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HelpAge International
HIV/AIDS in an ageing society- the challenge of older
carers in Sub-Saharan Africa
By Dolline Busolo and Dr. Tavengwa Nhongo
March 1, 2006
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1.
Situation of older people in Subsaharan Africa
2.
Impact of HIV/AIDS on older people
3.
Intervention by Helpage International on HIV/AIDS
4.
Recommendations
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Situation of Older people in Sub Sahara Africa (SSA)
The world population aged 60 years and above is
increasing rapidly. The developing world is experiencing
fastest growth with the population of older people 60 and
above in Africa alone projected to rise to between 204
and 210 million by the year 2050.
 In Africa most older people age with no means of
survival or social protection.
 Poverty has risen in Africa with the proportion of those
living on less than a dollar per day having risen from 44.6
per cent to 46.4 per cent between 1990 and 2001.
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 Studies by International Labour Organisation on Decent
work and poverty reduction in Africa(2002) revealed that
Poverty is highest among the young & the old people.
In Uganda for instance 64% of the older people and 38%
of the general population live in abject poverty
Declining economic situation, poor agricultural
performance exacerbate poverty among older people
 The impacts of HIV/AIDS together with the increasing
conflict and emergency situations have worsened the
living conditions for older people
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POLICIES AND LEGISLATION
Only a couple of countries in Africa have national
policies and legislation aimed at protecting the rights and
needs of older people ( Mali, Tanzania, Mozambique,
RSA and Northern Africa)
Majority of national and regional policy documents and
strategies, such as the Poverty Reduction Strategies,
and sector plan (Health Strategic Sector Plans) do not
target older people as a vulnerable group
As a consequence of this exclusion there are
inadequate government resource allocation to meet the
basic needs of older carers.
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Changes in care paradigm within multigenerational
households
In the old African care paradigm younger generations
cared for older people.
HIV/AIDS has reversed this paradigm. Currently
across SSA, an average of 30% of the multigenerational households are headed by a person aged
55+
Over 65% of older-headed households have at least
one child under the age of 15
In southern Africa 59% of the double orphans, live in
households headed by older people, compared to 30%
of non-orphaned children
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Continued……………….
 Older women more a bigger role in the caring for
children. Over 60% of the households headed by older
women are twice as likely to include orphans as
households headed by mostly older men
 Unfortunately, 80% of older people who are primary
carers do not receive a regular income
HIV/AIDS policies and programmes on prevention,
care, treatment and support fail to recognise this shift
in care
Source : UNICEF/HAI 2004
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Impact of HIV/AIDS on older people
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HelpAge International has since 1992 been supporting partners in Africa
to reduce the impacts of HIV/AIDS on older people. From the current
programme implemented in 10 countries lessons have been learned on
key impacts of the pandemic on older people
Direct infection from partners as sexually active people and also while
observing cultural practices such as polygamy, wife inheritance etc)
As carers of the sick and orphans
Denial of information about the transmission, prevention and treatment of
HIV/AIDS using Anti Retroviral Infection-ART’s. They are ill equipped to
care for others
Stigma by health workers who do not expect older people to be infected.
As a result older people find it hard to access conventional health
services for themselves and those under their care particularly Voluntary
Counselling and testing (VCT)
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Older people 50+ are infected by HIV/AIDS
(The data on HIV/AIDS infection covers in this section covers
those 50+ since UNAIDS collects data up to 49 years of age)
The scanty data gathered from VCT and National surveys is
showing older people are infected. In Sub-Sahara Africa 7% of
older people 50+ are estimated to have AIDS
In Uganda data collected from people aged 50+ seeking
Voluntary Counselling and Testing (VCT) services increased
from 3 to 30 per cent between 1992 and 2002. Over 20% of
them tested positive
 The March 2005 monthly report from the Senkatana
Counselling Centre(VCT) in Lesotho showed that 17 of the 28 of
those 50+ years who consented to be tested were HIV/AIDS
positive
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Older people are carers of ill/PLWHAS
100
80
60
40
20
0
% of Pop who are OP
% of PLWHA /ill people
cared for by OP
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Percentage
Proportion of ill/PLWHAS under the care of Older people
Country: Source Helpage International
2006
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Older people undertake Home Based care (HBC)- which
entails physical, clinical, nutritional, health and emotional
care; Where death occurs funeral and related expenses
form part of the care package
HBC roles by older people are not matched by response
programmes.
