An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa

BackgroundDespite the severe impact of HIV in sub-Saharan Africa, the health of older people aged 50+ is often overlooked owing to the dearth of data on the direct and indirect effects of HIV on older people's health status and well-being. The aim of this study was to examine correlates of health and well-being of HIV-infected older people relative to HIV-affected people in rural South Africa, defined as participants with an HIV-infected or death of an adult child due to HIV-related cause. MethodsData were collected within the Africa Centre surveillance area using instruments adapted from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE). A stratified random sample of 422 people aged 50+ participated. We compared the health correlates of HIV-infected to HIV-affected participants using ordered logistic regressions. Health status was measured using three instruments: disability index, quality of life and composite health score. ResultsMedian age of the sample was 60 years (range 50-94). Women HIV-infected (aOR 0.15, 95% confidence interval (CI) 0.08-0.29) and HIV-affected (aOR 0.20, 95% CI 0.08-0.50), were significantly less likely than men to be in good functional ability. Women's adjusted odds of being in good overall health state were similarly lower than men's; while income and household wealth status were stronger correlates of quality of life. HIV-infected participants reported better functional ability, quality of life and overall health state than HIV-affected participants. Discussion and Conclusions The enhanced healthcare received as part of anti-retroviral treatment as well as the considerable resources devoted to HIV care appear to benefit the overall well-being of HIV-infected older people; whereas similar resources have not been devoted to the general health needs of HIV uninfected older people. Given increasing numbers of older people, policy and programme interventions are urgently needed to holistically meet the health and well-being needs of older people beyond the HIV-related care system. <br/

Burial surveillance detected significant reduction in HIV-related deaths in Addis Ababa, Ethiopia

Objective  To determine the level of HIV-related mortality reduction after the introduction of large-scale antiretroviral therapy (ART) using a burial surveillance system coupled with verbal autopsy (VA) in Addis Ababa, Ethiopia. Methods  Prospective burial surveillance was established in 2001 at cemeteries in Addis Ababa. VA interviews were periodically conducted on a random sample of adult burials registered between 2001 and 2009. Independent physicians reviewed the completed VA questionnaires and assigned underlying causes of death. The period before 2005 was defined as pre-ART and that since 2005 as the ART era. HIV-specific mortality fractions were calculated by age, sex and year of burial to examine the mortality trends before and during the ART era. Results  Of the 4239 VA physician diagnoses, 1087 (25.6%) were ascribed to HIV-related deaths. HIV-related deaths in 2009 were 33% fewer than in 2001. The proportion of HIV-related deaths was reduced from 44.0% in the pre-ART period to 20.0% in the ART era. Mortality in women (36.7%) declined more than in men (30%). A marked reduction in HIV-specific mortality was observed in the age group 30–39 years (from 69.1% pre-ART to 46.8% during ART era) compared to 20–29 (from 60.5% pre-ART to 41.0% during ART) and 40–49 year olds (49.7%) pre-ART to 34.4% during ART provision). Conclusion  Burial surveillance combined with VA demonstrated a significant reduction in HIV-related deaths during the provision of free ART. Replication of burial surveillance is recommended in similar settings, where a vital registration system is non-existent, to track large-scale population-level interventions