{"id":557,"date":"2025-05-12T14:01:34","date_gmt":"2025-05-12T14:01:34","guid":{"rendered":"http:\/\/www.vecimasupport.com\/?p=557"},"modified":"2025-05-13T00:22:08","modified_gmt":"2025-05-13T00:22:08","slug":"the-proportion-of-people-50-with-hiv-has-doubled-in-10-years","status":"publish","type":"post","link":"http:\/\/www.vecimasupport.com\/index.php\/2025\/05\/12\/the-proportion-of-people-50-with-hiv-has-doubled-in-10-years\/","title":{"rendered":"The proportion of people 50+ with HIV has doubled in 10 years"},"content":{"rendered":"

The success of South Africa\u2019s HIV treatment programme \u2014 the largest in the world<\/a> \u2014 has also created a slumbering threat: a considerably larger group of people who need to be treated for age-related illnesses such as diabetes, heart conditions and high blood pressure \u2014 also called noncommunicable diseases \u2014 on top of having to receive HIV care. <\/p>\n

Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa \u2014 public sector treatment started in 2004<\/a> and in 2025 we\u2019ve got around 6 million people on ARVs<\/a> \u2014 means that most people with HIV and who take ARVs correctly now live just as long<\/a> as those without the virus.   <\/p>\n

Bhekisisa<\/em>\u2019s data analysis shows the proportion of older people with HIV doubled over the past decade: people over 50 are now the second biggest HIV-positive group in South Africa today; 15 years ago, they were the smallest group.<\/p>\n

If this trend carries on, there could be three times as many HIV-positive people over 50 by 2030 as in 2015.<\/p>\n

As people age, their chance for developing health problems like high blood pressure, heart disease and diabetes rises \u2014 which means that people with HIV might live long lives, but not necessarily healthy ones.<\/p>\n

With nearly two-thirds<\/a> of all people with HIV living in sub-Saharan Africa, the continent will keep on bearing the brunt of the epidemic \u2014 despite massive gains in curbing new infections<\/a> over the past 15 years \u2014 if health systems aren\u2019t geared to handle the growing number of people who have both HIV and a chronic illness like heart disease or diabetes.<\/p>\n

Experts have raised the alarm about this \u201cinevitable price of success\u201d<\/a> more than a decade ago. Yet, write the authors of an editorial in a March issue<\/a> of The Lancet Healthy Longevity<\/em>, without thorough data on older people with HIV in African countries, putting plans for their healthcare in place will be hard \u2014 or not be done at all. <\/p>\n

And with many countries\u2019 governments, including South Africa\u2019s<\/a>, scrambling to find the money to replace the thousands of data capturers for HIV programmes previously funded by the US government after the abrupt halt in aid, funds for tracking health conditions of older people with HIV will probably be a low priority<\/a>. <\/p>\n

In the wake of funding cuts, employing health workers to capture and manage health data will be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute<\/a>, during a webinar<\/a> hosted by Bhekisisa <\/em>and the Southern African HIV Clinicians Society on Thursday \u2014 something that, for a public health issue that might be ignored because its fallout isn\u2019t immediately visible \u2014 could make the problem so much worse. <\/p>\n

What then, does South Africa\u2019s picture look like and could policymakers focus forward to stave off a calamity in the making? <\/p>\n

Here\u2019s what the numbers show.<\/p>\n

The proportion of people with HIV and who are 50 or older is growing \u2014 and faster than increases in other age groups.<\/p>\n

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In 2015, the count in the 50+ age group was just over 700 000, which translates to about 12% of the total HIV-positive population. The age group 40 to 49 years, though, was about 1.3 million strong, which works out to 22% of the total. <\/p>\n

A decade later, the 50-plussers\u2019 total had jumped by 1.15 million to reach 1.85 million and they now make up roughly 24% of the total number of HIV-positive South Africans. <\/p>\n

Although the 40 to 49 group\u2019s total also grew by 1.15 million, proportionally they now make up 32% of everyone. <\/p>\n

In other words, the proportion of older people with HIV doubled in a decade, but the proportion of people 10 years younger grew only 1.5 times bigger \u2014 a result, experts say<\/a>, of people with HIV living longer, new infections<\/a> still happening<\/a> in older people and fewer new cases<\/a> in the younger group. If this trend carries on, there could be three times as many HIV-positive people over 50 by 2030 as in 2015. <\/p>\n