Exclusion of older people from conventional information
and training on HIV/AIDS prevention care and support
predisposes them to infection from giving care.
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Recognition of older carers of Orphaned children
UNICEF has recognised this care role by older people and states,
“One of the rarely told stories from sub-Saharan Africa is that of the
grandparents who care for children orphaned by AIDS. Research in
seven countries (Burkina Faso, Cameroon, Ghana, Kenya,
Mozambique, Nigeria and the United Republic of Tanzania) with recent
data reveals the enormous burden that orphaning is exerting on the
extended family in general and grandparents – often grandmothers – in
particular.” UNICEF’s recent State of the World’s Children 2007
report
Evidence from HAI work on HIV/AIDS in Africa(2006) has further
clarified the proportion of OVC under the care of older carers as shown
in charts:
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Older people as care givers to OVC
Proportion of OVC under care of Older people
80
70
% of Pop who are OP
50
40
% of OVC in community
cared by OP
30
20
10
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Percentage
60
Country: Source Helpage
International 2006
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A proportionately larger proportion of ÔVC are under the care of older people
compared to those under the care of younger adults
Older people provide basic needs of OVC under their care with an average number
of 4 per family. These entail physical, educational, emotional, nutrition and health
care needs.
School access, vocational fees and educational support including homework are a
big challenge for illiterate older women and men
Management of child illnesses particularly accessing health facilities for
immunisation is often constrained by lack of transport and poor mobility
The situation is worse for the young HIV/AID positive children. Health officials and
Doctors at the Baylor International Paediatric AIDS Initiative reported that 600 of the
4000 young HIV + children receiving ART were under the care of older women.
They raised concerns about the inability of older women to administer ART to
young OVC children using syringes, breaking tablets to smaller portions and
inability to take them for timely review. ( East African Feb 14-25, 2007)
Household Conflicts between Adolescents children and older carers as new
mothers has often exposed OVC to exploitation, character flaws and risky behaviour
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Older people have to secure property rights and
inheritance for OVC an issue which is often unsupported
due to lack of national identity cards required for official
transactions , lack of exposure to succession laws and other
legal documents.
 Legal systems in many countries fail to provide adequate
protection to children affected by HIV/AIDS and elderly
caregivers. Even where legal protections exist, the capacity
to put them into practice is often very weak; ( UNGASS
Declaration of Commitment on HIV/AIDS: five years later, 24
March 2006)
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Economic Impact of care on older carers
Caring for the sick and OVC involves considerable expenditure on
medical support, both from traditional and hospital based
practitioners.
Older carers sell assets livestock and land) to meet basic needs
further impoverishing them.
Limited data shows :In rural Mozambique : The average monthly
cost of care for OVC is $21 and for PLWA is $30, while ave. monthly
income for an older person is $12
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In Tanga in Tanzania: Older people required average $19
monthly to care for one OVC
Beneficiaries of ‘The National Old Age Universal Pension
scheme given to older people over 70 in Lesotho, confirmed
the pension of M150 (US$25) only lasted half way through
the month since it was shared with dependents.
The UNGASS Declaration of Commitment on HIV/AIDS:
five years later, 24 March 2006 indicated that fewer than 10
percent of households supporting children orphaned or made
vulnerable by HIV/AIDS are reached by community based or
public sector support programmes. (para 42)
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Recommendations
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Develop HIV/AIDS policies that support and assist older women
carers
All home-based care policies and programmes, including standards of
care guidelines, to include older women carers
Ensure older people access treatment and care for OVC and PLWHAS
including ARTs
Provide financial support for older women carers
Agencies designing and implementing HIV & AIDS programmes must
ensure that older women carers are systematically involved in the
design, implementation and monitoring of prevention, care and
treatment interventions at household and community level
Gather gender-disaggregated data, on infection rates and on access to
treatment, including for people over 50
Provide legal advice to carers with particular emphasis on advocacy
for custody of the property for OVC by older carers
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AHSANTENI SANA= Merci
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Selected Interventions
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