In recent decades, the landscape of the HIV epidemic in sub-Saharan Africa has undergone a significant demographic shift that remains largely unacknowledged within public health campaigns. Where HIV was once predominantly perceived as a disease affecting younger populations, new research reveals that adults aged 50 years and older are now facing a growing and alarming burden of HIV. This changing epidemiology is not only a critical public health concern but also points to a substantial gap in current prevention and treatment strategies that fail to adequately address the unique challenges confronting older adults.
Between 2000 and 2016, the number of people over 50 living with HIV in sub-Saharan Africa doubled, a trend that starkly contrasts with conventional disease narratives. Remarkably, the prevalence of HIV in this age group now exceeds that of younger adults, signaling an urgent need for targeted awareness and intervention programs. This demographic transformation demands that health authorities recalibrate their response frameworks to avoid perpetuating misconceptions and missed opportunities for early detection and effective management in this vulnerable population.
By the year 2040, projections estimate that one in every four people living with HIV in Africa will be aged 50 or older. This demographic shift signals a pressing imperative: the development and deployment of tailored awareness campaigns and treatment regimens that recognize the specific physiological, social, and psychological needs of older adults living with HIV. Failure to adapt public health measures risks undermining progress toward global HIV targets and sustaining untreated infections among the elderly.
Dr. Luicer Olubayo, a lead investigator at the Sydney Brenner Institute for Molecular Bioscience (SBIMB) at Wits University, emphasizes the prevailing misconception surrounding the age profiles of people living with HIV. She notes that HIV intervention efforts predominantly focus on youth populations, reinforcing a limited public understanding that can be detrimental to reaching older adults at risk. This narrow perspective, Olubayo argues, necessitates a paradigm shift in public health messaging that encompasses the full spectrum of age groups impacted by the epidemic.
A critical barrier highlighted in the study is the pervasive stigma that continues to thwart HIV testing and treatment uptake among older adults. The low frequency of HIV testing in this group directly impairs timely diagnosis and access to lifesaving antiretroviral therapy (ART), thereby exacerbating morbidity and mortality rates. Stigma, deeply entrenched in societal attitudes towards HIV, not only inhibits testing but also adversely affects mental health and overall well-being, compounding the challenges faced by aging individuals living with the virus.
Moreover, older adults often harbor a belief that they are not susceptible to HIV infection, a misconception that undermines prevention efforts. The misconception is particularly alarming in light of UNAIDS’ ambitious 95-95-95 targets, aiming for 95% of people living with HIV to know their status, 95% of those diagnosed to be receiving ART, and 95% of those treated to achieve viral suppression by 2030. Unless focused attention is given to closing these gaps among older populations, the global HIV control agenda risks falling short.
Adding complexity to the epidemiological understanding, Associate Professor F. Xavier Gómez-Olivé of the MRC/Wits-Agincourt Research Unit elucidates that many HIV surveillance studies have traditionally focused on younger cohorts, leaving significant blind spots in data pertaining to older adults. This lack of comprehensive surveillance creates critical knowledge gaps relating to HIV prevalence, incidence, and treatment efficacy in older age groups, consequently impinging on the design of effective interventions for this demographic.
The intersection of chronic disease management and HIV care emerges as a vital consideration in this context. Sub-Saharan Africa is witnessing a surge in non-communicable diseases such as hypertension, diabetes, and obesity, particularly impacting older populations. Given that HIV has transformed into a manageable long-term illness through the widespread availability of ART, integrating HIV treatment within the broader framework of chronic disease management holds promise for improving health outcomes and streamlining care for older adults with multiple comorbidities.
The study further uncovers a multifaceted interplay of sociodemographic factors shaping HIV risk among the elderly. Variables including age stratification, educational attainment, gender, and rural or urban residence exert considerable influence on vulnerability to HIV infection. Notably, widowed women exhibit disproportionately high HIV prevalence rates, a finding attributed to factors such as partner loss through HIV-related illness, stigma, economic vulnerabilities driving transactional sex, and diminished agency in sexual health negotiations.
Education and income levels also emerge as significant determinants of HIV risk. Individuals lacking formal education and those living in poverty face elevated risk profiles, underscoring the importance of socioeconomic interventions alongside medical strategies. This complexity calls for holistic approaches that address not only biological and behavioral factors but also the structural inequalities perpetuating HIV vulnerability in older adults.
A distinctive strength of this study lies in its longitudinal methodological design, providing temporal insights into the progression of the HIV epidemic among aging cohorts. Longitudinal data allow researchers to track changes in HIV prevalence and treatment coverage over time, thereby evaluating the effectiveness of ART programs and identifying emerging trends that cross-sectional studies might overlook. Such robust data are indispensable for evidence-based policy formulation and resource allocation tailored to older populations.
The data underpinning this research were sourced from the Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen), a multicenter longitudinal cohort encompassing adults aged 40 and above across South Africa, Kenya, Burkina Faso, and Ghana. By encompassing both urban and rural sites and incorporating diverse demographic profiles, AWI-Gen enriches our understanding of how HIV interplays with genetic, environmental, and social determinants in older African populations, offering an invaluable platform for ongoing investigation.
Over a decade of meticulous research, the study’s findings coalesce to illuminate the evolving patterns of HIV infection among older adults in sub-Saharan Africa, challenging entrenched assumptions and highlighting critical gaps in knowledge and service delivery. The cumulative knowledge gained paves the way for innovative interventions designed to enhance testing uptake, mitigate stigma, and integrate HIV care within holistic models addressing the comprehensive health needs of the aging population.
In tackling the challenges brought to light by this research, public health authorities and policymakers must prioritize inclusive strategies that dissolve ageist biases in HIV programming. By embracing the realities of an aging HIV epidemic, tailored prevention, diagnosis, and treatment efforts can significantly improve health outcomes, support mental well-being, and uphold the dignity of older individuals living with HIV. The imperative now lies in translating these research insights into actionable policies and impactful community interventions that resonate with older African adults’ lived experiences.
Subject of Research: HIV prevalence, incidence, and sociodemographic risk factors among older adults in sub-Saharan Africa.
Article Title: The prevalence, incidence, and sociodemographic risk factors of HIV among older adults in sub-Saharan Africa (AWI-Gen): a multicentre, longitudinal cohort study
News Publication Date: 25-Mar-2025
Web References:
- DOI link to article
- Sydney Brenner Institute for Molecular Bioscience (SBIMB)
- MRC/Wits-Agincourt Research Unit
- Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen)
References:
- Olubayo, L., Gómez-Olivé, F. X., et al. (2025). The prevalence, incidence, and sociodemographic risk factors of HIV among older adults in sub-Saharan Africa (AWI-Gen): a multicentre, longitudinal cohort study. The Lancet Healthy Longevity. DOI: 10.1016/j.lanhl.2025.100701
Keywords: Viruses, Subpopulations, Older adults, Biomedical policy, Gerontology
