Assessing the risk of HIV in older age in South Africa

HIV after 40 in rural South Africa: a life course approach to HIV vulnerability among middle aged and older adults.

Mojola SA, Williams J, Angotti N, Gomez-Olive FX. Soc Sci Med. 2015 Oct;143:204-12. doi: 10.1016/j.socscimed.2015.08.023. Epub 2015 Aug 17.

South Africa has the highest number of people living with HIV in the world (over 6 million) as well as a rapidly aging population, with 15% of the population aged 50 and over. High HIV prevalence in rural former apartheid homeland areas suggests substantial aging with HIV and acquisition of HIV at older ages. We develop a life course approach to HIV vulnerability, highlighting the rise and fall of risk and protection as people age, as well as the role of contextual density in shaping HIV vulnerability. Using this approach, we draw on an innovative multi-method data set collected within the Agincourt Health and Demographic Surveillance System in South Africa, combining survey data with 60 nested life history interviews and 9 community focus group interviews. We examine HIV risk and protective factors among adults aged 40-80, as well as how and why these factors vary among people at older ages.

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Editor’s notes: A growing body of work is documenting the importance of HIV in older age in East and southern Africa. This paper is a valuable addition to the literature. The authors look at how the risk of HIV infection, and the impact of living with HIV, affects women and men aged 40-80 years old. Forty is a relatively young age for a study of older people, but the age span covered by this paper does allow the authors to trace HIV vulnerability for people actively engaged in migrant labour to when they settle, as they age into their 60s and 70s. The finding that risk of HIV-infection and vulnerability to the impact of HIV vary across the life course, is not new. But the findings presented in this paper provide a compelling picture of changing risk. Indeed, the possibility that men in their 60s might be at particular risk of acquiring HIV because of their wives diminishing interest in sex highlights the importance of not assuming only people under 50 are ‘sexually active’. The authors also illustrate the risk that older women face who may prefer to remain celibate but cannot always refuse to have sexual intercourse with their husbands. One notable finding is that older men with a pension are attractive partners for younger women in what the authors describe as a poverty stricken area. The mixture of quantitative and qualitative data the authors use provide both breadth and depth to the findings presented making this both an interesting and informative paper.

South Africa
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