The proportion of people 50+ with HIV has doubled in 10 years

Mail & Guardian

12-05-2025

As people age, their chance for developing health problems like high blood pressure, heart disease and diabetes rises — which means that people with HIV might live long lives, but not necessarily healthy ones. (File photo)
The success of South Africa's HIV treatment programme —
Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment
Bhekisisa
's 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.
If this trend carries on, there could be three times as many HIV-positive people over 50 by 2030 as in 2015.
As people age, their chance for developing health problems like high blood pressure, heart disease and diabetes rises — which means that people with HIV might live long lives, but not necessarily healthy ones.
With
Experts have raised the alarm about this
The Lancet Healthy Longevity
, without thorough data on older people with HIV in African countries, putting plans for their healthcare in place will be hard — or not be done at all.
And with many countries' governments,
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
Bhekisisa
and the Southern African HIV Clinicians Society on Thursday — something that, for a public health issue that might be ignored because its fallout isn't immediately visible — could make the problem so much worse.
What then, does South Africa's picture look like and could policymakers focus forward to stave off a calamity in the making?
Here's what the numbers show.
The proportion of people with HIV and who are 50 or older is growing — and faster than increases in other age groups.
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.
A decade later, the 50-plussers' 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.
Although the 40 to 49 group's total also grew by 1.15 million, proportionally they now make up 32% of everyone.
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 — a result,
Speeding up, changing ranks
People over 50 are the second biggest HIV-positive group in South Africa today. Fifteen years ago, they were the smallest group.
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 — so much so that by around 2012 they overtook the group aged 20 to 34 and assumed top rank.
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 — about 10 years since their previous rank jump — people over 50 will already have been the second biggest group of the HIV-positive population for some time.
The 35 to 49-years group will keep on growing in the next five years,
Living long but not necessarily healthy
This is where the warning lies.
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.
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 — on top of receiving HIV care.
In fact, in a
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
High blood pressure combined with high cholesterol is bad for your heart. It can
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
Age-related health problems like heart disease, diabetes and being overweight are often linked to
However, inflammation is even
'In future, every clinic nurse will have to be Nimart trained,' said Ndiviwe Mphothulo, president of the Southern African HIV Clinicians Society
Nimart nurses — short for Nurse-Initiated Management of Antiretroviral Treatment — are
But, experts say, the flip side is also true if South Africa is to deal with the ageing HIV epidemic — every Nimart nurse will have to be equipped to deal with noncommunicable diseases in this population too.
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