20th International AIDS Conference - Melbourne, Australia


WEPDC0103 - Poster Discussion Abstract

HIV among older adults in Zimbabwe: ageing with HIV or seroconverting after age 50?

Presented by Simon Gregson (United Kingdom).

J. Negin1, C. Nyamukapa2,3, J. Eaton3, N. Schur3, A. Takaruza2, P. Mason2,4, S. Gregson2,3

1University of Sydney, Sydney School of Public Health, Sydney, Australia, 2Biomedical Research and Training Institute, Harare, Zimbabwe, 3Imperial College School of Public Health, Department of Infectious Disease Epidemiology, London, United Kingdom, 4University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe

Background: With the scale-up of antiretroviral treatment across Africa, more and more people are living longer with HIV. As a result, the HIV cohort has aged with an estimated 3 million people aged 50 years and older living with HIV in sub-Saharan Africa. The question persists regarding what percentage of those older adults living with HIV have “aged with HIV” and what percentage seroconverted at age 50 or older.
Methods: We used data from a large population-based open cohort in eastern Zimbabwe. Five survey rounds have been completed since the establishment of the cohort in 1998 through to 2010. In each survey round, residents of the study area were enumerated in a household-based census, and were invited to participate. Participants completed an hour-long interview and dried blood spots were taken and tested for HIV.
Results: There was a total of 58120.6 person years among 11,884 individuals for an average of 4.89 years per person. Among those aged 50 years and older, there were 44 seroconversions in 6501.5 person years for an HIV incidence of 0.677 per 100 person years. Incidence among older men was higher than among men aged 40-49. Of the 78 people in the dataset aged 50+ at last survey and living with HIV (and for whom there is a recorded estimated date of seroconversion), 44 of them (56.4%) seroconverted at age 50 or older - rather than aged into their 50s already with HIV. Further analysis revealed that 29.3% of the individuals seroconverted in the last three years. We therefore estimate that the true percent of older adults living with HIV who seroconverted past the age of 50 ranges from 29-56%. Using both methods, seroconversion past the age of 50 was more likely among men than women.
Conclusions: Considerable numbers of older adults living with HIV seroconverted past the age of 50. Ageist assumptions about the sexual activity of older adults hamper an appropriate response. Targeted HIV prevention programs should be developed for older adults as well as age-appropriate services to ensure that older adults are tested and are able to access treatment.

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