Project 3: Aging with HIV in Sub-Saharan Africa in the Era of Antiretroviral Treatment Conventionally, HIV infection in Sub-Saharan Africa (SSA) has been viewed as a disease that is in-elevant to older adults, because it is acquired in youth and its consequences are suffered in middle age. This view is expressed in limits to age-eligibility in HIV surveys and surveillance and the targeting of HIV prevention programs to youth or working-age adults. While global evidence strongly suggests that older adults continue to engage in risky sexual activity and a recent study in one rural community in SSA shows high HIV incidence in adults over 50 years of age, strong data on HIV prevalence, incidence, and risk factors in older adults are lacking for SSA and we know little of the consequences for older adults of having family members living with HIV. Expansion of antiretroviral treatment (ART) coverage in SSA is likely to have dramatically increased the life expectancy of HIV-infected adults. We know little ofthe increase in the number of HIV-infected elderly people in SSA, and treatment and services requirements may be different for the elderly than for the youth population. Moreover, the economic and social needs, and abilities, ofthe HIV-infected elderly population receiving ART are largely unknown. Our long-term goal is to understand how health policy can reduce older adults'risk of acquiring HIV, and reduce the impact of the HIV epidemic on economic and social well-being in this growing population age-group in SSA. The overall objective here is to elucidate the factors leading to new HIV infection and HIV treatment access in older adults in SSA, and the effects of HIV infection and treatment, on health, social, behavioral, and economic outcomes.
Three specific aims are designed to test the central hypothesis and achieve the goal ofthe proposal. They are: 1. Determlne HIV prevalence and incidence and identify the risk factors of HIV acquisition in older adults in SSA. 2. Identify the extent and determinants of HIV treatment access and ART success in older adults in SSA. 3. Establish the direct and indirect effects ofthe HIV epidemic on health, social, behavioral, and economic outcomes in older adults in SSA, and determine how ART modifies these effects.
Our central hypothesis is that older adults in SSA are substantially affected by the HIV epidemic - both directly and indirectly - and that the impact of the HIV epidemic on older adults in SSA is currently being transformed by the large-scale ART provision in SSA. This project seeks to understand (i) risk factors and the effects of HIV infection in older adults, (ii) the determinants and effects of ART in this age group, and (iii) the effect of HIV and ART in family members on outcomes in older adults. The long-term goal is to elucidate the risk factors and effects of HIV in older adults living in SSA and to understand how ART changes these effects.
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