Speeding up, changing ranks<\/strong><\/p>\n

People over 50 are the second biggest HIV-positive group in South Africa today. Fifteen years ago, they were the smallest group.<\/p>\n

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Around 2012, the 50-plussers moved up one rank, surpassing growth in the under-20s group. But the number of HIV-positive people between 35 and 49 grew rapidly \u2014 so much so that by around 2012 they overtook the group aged 20 to 34 and assumed top rank. <\/p>\n

In the following years, the 50+ group increased too: people moved out of their late forties and new infections in that age group continued. By 2026 \u2014 about 10 years since their previous rank jump \u2014 people over 50 will already have been the second biggest group of the HIV-positive population for some time. <\/p>\n

The 35 to 49-years group will keep on growing in the next five years, modelled data shows<\/a>, albeit more slowly than before. Because people are living longer, the older group will grow too as people move into their fifties, and because it\u2019s been expanding for some time already, the group will edge closer and closer to top rank over the coming years. <\/p>\n

Living long but not necessarily healthy<\/strong><\/p>\n

This is where the warning lies. <\/p>\n

Data from 2020<\/a> shows that, when Covid-19 is ignored, one in seven deaths in people between 45 and 64 years old were due to health problems like heart attacks, stroke and high blood pressure that year. In comparison, only one in 20 deaths in that age group were linked directly to HIV.<\/p>\n

Above age 65, a quarter of deaths were from these conditions. So few were linked to HIV in this age group that, proportionally, it was hardly a noticeable concern.<\/p>\n

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So, as the peak of the HIV-infected population shifts into an older age band, more and more people will probably have to be treated for noncommunicable diseases like heart conditions, diabetes, being overweight and high blood pressure \u2014 on top of receiving HIV care. <\/p>\n

In fact, in a large study in Mpumalanga<\/a>, in which most people were in their late 40s to early 70s, about half had at least two age-related illnesses. <\/p>\n

For example, in this sample of just over 5 000 people, six in 10 had high blood pressure, with it being more likely the older someone is. About 10% of women had bad chest pain, called angina<\/a> (which happens when the heart doesn\u2019t get enough oxygen-rich blood) and up to 11% of people had high cholesterol.<\/p>\n

High blood pressure combined with high cholesterol is bad for your heart. It can damage your arteries<\/a>, and especially those that supply oxygen-rich blood to the heart. In turn, this ups the chance of fatty plaques building up along the walls of the blood vessels. This narrows and stiffens the arteries, meaning blood pressure builds up even more and the chance of a blood vessel rupturing increases. <\/p>\n

High blood pressure can lead to angina or a heart attack because the heart muscle gets too little oxygen and also cause a suite of other health problems called metabolic syndrome<\/a>, which includes conditions like diabetes, stroke and heart disease.<\/p>\n

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Age-related health problems like heart disease, diabetes and being overweight are often linked to inflammation<\/a>. This is a natural response of the immune system when tissues are damaged, like when we get older<\/a>.<\/p>\n

However, inflammation is even more common with HIV-infection<\/a> \u2014 because of<\/a> the body\u2019s immune response, damage caused by the virus itself and also the effects of ARV treatment \u2014 and studies have shown that people with HIV who are older than 50 have double the chance<\/a> of having conditions like diabetes or high blood pressure too than what is seen in younger HIV-positive people.<\/p>\n

\u201cIn future, every clinic nurse will have to be Nimart trained,\u201d said Ndiviwe Mphothulo, president of the Southern African HIV Clinicians Society at last week\u2019s webinar<\/a>.<\/p>\n

Nimart nurses \u2014 short for Nurse-Initiated Management of Antiretroviral Treatment \u2014 are specially trained in how to prescribe ARVs and how to manage long-term patients<\/a>. <\/p>\n

But, experts say, the flip side is also true if South Africa is to deal with the ageing HIV epidemic \u2014 every Nimart nurse will have to be equipped to deal with noncommunicable diseases in this population too.<\/p>\n

This story was produced by the<\/em> Bhekisisa Centre for Health Journalism<\/em><\/a>. Sign up for the<\/em> newsletter<\/em><\/a>.<\/em><\/p>\n

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