AIDS and older persons: an international perspective

The impact of the worldwide AIDS epidemic on persons age 50 and over has received relatively little consideration except in the United States where interest has focused almost exclusively on older persons living with AIDS or at risk of infection. The place of older persons in the epidemic deserves international attention because their lives are being significantly affected in a variety of ways.

This paper makes a number of observations and recommendations for future action. It notes that the effects of the AIDS on older persons could change dramatically as the epidemic’s consequences are absorbed by the societies where it occurs and as social and medical responses to the epidemic evolve. If existing systems of old age support breakdown or are altered because of widespread infection and incapacitation of working age adults, older persons will be forced to either forego the income expected from younger relatives and adjust their standard of living downwards or replace the lost income from other sources.

Widespread orphanhood also bodes poorly for older persons in medium to high prevalence developing countries, since grandparents often become surrogate guardians when parents are unavailable to raise their young children.

More hopeful are expectations of increasing availability of anti-retroviral therapy and more effective treatments of opportunistic infections. Availability would lengthen the productive life spans of HIV infected young adults who have both older persons and young children dependent upon them. Such progress also could expand the role (and the burden) of older persons as liaisons between their ill adult children and the health care system.

Suggested research agenda and priorities include the following points:

• consequences of the epidemic for older persons as parents and relatives of HIV infected adults: explication of the full range of impacts and how they differ across a variety of settings should be of the highest priority for international research
• impact of AIDS mortality and morbidity on social security, pension, health and welfare systems: assessing the current extent of impacts and projecting their likely future course is necessary if the adverse effects for the older population are to be minimized
• sexual behavior and practices of older persons: In the majority of countries with moderate to severe epidemics, the predominant mode of transmission is heterosexual relations. Yet almost no systematic research has been done on the sexual activity and practices of older adults in these countries. Attention should be directed to both marital and extramarital sexual behavior, especially the involvement of older men in transactional or commercial sex patronage
• estimating the demographic extent of impacts on older persons: few developing countries have reliable age profiles of either the HIV infected population or of AIDS cases. Determination of how many older persons are infected in different regions in needed
• methodologies to study the family level impact on older persons of illness and death of an adult child or younger generation relative need to be developed
• interactions between the health care system and older-aged caregivers: Research is needed to assess the extent and manner of interactions with the formal health care system
• the potential of older persons as intermediaries in HIV prevention and treatment programs: older persons have a substantial stake in encouraging safe behavior among younger adults. They may also have the emotional and material leverage to do so. Developing interventions that take advantage of these assets could significantly contribute to stemming the epidemic. Older caregivers might also be able to provide peer counseling and socio-emotional support to other older persons in the same predicament

[Adapted from author]