Aging with HIV: An Overlooked Crisis

By Raymond Kyazze

Uganda remains one of the countries most heavily affected by HIV, with 8.2 million people—13.7% of the population—living with the virus. Despite having one of the most successful antiretroviral treatment programs globally, which supports over five million people, significant gaps remain in addressing HIV prevention and care for older adults. Since the widespread availability of antiretroviral therapy in 2008, millions of Ugandans have aged with chronic HIV, but national HIV programs still prioritize younger populations, leaving many older individuals neglected.

Most HIV prevention efforts in Uganda center on adolescents and young adults, while adults over 40 are often excluded. Little research has explored the unique challenges this age group faces regarding sexual health, stigma, and access to preventive care. However, the Health and Aging in Africa: Longitudinal Studies of Uganda offers valuable insights. This initiative, a collaboration between Makerere University and UNAIDS, has tracked over 5,000 adults aged 40 and above in northeastern Uganda for more than a decade to better understand the aging experience of living with HIV.

Sexual Activity and HIV Risks

Contrary to stereotypes, older adults remain sexually active. A 20201 UNAIDS study revealed that nearly one in four people over 40 in Uganda live with HIV. Among respondents, 56% had engaged in sexual activity in the previous 24 months. However, condom use was worryingly low—just 15% among HIV-positive individuals unaware of their status. In contrast, condom use rose to 27% among those who did not know their HIV status and an encouraging 75% among those aware of their positive diagnosis. The data also highlighted that women experienced nearly double the HIV infection rates of men between 2010 and 2016.

The Impact of Stigma

HIV-related stigma remains a pervasive issue for older adults. While most studies on stigma focus on younger populations, UNAIDS findings underscore the critical need to address stigma among older individuals. A quarter of older adults surveyed reported experiencing social stigma tied to their HIV status. This stigma significantly affects care-seeking behavior—those facing severe stigma are less likely to get tested and are often hesitant to begin treatment.

A pilot study highlighted that self-testing could be a game-changer for this age group, providing the privacy necessary to encourage more individuals to determine their status. Tailored strategies that reduce stigma and increase access to discreet testing are vital for improving outcomes in older adults.

Progress and Treatment Goals

UNAIDS monitors progress toward global HIV treatment targets, and HAALSA’s findings provide valuable context. In 2014-2015, 63% of surveyed adults with HIV were on antiretroviral therapy (ART), with 72% achieving viral suppression. By 2018-2019, treatment coverage among older adults had increased further, signaling improvements in care.

Nonetheless, viral suppression remains critical for healthy