HIV and TB co-infection: A double ethical challenge in South African public hospitals

Prevalence and association of HIV and tuberculosis status in older adults in South Africa: an urgent need to escalate the scientific and political attention to aging and health

“…Many studies conducted on HIV and TB and unemployment suggested that for older adults, being without employment may affect their likelihood of contracting HIV and TB as well (13). Thus, employment and wealth index are major critical factors in determining the quality of life for older adults after being affected by HIV and TB (17). We found that older adults residing in rural areas had increased odds of being associated with HIV and TB.…”

“…Our study findings revealed that older adults with HIV and TB without medical aid coverage had no business activities, were from the poorest households, and residing in rural provinces. Studies have shown that wealthier older adults are more likely to afford and opt for medical aid premiums and access private health facilities where they can have quality healthcare provided to them for their HIV and TB status (11,17). In most sub-Saharan African countries, such as in South Africa, medical aid coverage usually applies to private health facilities, while public health facilities usually treat those without medical aid (37, 43).…”

“…For instance, assessments from 2012 showed that the average prevalence of HIV in those over 50 years old is 7.6% (95% CI 6.5-8.8), while the prevalence of HIV infection in age cohorts of 15-49 years is anticipated to decrease by half, and in the next 30 years, HIV infection in older adults aged over 50 years is predicted to double in the next 30 years (14,15). Furthermore, in South Africa, older persons are not specifically targeted for HIV and TB prevention and testing, and medical providers, especially community health workers, may fail to suspect or test for infections in this "hard-to-reach population, " resulting in ignored, delayed or postponed diagnosis (16)(17)(18)(19)(20). Also, a lack of non-use of condoms has been reported among older adults, and studies have shown that marital status plays a significant role in the non-use of condoms among older married adults (3,7).…”