Journal of Cross-Cultural Gerontology

, Volume 28, Issue 4, pp 491–493 | Cite as

Inequality in Health Status Among Older Adults in Africa: The Surprising Impact of Anti-Retroviral Treatment

  • Joel NeginEmail author
  • Makandwe Nyirenda
  • Janet Seeley
  • Portia Mutevedzi

It is well known that the large-scale roll-out of antiretroviral therapy (ART) has reduced mortality and improved the health status of millions of people living with HIV (PLWH) in resource-limited settings (UNAIDS 2011). Although most common prevalence and epidemiological measures neglect measuring older people in these settings, estimates reveal that there are at least 3 million PLWH aged 50 years and above in sub-Saharan Africa (Hontelez et al. 2012; Negin and Cumming 2010). Though not specifically targeted by most treatment programs, increasing numbers of older adults in Africa have accessed ART services.

There has been an ongoing debate in the literature about how the large scale roll-out of HIV services in Africa has affected wider health systems (Biesma et al. 2009; Brugha et al. 2010). Yet, to date, none of this literature examines the impact on older adults in particular. Studies from South Africa and Uganda reveal that the huge investments in strengthening HIV services and...


Mental Health Challenge Visit Health Facility High Level Care Ugandan Study Composite Health Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare that no competing interests exist. The Wellbeing of Older Peoples Studies (WOPS) cited in this paper were funded by The World Health Organisation’s (WHO) Study on Global Ageing and Adult Health (SAGE) via support from the US National Institute on Aging’s Division of Behavioural and Social Research and the US National Institute of Health (NIH). The Africa Centre for Health and Population Studies is funded by the Welcome Trust, UK. The qualitative research in Uganda was funded by Cordaid and the Medical Research Council (UK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


  1. Bendavid, E., Ford, N., & Mills, E. J. (2012). HIV and Africa’s elderly: the problems and possibilities. AIDS, 26(Suppl 1), S85–S91.CrossRefGoogle Scholar
  2. Biesma, R. G., Brugha, R., Harmer, A., Walsh, A., Spicer, N., & Walt, G. (2009). The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control. Health Policy and Planning, 24, 239–252.CrossRefGoogle Scholar
  3. Brugha, R., Simbaya, J., Walsh, A., Dicker, P., & Ndubani, P. (2010). How HIV/AIDS scale-up has impacted on non- HIV priority services in Zambia. BMC Public Health, 10, 540.CrossRefGoogle Scholar
  4. Hogerzeil, H. V., Liberman, J., Wirtz, V. J., Kishore, S. P., Selvaraj, S., Kiddell-Monroe, R., et al. (2013). Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration. Lancet, 381, 680–689.CrossRefGoogle Scholar
  5. Hontelez, J. A., de Vlas, S. J., Baltussen, R., Newell, M. L., Bakker, R., Tanser, F., et al. (2012). The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS, 26(Suppl 1), S19–S30.CrossRefGoogle Scholar
  6. Kikafunda, J. K., & Lukwago, F. B. (2005). Nutritional status and functional ability of the elderly aged 60–90 years in the Mpigi district of central Uganda. Nutrition, 21, 59–66.CrossRefGoogle Scholar
  7. Kimokoti, R. W., & Hamer, D. H. (2008). Nutrition, health, and aging in sub-Saharan Africa. Nutrition Reviews, 66, 611–623.CrossRefGoogle Scholar
  8. Kuteesa, M. O., Seeley, J., Cumming, R. G., & Negin, J. (2012). Determining the healthcare needs of older people living with HIV and AIDS in Uganda. African Journal of AIDS Research, 11, 295–305.CrossRefGoogle Scholar
  9. Mills, E. J., & Ford, N. (2012). Political lessons from the global HIV/AIDS response to inform a rapid noncommunicable disease response. AIDS, 26, 1171–1173.CrossRefGoogle Scholar
  10. Negin, J., & Cumming, R. G. (2010). HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bulletin of the World Health Organization, 88, 847–853.CrossRefGoogle Scholar
  11. Nyirenda, M., Chatterji, S., Falkingham, J., Mutevedzi, P., Hosegood, V., Evandrou, M., et al. (2012). An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa. BMC Public Health, 12, 259.CrossRefGoogle Scholar
  12. Rabkin, M., & El-Sadr, W. M. (2011). Why reinvent the wheel? Leveraging the lessons of HIV scale-up to confront non-communicable diseases. Global Public Health, 6, 247–256.CrossRefGoogle Scholar
  13. Scholten, F., Mugisha, J., Seeley, J., Kinyanda, E., Nakubukwa, S., Kowal, P., et al. (2011). Health and functional status among older people with HIV/AIDS in Uganda. BMC Public Health, 11, 886.CrossRefGoogle Scholar
  14. UNAIDS. (2011). World AIDS day report 2011. How to get to zero: Faster. Smarter. Better. Geneva: UNAIDS.Google Scholar
  15. Wright, S., Zalwango, F., Seeley, J., Mugisha, J., & Scholten, F. (2012). Despondency among HIV-positive older men and women in Uganda. Journal of Cross-Cultural Gerontology, 27, 319–333.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Joel Negin
    • 1
    Email author
  • Makandwe Nyirenda
    • 2
    • 3
  • Janet Seeley
    • 4
    • 5
  • Portia Mutevedzi
    • 2
  1. 1.Sydney School of Public HealthUniversity of SydneySydneyAustralia
  2. 2.Africa Centre for Health and Population StudiesUniversity of KwaZulu-NatalMtubatubaSouth Africa
  3. 3.School of Social SciencesUniversity of SouthamptonSouthamptonUK
  4. 4.MRC/UVRI Uganda Research Unit on AIDSEntebbeUganda
  5. 5.School of International DevelopmentUniversity of East AngliaNorwichUK

Personalised recommendations