antiretroviral treatment. HIV responses therefore need to account for this important demographic by reflecting risks and trends and providing appropriate prevention, testing and treatment services. HIV services for people aged 50 or over would be helpfully integrated with non-communicable disease screening and treatment as well as other age-appropriate health services. A special supplement to the UNAIDS report on the global AIDS epidemic 2013

3. Statistics • Worldwide, an estimated 3.6 million people aged 50 and older are living with HIV • For the first time since the start of the HIV epidemic, 10% of the adult population living with HIV in low- and middle-income countries is aged 50 or older • In 2012 there were an estimated 2.9 million people aged 50 years and over living with HIV in low- and middle-income countries. • In high-income countries, approximately 30% of all adults living with HIV are aged 50 years and over • The proportion of adults living with HIV that is aged 50 years and older has increased in all regions, at varying rates, since 2007 A special supplement to the UNAIDS report on the global AIDS epidemic 2013

4. FACTORS • The success of antiretroviral therapy in prolonging the lives of people living with HIV; • Decreasing HIV incidence among younger adults shifting the disease burden to older ages; • The often-unmeasured, and thus often overlooked, fact that people aged 50 years and older exhibit many of the risk behaviours also found among younger people. A special supplement to the UNAIDS report on the global AIDS epidemic 2013

5. My personal journey HIV positive status in 2002 Husband died in 2001 Tuberculosis, herpes zoster Karposis Sarcoma, Chemotherapy for cancer, Anti retroviral therapy Positive living Set up patient-led NGO International TB/HIV Advocate Last CD4 1240

6. SERVICES/ISSUES • HIV prevention services – and other services, such as tuberculosis screening – need to place increased emphasis on people 50 years and older and their specific realities and needs (PLHIV who are 50 years and older appear to be at greater risk of infectious diseases such as tuberculosis) • There are indications that people 50 years and older may know less about HIV compared with younger people, especially among women • For women, biological changes can also put sexually active women aged 50 years and older at high risk of acquiring HIV. The thinning of the vaginal wall after menopause, which increases the chances of lesions and tears, thereby increasing the risk of HIV transmission during sex. • Lipodystrophy (fat redistribution)

7. SERVICES/ISSUES • PLHIV aged 50 and over tend to recover more slowly compared with younger people • Usually less likely to take an HIV test compared with persons under 50 • likely to be diagnosed late in the course of HIV infection, often after their health has deteriorated considerably • more than 1 in 10 people initiating antiretroviral therapy were aged 50 years or more and about two thirds were women.

8. SERVICES/ISSUES • HIV treatment can be challenging if the person living with HIV is also experiencing other chronic conditions – (heart attacks, bone fractures, kidney disease or certain cancers have been noted in older people living with HIV and these may worsen HIV disease progression) • Though more likely to adhere to ART than the younger counterparts, this can be affected if they are experiencing several other chronic

9. STIGMA • INDIVIDUAL: No adherence • GROUP: Congregate settings (churches, villages – communities) • SYSTEM: Health care workers • Open about ones status – fellow PLHIV

10. CONCLUSION • HIV/AIDS is not a disease of the young – all will be old as some point, number will keep growing • More studies – (long term effects of ART) • Services need to be put in place to accommodate the specific needs and ensure dignity - Older persons friendly services • Tailored messages • Targeted Outreach • Support systems

11. For more information contact: PAN AFRICA POSITIVE WOMENS COALITION COALITION OF ZAMBIAN WOMEN LIVING WITH HIV CAROL NAWINA NYIRENDA carolnawina@yahoo.com cozwha@gmail.com +260 977 960043 LUSAKA, ZAMBIA