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HIV/AIDS in an ageing society- the challenge of older carers in Sub-Saharan Africa

By Dolline Busolo and Dr. Tavengwa Nhongo

March 1, 2006

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1. Situation of older people in Subsaharan Africa

2. Impact of HIV/AIDS on older people

3. Intervention by Helpage International on HIV/AIDS

4. Recommendations

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Situation of Older people in Sub Sahara Africa (SSA)The world population aged 60 years and above is increasing rapidly. The developing world is experiencing fastest growth with the population of older people 60 and above in Africa alone projected to rise to between 204 and 210 million by the year 2050. In Africa most older people age with no means of survival or social protection. Poverty has risen in Africa with the proportion of those living on less than a dollar per day having risen from 44.6 per cent to 46.4 per cent between 1990 and 2001.

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Studies by International Labour Organisation on Decent work and poverty reduction in Africa(2002) revealed that Poverty is highest among the young & the old people. In Uganda for instance 64% of the older people and 38% of the general population live in abject poverty Declining economic situation, poor agricultural performance exacerbate poverty among older people The impacts of HIV/AIDS together with the increasing conflict and emergency situations have worsened the living conditions for older people

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POLICIES AND LEGISLATIONOnly a couple of countries in Africa have national policies and legislation aimed at protecting the rights and needs of older people ( Mali, Tanzania, Mozambique, RSA and Northern Africa)Majority of national and regional policy documents and strategies, such as the Poverty Reduction Strategies, and sector plan (Health Strategic Sector Plans) do not target older people as a vulnerable groupAs a consequence of this exclusion there are inadequate government resource allocation to meet the basic needs of older carers. 

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Changes in care paradigm within multigenerational households

In the old African care paradigm younger generations cared for older people.

HIV/AIDS has reversed this paradigm. Currently across SSA, an average of 30% of the multi-generational households are headed by a person aged 55+

Over 65% of older-headed households have at least one child under the age of 15

In southern Africa 59% of the double orphans, live in households headed by older people, compared to 30% of non-orphaned children

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Continued………………. Older women more a bigger role in the caring for children. Over 60% of the households headed by older women are twice as likely to include orphans as households headed by mostly older men Unfortunately, 80% of older people who are primary carers do not receive a regular income

HIV/AIDS policies and programmes on prevention, care, treatment and support fail to recognise this shift in care 

Source : UNICEF/HAI 2004

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Impact of HIV/AIDS on older people HelpAge International has since 1992 been supporting partners in Africa

to reduce the impacts of HIV/AIDS on older people. From the current programme implemented in 10 countries lessons have been learned on key impacts of the pandemic on older people

Direct infection from partners as sexually active people and also while observing cultural practices such as polygamy, wife inheritance etc)

As carers of the sick and orphans Denial of information about the transmission, prevention and treatment of

HIV/AIDS using Anti Retroviral Infection-ART’s. They are ill equipped to care for others

Stigma by health workers who do not expect older people to be infected. As a result older people find it hard to access conventional health services for themselves and those under their care particularly Voluntary Counselling and testing (VCT)

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Older people 50+ are infected by HIV/AIDS(The data on HIV/AIDS infection covers in this section covers those 50+ since UNAIDS collects data up to 49 years of age)

The scanty data gathered from VCT and National surveys is showing older people are infected. In Sub-Sahara Africa 7% of older people 50+ are estimated to have AIDS In Uganda data collected from people aged 50+ seeking Voluntary Counselling and Testing (VCT) services increased from 3 to 30 per cent between 1992 and 2002. Over 20% of them tested positive The March 2005 monthly report from the Senkatana Counselling Centre(VCT) in Lesotho showed that 17 of the 28 of those 50+ years who consented to be tested were HIV/AIDS positive

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Proportion of ill/PLWHAS under the care of Older people

020406080

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Country: Source Helpage International 2006

Per

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age % of Pop who are OP

% of PLWHA /ill peoplecared for by OP

Older people are carers of ill/PLWHAS

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Older people undertake Home Based care (HBC)- which entails physical, clinical, nutritional, health and emotional care; Where death occurs funeral and related expenses form part of the care packageHBC roles by older people are not matched by response programmes. Exclusion of older people from conventional information and training on HIV/AIDS prevention care and support predisposes them to infection from giving care.  

