HIV after 50 in its Chronic Era in Rural South Africa
As anti-retroviral treatment (ART) continues to help people living with HIV (PLWH) live longer, more and more PLWH will be growing older in the years ahead. Those numbers will be highest throughout sub-Saharan Africa, the region of the world hit hardest by the HIV epidemic. HIV in older ages is unique in at least two ways: 1) HIV infection exists alongside the onset of other health conditions associated with aging; and 2) HIV care relies on social relationships and social support, ties which may attenuate with aging. In high HIV prevalence, resource-constrained settings, HIV care has long relied on supportive household and community networks. How these dynamics work for older Africans living with HIV is less known, yet critical to mitigating ART adherence issues and, ultimately, reducing HIV incidence. Focusing on rural South Africa (Mpumalanga Province) and using 1) in-depth interviews with older Africans living with HIV as well as with individuals identified as providing domestic and logistical support for their HIV management and ART uptake and 2) a case study approach focused on the observation of older Africans’ routine HIV/ART-related activities, the proposed pilot study aims to understand how older Africans living with HIV draw upon household and community resources to leverage the requisite support upon which viral suppression depends: daily pill-taking and regular clinic visits. The study builds upon ongoing research collaboration with the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt). While the study is not based in Washington DC, there is a lot that can be learned from the African experience that may extend to the DC community, where the number of older adults living with HIV is also growing and where some of the biomedical and social challenges of managing HIV in older ages are similar.