Supporting an ageing HIV-positive population

OZIEL MDLETSHE

Ageing with HIV is an experience that many people never imagined when they were first diagnosed. Especially those diagnosed in the 80s or 90s could scarcely envision a future decade down the line, let alone the complexities that would come with it.

Today, we stand in a unique place where living with HIV into older age is possible, thanks to medical advancements like antiretroviral therapy (ART). Yet, even as life expectancy increases, our healthcare system is struggling to catch up with the unique needs of ageing individuals living with HIV.

The reality of ageing means that the human body becomes vulnerable to a range of health conditions. But for those living with HIV, this natural ageing process carries added complications. On top of managing HIV, individuals often face other chronic conditions like diabetes, hypertension, cancer, and depression.

This is compounded by the psychological weight of dealing with a lifetime of stigma, often resulting in isolation. The question we must ask is this, where is the tailored support for people ageing with HIV? And where in our healthcare facilities is a safe, comforting space to process these multiple layers of health and life complexity?

In South Africa, the current HIV response framework is largely focused on prevention, treatment, and care aimed at younger populations or high-risk groups. Yet people over 50 living with HIV do not receive special recognition as a “key population,” despite having specific medical and social needs. This oversight means that many of their challenges go unaddressed.

As these individuals navigate complex health conditions, they lack a comprehensive support system that would help them understand and manage their health in the context of HIV and ageing. For many, the experience of ageing with HIV is a lonely one, with healthcare facilities often lacking resources or support networks tailored to their needs.

Consider, for instance, an older individual who has managed HIV for decades but now faces other health concerns like prostate issues or cancer. These chronic conditions can make everyday life overwhelming, even demoralising.

Elderly individuals often feel like they have nowhere to turn within the health system, and the daily stress of managing multiple health issues can make them feel like a burden to those around them. When symptoms are numerous and diverse, it can be difficult to explain them to family members or even healthcare providers without feeling like a burden. The social and psychological toll of this experience is tremendous and is frequently overlooked in our broader public health response.

Stigma, too, remains a silent force that can intensify with age. Many ageing individuals have kept their HIV status private for decades, fearing discrimination and judgment, particularly from younger generations who may carry outdated beliefs about HIV.

Disclosure remains a challenge, especially as one gets older, because the stigma associated with HIV has not disappeared, and the courage to confront it may diminish over time. This silence can easily lead to mental health struggles, from anxiety to depression, which compound the physical health issues already faced by older individuals living with HIV.

The dilemma of ageing with HIV calls for a holistic response. Antiretroviral treatment (ART) has been a great success, allowing people to live long, fulfilling lives. But ART alone is not a solution for those facing the additional burdens that come with age. The healthcare sector should evolve to provide specialised care for this unique group.

This would involve not only targeted medical interventions but also creating environments that encourage acceptance and support. Imagine if our healthcare facilities included “comfort rooms” where elderly individuals could access mental health support, connect with others facing similar challenges, and receive guidance on managing multiple health conditions alongside HIV.

People ageing with HIV today need a comprehensive, empathetic approach that acknowledges their lived experiences, honours their resilience, and supports their unique health needs. The need for such an approach is urgent. Many of these individuals are heads of families, pillars of communities, and, in many ways, custodians of South Africa’s HIV journey. They deserve to age with dignity, free from stigma, and with a support system that affirms their contributions to society.

As a community of people living with HIV, we must come together and advocate for these changes. Just as we fought in the 1990s for universal access to ART, we must now fight for the right to age with dignity and appropriate support. This advocacy is essential not only for those who are currently ageing but also for future generations. After all, managing HIV is no longer just about surviving today, it’s about building a future where people can live fully at every age, with every part of their health addressed and supported.

It’s time to shift the narrative and remind ourselves and our society that ageing with HIV is not an isolated experience. It’s a journey of resilience that deserves recognition, respect, and the comprehensive care it has long been denied. Let’s make this vision a reality for our elder community members living with HIV—they deserve nothing less.

Oziel Mdletshe is an HIV and Human Rights activist.

The views expressed here are not necessarily those of Independent Media or IOL.

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