Agenda 11: Thematic Segment HIV and Ageing
Intervention for Preventing HIV in older people: risks and responses
By Sonal Mehta
The world is deservedly moving towards focus on young people. There are discussions about demographic gains including in my country, India. In this scenario it is very important that we do not forget the needs, issues and risks that the older people need. People with access to life-saving HIV medicines are living longer but experience unique comorbidities as they enjoy later life requiring unique support strategies.
From experiences and studies it is clear that at 50 years of age women living with HIV have much higher possibilities of cervical cancer than women without , this age goes down to 35 if the woman is a sex worker living with HIV. My transgender colleague always tells me that the highest vulnerability she had of HIV was when she was gender transitioning, and the second highest will be when she is going to be 50 and above. But in many countries, the age of risk is 15-49 years. I think a mistake HIV programme often make, is borrowing some of the ideas of reproductive health programmes. For years reproductive health was as far as we could go to talk about sex, but HIV has changed the world. Therefore, I can very well accept the age of reproduction to end at 49 years, but it is really not possible for me to accept 49 as age to end having sex, based on personal experience.
The national programmes, particularly for countries where the epidemic came a little later and where HIV is still concentrated within key populations, a response to the community that is aging with HIV or who might be vulnerable to HIV at older age is rare to see. It is heart moving to hear stories of men and women who contract HIV after or around 50 years of age and have to disclose their status and who have children or grandchildren who themselves are already in reproductive age.
As I move towards the group that is called “aging”, I realise that it is really sad in many countries and cultures including mine, that it is not only assumed but expected that women above fifty are asexual or at least silent about their sexual lives. There is also often a discussion about the needs of men, including men who have sex with men and male sex workers and their need for HIV prevention but rarely about women, women sex workers and trans-women.
It is time that UNAIDS Secretariat and the Co-sponsors take up the issues of older people and their needs for prevention of HIV and be bold to say, that when love and sex is life-long and not bound by age; how can HIV be?