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

Abstract

Background Despite 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. Methods Data 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. Results Median 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.

Disability and Health Outcomes – From a Cohort of People on long term ART

“…In this cohort 51.9% of the participants scored 2 or more on the WHODAS 2.0 using the adjusted measure [14,28,29]. This is higher than in the sister study in KZN [6] and suggest a high prevalene of functional limitations that if not addressed may be a risk of disability.…”

“…This is higher than in the sister study in KZN [6] and suggest a high prevalene of functional limitations that if not addressed may be a risk of disability. In many studies, disability is described differently and often interchangeably between functional and activity limitation, disability and functioning [5], [28][29][30]. Current measures of disability such as the WHODAS on muscle function as well as aptotic effects on muscle cells [34,35].…”

Living Arrangements and Conditions of Older Persons in Namibia

“…A cohort study in Malawi indicated that older women were more likely to be disabled than older men [12]. Even among HIV infected populations in South Africa, older women were still at a higher risk of disabilities compared to older men [13]. Studies in middle income countries have also reported increased disability among older women [14] [15].…”

HIV-Related Disability in HIV Hyper-Endemic Countries: A Scoping Review

“…Prevalence of activity limitations and participation restrictions was 80% and 93%, respectively. In Southern Africa, the ICF has been used to study HIV in four studies [7,16,17,20], each of which describes a diverse experience of disability among people living with HIV.…”