Approximately 8.2 million South Africans, or 13.7% of the population, are living with HIV, one of the highest prevalence rates globally.
Since the widespread introduction of antiretroviral treatments in 2008, over 5 million individuals are currently receiving antiretroviral therapy.
Many people are now living longer with chronic HIV, resulting in an ageing HIV-positive population. Today, people living with HIV are, on average, older than they were a decade ago.
Despite this demographic shift, most HIV prevention and treatment initiatives in South Africa continue to focus on adolescents and young adults, leaving a growing group of middle-aged and older adults with HIV largely neglected.
Research on sexual behaviour, HIV transmission risks, stigma, and prevention for individuals over 40 remains limited.
The Health and Ageing in Africa Longitudinal Study (HAALSA) aims to bridge this gap by exploring the risk of HIV and the health outcomes of older adults with HIV in South Africa.
This project, a collaboration between the University of the Witwatersrand and Harvard University, has been tracking over 5,000 adults aged 40 and older in the Agincourt region of north-eastern South Africa for more than a decade. Through this study, researchers are gaining insight into the “greying” HIV epidemic.
Here are some of their key findings:
Sexual activity is common
The research revealed a significant HIV prevalence in older adults, with nearly 1 in 4 individuals over 40 living with HIV.
It was found that 56% of participants, regardless of their HIV status, had engaged in sexual activity within the past 24 months.
Condom usage varied; only 15% of HIV-negative adults used condoms, compared to 27% of HIV-positive individuals unaware of their status, and 75% of those who were aware.
The study also found that women had double the incidence rate of HIV compared to men.
Social stigma
HIV-related stigma remains a significant barrier for older adults. A quarter of respondents reported experiencing stigma, which had serious implications for care.
Those facing high levels of stigma were less likely to get tested or seek treatment. A recent pilot study showed that older adults preferred self-testing options for HIV, suggesting new avenues for increasing diagnosis in this age group.
Treatment and viral suppression
HAALSA also focuses on how older adults with HIV are managing their treatment and whether they are achieving viral suppression. Recent findings show that more older adults with HIV are reaching viral suppression.
However, there remain substantial differences in life expectancy depending on viral suppression status.
For instance, a 45-year-old man without HIV could expect to live another 27 years, compared to 24 years for a man with suppressed HIV, and 17 years for one with unsuppressed HIV.
Similarly, a woman aged 45 without HIV could expect to live another 33.2 years, compared to 31.6 years for a woman with suppressed HIV, and 26.4 years for one with unsuppressed HIV.
HAALSA said that targeted strategies are urgently needed to prevent new HIV infections, raise awareness, and provide support to help older adults living with HIV achieve viral suppression and improve their quality of life.
