havvacc text resource: hiv/aids & aging: effects in developing countries — excerpts from 2007 prb report, links (008)

[Sunday, November 23rd, 2008, los angeles]

How Does HIV/AIDS Affect the Elderly in Developing Countries?

Today’s Research on Aging
population reference bureau
N o . 6 | August 2007

Of the estimated 40 million people living with HIV, the vast majority are adults in their prime working years, but as this middle generation dies of AIDS, a generation of young children and a generation of elderly ages 50 and older are left behind (UNAIDS and WHO 2006). The elderly not only lose the support of their adult children, but they must increasingly take on additional familial responsibilities— with potentially adverse effects for their own well-being. Despite extensive amounts of research on the AIDS epidemic, relatively few studies have focused on the elderly. This newsletter highlights National Institute on Aging-funded research and other recent research that explores the impact of HIV/AIDS on the elderly in developing countries.

Caring for Families

In the wake of the AIDS epidemic, some elderly assume even more family responsibility as they take on the care of their adult children or relatives who are sick. . . . Due to the infectious nature of HIV, once one parent is lost to AIDS, the risk of also losing the second parent is relatively high. Given the lack of orphanages in many settings, support from extended family and community members offers the best and perhaps only realistic long-term solution to meeting the needs of children whose parents have died. In many cases, grandparents take on a share of the responsibility. Research from South Africa shows that in provinces where HIV prevalence has increased the fastest, the proportion of elderly living with an orphaned grandchild has also increased (Merli and Palloni 2006). However, according to John Knodel at the University of Michigan’s Population Studies Center, rapidly expanding access to antiretroviral therapy will likely decrease deaths of adult children and delay serious illness. As a result, parents may change how they help—instead of providing terminal stage care, they may help ensure adherence to demanding regimes of medications.

Economic Impact

The AIDS epidemic places economic pressure on some elderly . . . many older people resort to selling important assets to pay for expenses. . . . ). In many developing countries where strong extended family support systems exist, elderly people who care for their adult children or relatives with HIV/AIDS often receive material support from other relatives. In Malawi, intergenerational support networks exist between adult children and their parents and also with maternal and paternal aunts and uncles (Weinreb 2002). These networks help alleviate the potential financial burden on the elderly. . . .

Health Consequences

The physical demands and emotional strain of caring for the seriously ill can adversely affect the health of the elderly. . . . the increase in daily chores and activities related to caregiving adversely affects older people’s physical health and well-being during the time that they care for their ill adult children. In addition, worry and stress are commonly reported emotional problems as older people suffer anxiety over the illness or death of loved ones . . . The elderly suffered from a temporary decrease in physical well-being as measured by a decline in body mass index (BMI) during the period of the illness, but they recovered after the death of the sick adult. In households that did not experience an adult death during the study period, poor households had a significantly higher percent of elderly with a low BMI than nonpoor households, suggesting that these poor elderly need the greatest assistance while caring for a sick adult and need to improve their own health status.

Attitudes

Community reactions toward those living with HIV as well as toward their caregivers have generally been positive or neutral, despite widely held assumptions to the contrary. . . .

Supporting the Elderly

Despite their considerable caretaking role, the elderly remain largely hidden from the international HIV/AIDS agenda. Because it is assumed that they are not at risk of contracting HIV, the elderly have received minimal programmatic and policy attention. However, older people are not only at risk of infection, their income and health may also be adversely affected when they take on the role of caregiver. Furthermore, they may need support in their caregiving role. Resources and information targeted at the elderly can enhance the efforts older people make to care for their loved ones and to protect themselves. Older people can also play a key role in prevention by influencing their adult children to avoid risky behavior

Older People’s Vulnerability to HIV Infection

While the AIDS epidemic affects older people mainly through their role as caregivers, the elderly are also vulnerable to HIV infection. Older people do engage in sexual activity. Because they are not considered a target group, the elderly miss out on many of the HIV prevention messages. Additionally, many of the statistics on HIV/AIDS do not include those over the age of 50. For example, UNAIDS prevalence data refer to adults between the ages of 15 and 49, further reinforcing the notion that older people are not at risk of contracting HIV (UNAIDS and WHO 2006). However, data from national programs in Africa, Asia, and Latin America indicate that people ages 50 and older do make up a proportion of reported AIDS cases. Additionally, as access to antiretroviral therapy expands and the survival time of those living with HIV is extended, greater numbers of people with HIV will be living into their older years (Knodel 2006). As the HIV epidemic progresses, the elderly must be counted and educated about the risks of HIV. Armed with appropriate knowledge and tools, they will be able to protect themselves against infection and will also be able to play a greater role in educating and protecting their communities (Knodel and VanLandingham 2002; Knodel, Watkins, and VanLandingham 2003; HelpAge International 2002).

For More Information
Gerontological Society of America
Preconference Workshop on Aging and HIV Infection

www.agingconference.com/pre-conference_workshops.cfm

Global Ageing Issues and Action
www.ifa-fiv.org/en/accueil1.aspx?sortcode=2.7.6

Population Aging Research Center Working Papers, University of Pennsylvania Li-wei Chao and Hans-Peter Kohler, “The Behavioral Economics of Altruism, Reciprocity and Transfers Within Families and Rural Communities: Evidence From sub- Saharan Africa,” University of Pennsylvania Population Aging Research Center (PARC) Working Paper Series 07-01 (2007). Available online at: www.pop.upenn.edu/rc/parc/aging_center/2007/PARCw ps07-01.pdf

Li-wei Chao et al., “Time Preference and its Relationship With Age, Health, and Longevity,” University of Pennsylvania Population Aging Research Center (PARC) Working Paper Series 07-05 (2007). Available online at: www.pop.upenn.edu/rc/parc/aging_center/2007/PARCw ps07-05.pdf

Adeline Delavande and Hans-Peter Kohler, “Subjective Expectations in the Context of HIV/AIDS in Malawi,” University of Pennsylvania Population Aging Research Center (PARC) Working Paper Series 07-06 (2007). Available online at: www.pop.upenn.edu/rc/parc/aging_center/2007/PARCw ps07-06.pdf

Population and Health InfoShare AIDS and Older Persons: Studies of the Impact in Thailand and Cambodia
www.phishare.org/partners/AIDSELD/

Research Network on HIV/AIDS and the Elderly
http://agingaidsnet.psc.isr.umich.edu

The NIA Demography Centers The National Institute on Aging supports 13 research centers on the demography and economics of aging, based at the University of California at Berkeley, the University of Chicago, Harvard University, the University of Michigan, the National Bureau of Economic Research, the University of North Carolina, the University of Pennsylvania, Pennsylvania State University, Princeton University, RAND Corporation, Stanford University, the University of Southern California/University of California at Los Angeles, and the University of Wisconsin. [this issue of today’s research in aging] was produced by the Population Reference Bureau with funding from the University of Michigan Demography Center. This center coordinates dissemination of findings from the 13 NIA demography centers listed above. This issue was written by Marya Khan, research associate at the Population Reference Bureau; and Marlene Lee, Ph.D., senior policy analyst, Population Reference Bureau.

appearing originally at aids-write.org

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