AIDS and declining support for dependent elderly people in Africa

Demographics and Social protection

AIDS and declining support for dependent elderly people in Africa: retrospective analysis using demographic and health surveys.

The objective of the study was to determine the relation between the HIV epidemic and support for dependent elderly people in Africa. The authors conducted a retrospective analysis using data from Demographic and Health Surveys in 22 African countries between 1991 and 2006. 123,176 individuals over the age of 60 were included in the analysis. Kautz and colleagues investigated how three measures of the living arrangements of older people have been affected by the HIV epidemic: the number of older individuals living alone (that is, the number of unattended elderly people); the number of older individuals living with only dependent children under the age of 10 (that is, in missing generation households); and the number of adults age18-59 (that is, prime age adults) per household where an older person lives. An increase in annual AIDS mortality of one death per 1000 people was associated with a 1.5% increase in the proportion of older individuals living alone (95% CI 1.2% to 1.9%) and a 0.4% increase in the number of older individuals living in missing generation households (95% CI 0.3% to 0.6%). Increases in AIDS mortality were also associated with fewer prime age adults in households with at least one older person and at least one prime age adult (P<0.001).>Efforts to reduce HIV deaths could have large "spillover" benefits for elderly people in Africa.

Elderly people were defined as over 60 years in this study because this captures the oldest 5% of the African population - those most likely to require financial and physical support. In comparison, this cut-off of 5% would be 75 years in the USA. The fact that this analysis found an association between increases in the number of unattended elderly people and the severity of the HIV epidemic in 22 African countries makes sense as HIV affects primarily adults in the productive and reproductive years. Risk factors associated with living without the support of prime-age adults include female sex, not having completed primary school, living in a rural area, and poor household wealth (e.g. not having assets such as radios at home). Households in which elderly people are caring for sick adult children were not identified so this study likely underestimates the burden that HIV is placing on this age group. What is clear is that reducing morbidity and mortality in prime-age adults by preventing HIV infection and initiating HIV treatment in a timely fashion would not only prevent children from being orphaned by AIDS but would benefit elderly Africans.