HIV & Ageing
The world’s population is growing older. Over the past 50 years, the proportion of individuals aged 65 years and older has nearly doubled(5), a demographic shift that is particularly pronounced in low- and middle-income countries (LMICs) (6). Additionally, in the Southern African Region where the HIV prevalence is high, the success of antiretroviral therapy (ART) has led to a growing number of people ageing with HIV introducing new challenges to already strained health systems. Lesotho, heavily impacted by the HIV epidemic, now faces an ageing population of individuals with HIV. Among those aged 40 – 64, 30 to 40% are living with HIV, making this age group the one with the highest HIV prevalence in the country (7).
Evidence suggests that HIV accelerates or accentuates the ageing process (8, 9). Ageing is associated with an increased risk of chronic health conditions, including impaired lung function, sexual health challenges, frailty, cognitive decline, symptoms of menopause and cardiovascular diseases. Older adults with HIV may experience these conditions earlier and with greater severity than individuals without HIV (9-16). This phenomenon, often referred to as “accelerated ageing”, may be driven by chronic inflammation, immune dysregulation, and potential ART side effects (17). However, results are conflicting, and many open questions remain, particularly regarding the interaction of biology with lifestyle and psychosocial factors (17-19). Yet, research on the intersection of HIV and ageing remains limited in both Lesotho and the wider region. Most studies have concentrated on younger demographics or have been conducted in high-income countries, leaving significant gaps in understanding the unique needs of older people with HIV, especially older women.
Older women in Africa face disproportionate health burdens which are likely to be further aggravated by HIV infection. Studies suggest a high burden of cardiovascular, bone, renal and neurocognitive disease in women with HIV compared to women without HIV (18) and point towards an important research gap that explores ageing not only from the biomedical perspective but also includes economic, social, and cultural factors that influence older people’s well-being and quality of life and can explain differences in the experience of ageing between genders.
Although the population in Lesotho is ageing, there remains a lack of comprehensive health data on older adults with HIV. Through the HEalthy Ageing and HIV in Lesotho (HEAL) study, we aim to fill these significant evidence gaps by assessing the health needs and lived experiences of older adults with HIV in Lesotho, with a particular focus on women. Using the framework of intersectionality (20) we explore how different social categories—such as gender, age, socioeconomic status, and HIV status—interact and overlap to shape health outcomes and contribute to inequalities.
Our findings will inform the development of targeted interventions that address the complex and evolving needs of this vulnerable and growing population, helping to ensure that people ageing with HIV in Lesotho can live longer and healthier lives.
Funding: xxx
Leads: Dr Anna Klicpera (University Hospital Basel), …
Collaborators: Dr Mosa Tlahali (District Health Management Team Mokhotlong), Dr. Lebohang Sao-Chere (District Health Management Team Butha-Buthe), Dr. Tapiwa Tarumbiswa (Ministry of Health, Lesotho)
5. United Nations Population Fund. Ageing [Available from: https://www.unfpa.org/ageing.
6. United Nations Department of Economic and Social Affairs PD. World Population Ageing 2023: Challenges and opportunities of population ageing in the least developed countries. New York; 2023.
7. Lesotho Ministry of Health (MOH). Lesotho Population-based HIV Impact Assessment 2020 (LePHIA 2020): Final Report. Maseru: Lesotho Ministry of Health (MOH); 2022.
8. Trickey A, Sabin CA, Burkholder G, Crane H, d'Arminio Monforte A, Egger M, et al. Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: a collaborative analysis of cohort studies. Lancet HIV. 2023;10(5):e295-e307.
9. McMillan JM, Krentz H, Gill MJ, Hogan DB. Managing HIV infection in patients older than 50 years. Cmaj. 2018;190(42):E1253-e8.
10. Saylor D, Dickens AM, Sacktor N, Haughey N, Slusher B, Pletnikov M, et al. HIV-associated neurocognitive disorder--pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48.
11. Shah ASV, Stelzle D, Lee KK, Beck EJ, Alam S, Clifford S, et al. Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis. Circulation. 2018;138(11):1100-12.
12. Konstantinidis I, Crothers K, Kunisaki KM, Drummond MB, Benfield T, Zar HJ, et al. HIV-associated lung disease. Nat Rev Dis Primers. 2023;9(1):39.
13. Abdu Z, Dule A, Habib S. The Frequency and Predictors of Sexual Dysfunction Among People Living with HIV/AIDS. HIV AIDS (Auckl). 2023;15:729-37.
14. Ezechi OC, Akinsolu FT, Gbajabiamila TA, Idigbe IE, Ezeobi PM, Musa AZ, et al. Sexual dysfunction among Nigerian women living with HIV infection. PLoS One. 2024;19(4):e0292294.
15. Mwangala PN, Nasambu C, Wagner RG, Newton CR, Abubakar A. Prevalence and Factors Associated With Frailty Among Older Adults Living With HIV Compared to Their Uninfected Peers From the Kenyan Coast. Int J Public Health. 2024;69:1606284.
16. King EM, Prior JC, Pick N, van Schalkwyk J, Kestler M, Tkachuk S, et al. Menopausal hormone therapy for women living with HIV. Lancet HIV. 2021;8(9):e591-e8.
17. Rodés B, Cadiñanos J, Esteban-Cantos A, Rodríguez-Centeno J, Arribas JR. Ageing with HIV: Challenges and biomarkers. EBioMedicine. 2022;77:103896.
18. Raffe S, Sabin C, Gilleece Y. Comorbidities in women living with HIV: A systematic review. HIV Med. 2022;23(4):331-61.
19. Montano M, Oursler KK, Xu K, Sun YV, Marconi VC. Biological ageing with HIV infection: evaluating the geroscience hypothesis. Lancet Healthy Longev. 2022;3(3):e194-e205.
20. Crenshaw K. Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color. Stanford Law Review. 1991;43(6):1241-99.