Health, wellbeing, and disability among older people infected or affected by HIV in Uganda and South Africa

Abstract

ObjectiveTo describe and compare the health status, emotional wellbeing, and functional status of older people in Uganda and South Africa who are HIV infected or affected by HIV in their families.MethodsData came from the general population cohort and Entebbe cohort of the Medical Research Council/Uganda Virus Research Institute, and from the Africa Centre Demographic Information System through cross-sectional surveys in 2009/10 using instruments adapted from the World Health Organization (WHO) Study on Global Ageing and adult health (SAGE). Analysis was based on 932 people aged 50 years or older (510 Uganda, 422 South Africa).ResultsParticipants in South Africa were slightly younger (median age − 60 years in South Africa, 63 in Uganda), and more were currently married, had no formal education, were not working, and were residing in a rural area. Adjusting for socio-demographic factors, older people in South Africa were significantly less likely to have good functional ability [adjusted odds ratio (aOR) 0.72, 95% CI 0.53–0.98] than those in Uganda, but were more likely to be in good subjective wellbeing (aOR 2.15, 95% CI 1.60–2.90). South Africans were more likely to be obese (aOR 5.26, 95% CI 3.46–8.00) or to be diagnosed with hypertension (aOR 2.77, 95% CI 2.06–3.73).Discussion and conclusionsWhile older people’s health problems are similar in the two countries, marked socio-demographic differences influence the extent to which older people are affected by poorer health. It is therefore imperative when designing policies to improve the health and wellbeing of older people in sub-Saharan Africa that the region is not treated as a homogenous entity.

Prevalence and correlates of depression among HIV-infected and -affected older people in rural South Africa

“…It has long been known that women are particularly vulnerable to both depression and HIV, and it seems likely, given that women carry a disproportioned burden of caregiving in most low and middle income settings, that the effects of depression extend to impact on the family and the quality of care, rather than being limited to the individual. In earlier analyses (Nyirenda et al, 2013) we found that 2 in 3 of the older people were care-givers to at least one adult offspring or child; and as seen in other studies, a higher proportion of older people are main care-givers to HIV-infected adults and to children they leave behind orphaned (Hill et al, 2008; Ssengonzi, 2007; Schatz, 2007). Here we show a strong association between care-giving, especially to adults, and having a depressive episode.…”

Addressing predictors of HIV related risk behaviors: Demographic and psychosocial profile of Iranian patients

“…These findings are consistent with those of previous studies that have reported that women are more predisposed to the adverse effects of occupational stressors and also experience difficulties in acquiring emotional support that lead to psychological distress [21]. We also found an association between the level of education and social participation, which is similar to the findings of other studies [22]. The illiterate patients exhibited higher scores than did the literate patients.…”

Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations

“…120 Similarly, in Nairobi slums, an estimated 12% of urban adult low-income Kenyans have HIV/AIDS 78 and 10% of adults aged between 40 and 54 years have diabetes. 76 Cohort studies in Uganda and South Africa document HIV-NCD convergence; 121122123124 psychological distress increases among those with multiple conditions and NCDs are lower among older adults without HIV, which might result from routine antiretroviral therapy. 125 More epidemiological studies are needed that document the co-occurrence of diabetes and HIV within the same individuals; however, anthropological research shows that people with HIV are developing diabetes and this poses complex medical issues, including the prioritisation of HIV care over diabetes care because of international donor stipulations on AIDS funding.…”