When Sibongile Tshabalala was diagnosed with HIV in 2000, the focus was on survival due to then-president Thabo Mbeki's Aids denialism and the administration's refusal to provide life-saving treatment. Today, thanks to wide-scale provision of free treatment, South Africa has a large and steadily growing HIV population living into middle age and beyond. By 2040, more than half the people living with HIV in South Africa will be at least 50 years old, up from just 30% in 2025.
As people with HIV age, they face increased risks of chronic conditions such as diabetes, hypertension, and cardiovascular disease. These risks are heightened due to the chronic inflammation and immune system dysregulation caused by the virus, even if they are on effective treatment. HIV speeds up the metabolic clock, making it a double whammy for those living with the disease. Conditions such as diabetes and strokes manifest at a younger age in people living with HIV.
Cancers are not only diagnosed earlier but are also often more aggressive and harder to treat in people living with HIV. Women, who bear the brunt of South Africa's HIV/Aids epidemic, are especially vulnerable to the human papilloma virus (HPV), which causes cervical cancer and genital warts. HIV reduces their immune system's ability to clear HPV, making them at higher risk of persistent infection and faster onset of cervical cancer.
Estimates of the scale of the risk vary, but research published in The Lancet found HIV increased the likelihood of cervical cancer sixfold. A South African study found those living with HIV had triple the risk of developing cervical cancer compared to women without HIV. Cervical cancer was flagged by the World Health Organisation as the leading cause of cancer deaths among women in South Africa.
However, access to screening services hinges on socioeconomic status. Government guidelines say women living with HIV should be offered cervical cancer screening when they are diagnosed and every three years after that. But provision in the overcrowded public health service is patchy, and many women still get diagnosed only when the disease is advanced and harder to treat.
The Treatment Action Campaign (TAC) is campaigning for health minister Aaron Motsoaledi to make good on his promise to supply stable HIV patients with six months' worth of antiretroviral medicines at a time. This would not only make it easier for people to maintain their treatment but also reduce congestion in crowded facilities and lessen the load on overwhelmed nurses.
South Africa has only a handful of geriatricians who specialise in the needs of older adults, and the country faces a shortage of specialists to care for the incoming "silver tsunami" of ageing HIV patients. New clinical guidelines propose task-shifting care for older adults with HIV from specialists to GPs and nurses. The guidelines recognise that the challenge has gone beyond helping people survive HIV to ensuring they age well, maintaining their physical health, mental wellbeing, independence, and overall quality of life.
Key points
- By 2040, more than half the people living with HIV in South Africa will be at least 50 years old.
- HIV speeds up the metabolic clock, making those living with the disease at higher risk of chronic conditions.
- Access to screening services for cervical cancer hinges on socioeconomic status, with many women getting diagnosed only when the disease is advanced.
