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

Figure 1 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 and Mr. Luc Armand Bodea, (ICASA Director) of the Society for AIDS in Africa during the first meeting on Healthy Ageing for people living with HIV at the INTEREST conference in Maputo.

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


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.


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.


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Comments (10)

  • Christine Namonjeza Munthali Reply

    This is very interesting and has come at the right time. Yes we have neglected these populations for a long time and yet we want them to do well on treatment by promoting adherence forgetting that as time passes these individuals will age and might need additional care especially the risk of developing NCDs as you have highlighted and that the likelihood is high as compared to general population. We truly need to develop strategies of incorporating these services at all levels of care

    13 June 2023 at 05:42
  • Jepchirchir Kiplagat Reply

    Very insightful article that bring the needs for older adults living with HIV to the forefront.
    Happy to join this group advocating to tailor the service delivery to the unique needs of older adults living with HIV as I bring with me experience conducting research with older adults in western Kenya.

    13 June 2023 at 07:45
    • Timothy Reply

      Good thinking . My question is has this last 95 been adopted by the United Nations Programme for HIV/AIDS

      11 July 2023 at 16:50
  • SAA member Reply


    13 June 2023 at 12:55

    Très bonne initiative et approche . Cela est d’autant plus important à développer cette notion de qualité de vie en lien avec le quatrième 95. En effet l’évolution de la recherche permet aujourd’hui l’utilisation de protocoles optimaux permettant aux personnes vivants avec le VIH d’avoir une charge virale indétectable (succès virologique),relatif au 3eme 95. A partir de cet instant d’autres défis restent à relever pour la personne vivant avec le VIH qui doit se maintenir a ce niveau à défaut de l’améliorer .Ces défis dont certains ont été évoqués dans votre publication sont la gestion et la prise en charge des comorbidités ,la santé mentale, le stress financier, la stigmatisation, la gestion et la prise en charge des interactions médicamenteuses et des effets indésirables liés au traitement, le stress également d’une prise quotidienne du traitement ARV …d’ou la nécessité d’améliorer la communication autour de la maladie par la promotion de la notion de indétectable = intransmissible , l’allègement du traitement ARV…
    Bienvenue à ce quatrième 95 ( 95 % des personnes vivant avec le VIH qui ont une charge virale indétectable devraient avoir une bonne qualité de vie liée à leur santé)

    13 June 2023 at 13:20
  • MULINDAHABI Calliope Reply

    C’est vraiment heureux que je constate que cette tranche d’âge mérite toutes les attentions en général et, en particulier, les personnes âgées vivant avec le VIH. Encore, de nos jours, un grand nombre de ces PVVIH sont confrontées à une grande vulnérabilité liée à des problèmes de stigmatisation/discrimination, sans oublier le manque de ressources économiques pour pouvoir une vie descente et digne. Promouvoir le vieillissement en santé et l’autonomie des personnes âgées vivant avec le VIH constitue donc, en ce qui nous concerne, une priorité dans nos activités de plaidoyer pour plus de ressources pour la réduction, sinon l’élimination de la vulnérabilité des cette catégorie de nos bénéficiaires. C’est dans ce sens que notre ONG: HELP THE ELDERS milite au quotidien auprès des personnes et organisations de bonnes volontés, afin de contribuer un mieux-être des personnes du troisième âge.

    13 June 2023 at 21:15
    • Virginie Reply

      Super! Idée géniale,4 ème 95 approuvé.Bravo aux initiateurs ❤️… J’ai beaucoup des patients de troisième âge et qui se plaignent toujours d’une attention particulière compte tenue de leurs âges et se disent avoir beaucoup d’autres problèmes de santé que le VIH.En consultation, j’aime prendre beaucoup de temps avec eux.les écoutées, échangées et renforcer le counseling. Celle que j’ai reçu aujourd’hui en consultation,m’a d’ailleurs aidé à renforcer l’adhérence au traitement à un jeune non adhérent.Felicitations Cher team pour cette belle initiative.

      21 August 2023 at 18:40
  • David I Mbai Reply

    Good article and good workshop.

    14 June 2023 at 11:23
  • Nancy Nyokabi Reply

    This is absolutely good. The concerns and challenges 9f the aging plwhiv have not been noted lately. I as one of them (57) would really appreciate if more consideration is put on us and also inviting us into the seminars to educate and enlighten us more on how to take good care of ourselves and our loved one. It really is a good thought

    15 June 2023 at 19:52
  • Lifelong Vitality Reply

    I blog frequently and I truly thank you for your information. This great
    article has really peaked my interest. I will book
    mark your website and keep checking for new details about once per week.
    I subscribed to your Feed too.

    12 October 2023 at 02:19

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