HIV/AIDS: Unpacking the hidden disease among older persons

Ruth Waryaro was 50 in 2003 when she discovered she had contracted HIV and AIDS.

Ruth Waryaro was 50 in 2003 when she discovered she had contracted HIV and AIDS. In spite of the emotional and psychological devastation in her life, Ruth took the courage to discover herself and to take care of her four children and three grandchildren.

18 years on, Ruth is now an advocate and challenges self-stigma that she says is prevalent among the older persons who live with the HIV and AIDS.

“From my 18 years experience of living and ageing with HIV, I can hereby attest that the epidemic is no longer a problem of the younger people,” she says.

Speaking in Nairobi ahead of her travel to South Africa to attend the second World Congress on Health Ageing courtesy of HelpAge International where she was to deliver a speech, Ruth says similar to many other African countries, the impact of HIV and AIDS to old people is becoming an area of increasing concern.

“We older people need to do away with self-stigma and teach the younger people how to prevent it. Older persons living with HIV need to be accepting the reality that stigma starts with the person infected. If you don’t stigmatize yourself, no one will. Prevention, she says, starts with the person.

“Older persons should go for testing and counseling, so that when they are talking to their children, they know and have the courage of what they are talking about”, says Ruth.

Reflecting on her personal life, Ruth says one does not need to be promiscuous to contract the virus that leads to AIDS. It could come from an error by one’s partner, in her case, HIV entered her family through her husband who then worked in Lesotho.

“A week after testing, I sat down with my husband and told him about my status. He got up and went away without uttering a word and we have never lived together since then”, she says.

According to Ruth, acquiring HIV is bad enough, but is worse for a woman who is aging and living with HIV. “They are the section of Kenyan population subjected to worst forms of discrimination” she says.

We are often discriminated by family, community, society and government. For example, cash transfer programmes do not reach everybody yet most of those left out cannot afford going to clinics and eating properly and yet many have lost their physical strength and ability to care for their dependants. Even for those older persons receiving the cash, it doesn’t seem to be enough. The amounts should be raised.

Her husband’s behavior attests to what holds within research studies. According to a number of researches, African men tend to think that HIV affects the woman only which has been reinforced by the Joint UN Agency for AIDS (UNAIDS) reports that tell of feminization of HIV.

Sub-Saharan Africa has the most serious HIV and AIDS epidemic in the world. In 2012, roughly 25 million people were living with HIV, accounting for nearly 70 percent of the global. But HIV statistics from the region also show an epidemic that has disproportionately affected women, often as a result of social and economic inequality.

A UNAIDS report in 2012 showed that six in ten of all people living with HIV in the region were female. The highest HIV prevalence rates among women occur in southern Africa, particularly in South Africa, Botswana, Lesotho and Swaziland. Women and girls often face discrimination in terms of access to education, employment and healthcare. In this region, men often dominate sexual relationships. As a result, women cannot always practice safer sex even when they know the risks that are involved. Gender-based violence has been identified as a key driver of HIV transmission in the region.

Against this background, Ruth urges older women to encourage their husbands to use condoms and learn more about HIV and AIDS.

A nurse by profession and whose career has spanned 40 years working in Kenya, Uganda and the UK, Ruth says as people get old with HIV, their immune system considerably slows down unlike the immune system for people growing old without HIV.

For this reason, she advocates for such older persons to eat balanced diet and keep on testing for other non-communicable diseases like diabetes and hypertension, which are also common among older persons. “We also need to exercise a lot to keep fit,” she says.

A rights defender, Ruth also urges older persons to demand prompt medical people to test them for HIV since they won’t do so out of baseless assumptions and prejudice against ageing.

According to Dr Prafulla Mishra, Regional Director, HelpAge International, East, West and Central Africa, it is generally assumed that older persons cannot acquire HIV based on the wrong assumptions that they are not sexually active.

Worse still, a recent study by the HelpAge International and its network partners in four countries of Africa, namely, Tanzania, Uganda, Zambia and South Africa showed that there are few medical personnel who specialize on diseases of the older persons (geriatrics training) leave alone the knowledge of handling ageing and HIV. Yet, according to Ruth, nothing can be far from truth. “It is a fact that even older men have multiple sex partners and are shy and/or do not know how to use condoms. Just because HIV is mainly through sex, older people don’t want to be known that they still have sex. Many older women whose husbands passed away do not know what they died from and further more they don’t want to go for testing with the false believes that it has been a while since their spouses passed on,” she says.

Thus, adds Ruth, older persons should have an impetus to make sure that they leave nothing to chance. “Older persons need to go to counseling and testing centers and ask to be tested,” she says.

Ruth is now involved in advocating for all types of training and/or teaching on HIV and AIDS management to include older people for it to be effective. “Living out old people is doing half the job and will never meet zero infections as being advocated for,” she says.

Ruth pleaded with the government and development partners to priorities on ageing and HIV as an urgent matter.

She says that the population of older persons living with HIV might look insignificant compared with other vulnerable and at risk populations, but the reality is, she says that any unknown and uncontrolled virus is disastrous towards zero infection.

“Older People must no longer be marginalized in national and international HIV and AIDS policies and programmes. Our numbers and status qualify that any society and government to consider the health rights of older people to be human rights,” says Ruth.