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Recognition of older carers of Orphaned children

UNICEF has recognised this care role by older people and states,

“One of the rarely told stories from sub-Saharan Africa is that of the grandparents who care for children orphaned by AIDS. Research in seven countries (Burkina Faso, Cameroon, Ghana, Kenya, Mozambique, Nigeria and the United Republic of Tanzania) with recent data reveals the enormous burden that orphaning is exerting on the extended family in general and grandparents – often grandmothers – in particular.” UNICEF’s recent State of the World’s Children 2007 report

Evidence from HAI work on HIV/AIDS in Africa(2006) has further clarified the proportion of OVC under the care of older carers as shown in charts: 

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Proportion of OVC under care of Older people

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Country: Source Helpage International 2006

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% of Pop who are OP

% of OVC in communitycared by OP

Older people as care givers to OVC

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A proportionately larger proportion of ÔVC are under the care of older people compared to those under the care of younger adultsOlder people provide basic needs of OVC under their care with an average number of 4 per family. These entail physical, educational, emotional, nutrition and health care needs.School access, vocational fees and educational support including homework are a big challenge for illiterate older women and menManagement of child illnesses particularly accessing health facilities for immunisation is often constrained by lack of transport and poor mobilityThe situation is worse for the young HIV/AID positive children. Health officials and Doctors at the Baylor International Paediatric AIDS Initiative reported that 600 of the 4000 young HIV + children receiving ART were under the care of older women.

They raised concerns about the inability of older women to administer ART to young OVC children using syringes, breaking tablets to smaller portions and inability to take them for timely review. ( East African Feb 14-25, 2007)

Household Conflicts between Adolescents children and older carers as new mothers has often exposed OVC to exploitation, character flaws and risky behaviour

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Older people have to secure property rights and inheritance for OVC an issue which is often unsupported due to lack of national identity cards required for official transactions , lack of exposure to succession laws and other legal documents. Legal systems in many countries fail to provide adequate protection to children affected by HIV/AIDS and elderly caregivers. Even where legal protections exist, the capacity to put them into practice is often very weak; ( UNGASS Declaration of Commitment on HIV/AIDS: five years later, 24 March 2006)

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Economic Impact of care on older carersCaring for the sick and OVC involves considerable expenditure on medical support, both from traditional and hospital based practitioners. Older carers sell assets livestock and land) to meet basic needs further impoverishing them.Limited data shows :In rural Mozambique : The average monthly cost of care for OVC is $21 and for PLWA is $30, while ave. monthly income for an older person is $12

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In Tanga in Tanzania: Older people required average $19 monthly to care for one OVCBeneficiaries of ‘The National Old Age Universal Pension scheme given to older people over 70 in Lesotho, confirmed the pension of M150 (US$25) only lasted half way through the month since it was shared with dependents. The UNGASS Declaration of Commitment on HIV/AIDS: five years later, 24 March 2006 indicated that fewer than 10 percent of households supporting children orphaned or made vulnerable by HIV/AIDS are reached by community based or public sector support programmes. (para 42)

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Recommendations• Develop HIV/AIDS policies that support and assist older women

carers• All home-based care policies and programmes, including standards of

care guidelines, to include older women carers• Ensure older people access treatment and care for OVC and PLWHAS

including ARTs• Provide financial support for older women carers• Agencies designing and implementing HIV & AIDS programmes must

ensure that older women carers are systematically involved in the design, implementation and monitoring of prevention, care and treatment interventions at household and community level

• Gather gender-disaggregated data, on infection rates and on access to treatment, including for people over 50

• Provide legal advice to carers with particular emphasis on advocacy for custody of the property for OVC by older carers

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AHSANTENI SANA= Merci

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Selected Interventions 

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