Promoting Healthy Aging and Independence for Older Individuals Living with HIV: The Fourth 95

Blog Reference – HIHAA/23/0001

Date: 9th June 2023

Authors: Barbara Castelnuovo and Andrew Kambugu of the Infectious Diseases Institute-Makerere University Uganda; Nomathemba Chandiwana of Ezintsha, the University of the Witwatersrand, South Africa; Kwasi Torpey, University of Ghana, Mr. Luc Armand Bodea, (ICASA Director/SAA Coordinator) of the Society for AIDS in Africa (SAA), Prof. Morenike Ukpong, SAA Board Member and Professor Mohamed Chakroun, SAA Vice President

---

Introduction:

As African countries strive to attain the 95-95-95 targets for HIV (95% knowing their status, 95% accessing treatment, 95% with suppressed viral loads) and aim for even greater achievements, it is crucial to redirect our attention towards a new challenge: addressing the specific needs of individuals on antiretroviral therapy (ART) who are aging. While obstacles like delayed diagnosis and disengagement from care persist, it is imperative to proactively plan for the health and well-being of older individuals living with HIV. This article emphasizes the significance of delivering appropriate care and preserving physical, psychological, and cognitive abilities to promote independence among this population.

Defining “Older”:

The aging process is a gradual and ongoing phenomenon, and the term “older” can have different interpretations. In the general population without HIV, there are various age thresholds used (e.g., 60 years by the United Nations, 65 years in the US and Europe) to define older individuals. However, among people living with HIV (PLWH), the age cutoff for considering someone as older is generally around 50 years. This distinction is made because PLWH may experience unique challenges related to aging, including diminished immune response to antiretroviral therapy (ART), an increased risk of mortality (three times higher compared to those under 30), a higher likelihood of developing comorbidities, and the early onset of geriatric conditions such as frailty.

The Significance of Aging with HIV in Africa:

The influence of HIV on the aging process in Africa is a significant and cannot be overlooked. While high-income nations may have a larger percentage of older individuals living with HIV in their overall population, the absolute figures in countries like Uganda are noteworthy. Although the proportion of older people living with HIV in East and Southern Africa may be comparatively small, the total count surpasses 3 million. This emphasizes the critical need to prioritize the health and overall welfare of older individuals who are living with HIV in Africa.

Unique Considerations for Older PLWH:

Many older individuals living with HIV (PLWH) have been managing the virus for several decades and have undergone long-term antiretroviral treatment. While they generally exhibit positive responses to treatment and remain actively involved in their care, they may encounter additional long-term complications. Prolonged exposure to antiretroviral drugs, chronic inflammation resulting from HIV infection, previous infections, and other factors commonly found in the general population (such as sex, family history, urbanization, overweight, and physical inactivity) contribute to an increased susceptibility to non-communicable diseases. Conditions like hypertension, type 2 diabetes, cardiovascular disease, cancer, and organ-related ailments become more prevalent among older PLWH. Additionally, individuals with HIV tend to experience a decline in robustness at an earlier age and develop frailty later compared to their counterparts without HIV.

Comprehensive Geriatric Assessment (CGA):

To address the specific needs of older individuals living with HIV (OPLWH), it is crucial to incorporate comprehensive geriatric assessment (CGA). CGA is a structured approach that assesses their medical, psychological, functional, and social needs. It entails a collaborative effort among professionals from

various fields to ensure the overall well-being of older individuals. The primary objective is to foster healthy aging by preserving physical, psychological, and cognitive functions, thereby promoting independence, and enhancing their quality of life. Integrating CGA into HIV programs for individuals aged 50 and above is imperative for effectively addressing the needs of OPLWH.

The Fourth 95: Healthy Aging and Independence:

During the 17th INTEREST Conference, which took place in Maputo, Mozambique from May 8th to May 13th, 2023, a team of researchers from sub-Saharan Africa launched the HIV and Healthy Aging working group. This initiative proposed healthy aging and independence as additional targets, referred to as the fourth 95, for older individuals living with HIV. The establishment of this working group emphasizes the significance of integrating comprehensive care and support systems that specifically address the distinctive obstacles faced by this population. By doing so, it aims to promote healthy aging, preserve independence, and enhance the overall quality of life for older individuals living with HIV.

Conclusion:

As Africa advances towards reaching the 95-95-95 targets for HIV, it is vital to prioritize the long-term care of older individuals living with HIV. By acknowledging their specific challenges, promoting healthy aging, and implementing comprehensive geriatric assessments, we can empower them to maintain independence and improve their overall quality of life. Embracing the HIV and Healthy Aging initiative guarantees that this vulnerable population receives the necessary support and care to age gracefully and with vitality.

Back to HIV AND HEALTHY AGEING IN AFRICA (HIHAA) Group – Blog