For nearly a decade now, the UNAIDS agency has been reporting a growing trend in people over 50 years old aging with Human Immunodeficiency Virus/ Acquired immunodeficiency syndrome (HIV/AIDS).
It is estimated that 4.2 million people living with HIV globally are over the age of 50. The increased life expectancy has been attributed to the effectiveness of medical treatment as studies advance.
However, in Antigua and Barbuda the agency responsible for monitoring this trend is noticing a slightly different outcome in its graying problem.
While most new cases occur amongst young people, people over 60 are getting HIV at increasing rates.
Statistics from the National AIDS Programme suggests that people inching towards retirement age are amongst the highest groups newly infected with the virus.
Delcora Williams, AIDS Programme Manager in the Ministry of Health, Wellness and the Environment said the increase in the 60+ population is causing some concern, particularly as they are more susceptible to contracting various Non-Communicable Diseases (NCDs).
“We noticed that trend in 2015 or 2013 and so for that year we started having some awareness with the older persons; going to the unions and all those things because we noticed that change,” she said.
She said the data also suggests the likelihood that older individuals are having sex with much younger people.
“That tells you that they are having inter-generational sex,” she posited.
The latest figures were recorded over a period of three years from 2018 to 2021 and is based on compiled and approved statistics by the AIDS Secretariat.
For that period, approximately 41% of all new HIV infections, occurred in people over the age of 60, representing about 66 of the total 160 detected cases.
Women represented a slightly higher detection rate than men. A total of 9,532 people were tested for the virus during that period.
HIV cases are highest in three age ranges: 24 to 29 years old; 35 to 39 years old; and 40 to 44 years old. But the aging population has become the fourth group to display high rates of the virus in Antigua and Barbuda.
In 2021, people over the age of 60 accounted for approximately 15 of the 53 newly diagnosed HIV cases.
Why is HIV in the older population a concern
The threats and implications of HIV infection for older people differ slightly as they would for younger age groups, since the body’s ability to fight of viruses and diseases weaken with age.
This makes an older person more likely to become sick and because older people are less likely than younger people to get tested, they may not know they have HIV.
They may mistake the signs of HIV/AIDS for growing pains. Older adults are also likely coping with other diseases that can mask the signs of HIV/AIDS.
Without testing and knowledge of their status, they can unknowingly spread the virus to others.
A weakened immune system would also increase their risk of developing Non-Communicable Diseases (NCDs) like diabetes and hypertension and may lead to an earlier death.
Chronic NCDs are the leading cause of death in the Caribbean and are linked to more than 70% per cent of deaths in the region, according to the Pan American Health Organisation (PAHO).
HIV Cases Increase due to More Testing
Since 1984, the AIDS Secretariat has recorded 1,295 HIV cases.
After continuous database reviews and updates, it is estimated that in 2021, 707 of those people are currently living with the virus while 588 people have died with the virus.
“When it initially started in 1984, we didn’t know much about it, we didn’t have care and treatment. Then eventually it started and you had to take a whole tablespoon of drugs but now it’s so improved that it’s down to one tablet a day,” Ms. Williams recalled.
The numbers are however fluid, since there is no systematic way for the secretariat to know if someone with HIV/AIDS has migrated or has died abroad.
The absence of unique identification also causes duplication of test results.
Ms. Williams said, the agency has to continuously vet the list since one patient can get tested at several healthcare facilities with different code numbers each time.
“So, us, Mount St Johns [Sir Lester Bird medical Centre] and clinics, we use the same code but some private doctors and some labs use their own generated code,” she said.
“Last year we had a person test three times [at three different places] and their code appeared three times,” she recalled.
Instances like these can offset the data, causing it to represent more positive cases when there aren’t any: “Persons will see the numbers change, most of the time it goes down because of the duplication.”
The figures however only reflect the number of people who have been identified by presenting themselves for testing. There are likely other people living with the virus who have not come forward to test.
Overall, males have been identified as the gender most affected by HIV/AIDS. From 1985 to 2021, the percentage of HIV cases in men were at 53% (687 males) as opposed to women at 47% (608 females).
“Initially when the pandemic started it was gay men that we saw testing positive for HIV or dying from HIV syndrome [AIDS] but because we have bisexual males, then the disease started entering the female population and then with our women getting pregnant, now it started entering into the babies,” Ms. Williams explained.
Throughout the secretariat’s existence, it has identified 17 babies born with HIV in Antigua and Barbuda. Some have died while others have had the opportunity to access antiretroviral therapy provided free of cost through the Medical Benefits Scheme (MBS).
Despite the disease being more pronounced in males in the beginning, more women are now testing positive for the virus.
Ms. Williams believes that is because the women are coming forward to test more frequently, particularly when they become pregnant or are at the age of becoming pregnant.
The age range 24 to 29 is when most women get pregnant, she noted.
She explained that “Somebody who gets pregnant has to get tested for HIV, syphilis plus your other wellness needs like sickle cell anemia to ensure that you have a healthy pregnancy.”
“And so, you will find in certain age groups the female will out-strip the man,” Ms. Williams added.
Access to Treatment & Counselling is Free
The cost of theantiretroviral to treat the HIV virus is subsidized by the government of Antigua and Barbuda through MBS, yet Ms. Williams said there are still about 215 patients who have been diagnosed with the virus but do not seek care offered by the state.
She said this could be due to denial of initial positive results.
“They might decide that they’re not going into care 2,3,4,5,6 years until they start to get sick … all this time they can transmit the virus,” she noted.
Ms. Williams is encouraging those affected to seek treatment that can allow them to live healthy lives.
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