Latest news with #ARVs
Daily Maverick
2 days ago
- Health
- Daily Maverick
Trump's HIV funding cuts will also exacerbate diabetes, cervical cancer and depression
The impact of the Trump administration slashing of more than half of South Africa's HIV and TB projects funded by the US government, transcends reduced access to HIV testing and HIV prevention and treatment drugs. Treatment for diabetes, high blood pressure, cervical cancer, depression and anxiety will become harder to come by too. The impact of US President Donald Trump's administration slashing more than half of South Africa's HIV and TB projects, transcends reduced access to HIV testing and HIV prevention and treatment drugs: treatment for noncommunicable diseases (NCDs) will become harder to come by too. As government clinics take on HIV patients who were previously treated by the President's Emergency Plan sor Aids Relief-funded projects, the treatment of diseases like diabetes and heart disease — for all people — will come under pressure. And mental health issues such as depression and anxiety — also noncommunicable illnesses — will most likely become more common among people with HIV, because many now face extra stress, such as having to travel further to clinics for treatment, and groups like sex workers increasingly face discrimination at government clinics. At a Bhekisisa and Southern African HIV Clinicians Society webinar in May, the health advocacy organisation Treatment Action Campaign (TAC) and the sex worker movement Sisonke, for example, reported cases where sex workers — who used to get their treatment from US government-funded clinics where health workers were trained to address their reproductive health needs — have recently been turned away from state clinics or were denied condoms. In 2020, noncommunicable diseases were the cause of more than half of all deaths in South Africa. But, compared to HIV, funding for noncommunicable diseases has traditionally been scarce. We look at five ways in which HIV funding cuts could affect noncommunicable diseases. Fewer data capturers means fewer people to keep track of NCDs Today, people over 50 make up the second-largest group of South Africa's HIV-positive population, Bhekisisa's data team has found. Twenty years ago, they were the smallest proportion. As people age, their chances of developing health problems like high blood pressure, heart disease and diabetes rise, which means more and more people will have to be treated for these conditions — on top of getting HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment started in 2004 and in 2025 we've got about six million people on ARVs — means that most people with HIV and who take ARVs correctly now live just as long as those without the virus. 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, overweight and high blood pressure — on top of receiving HIV care. Studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure than younger HIV-positive people. But without tracking the numbers — which will be challenging with the loss of thousands of US government-funded data capturers in the wake of foreign aid cuts — putting plans in place to care for an ageing HIV population will be hard. And with many countries' governments, including South Africa's, 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 the health conditions of older people with HIV will probably be a low priority. Employing health workers to capture and manage health data would be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute, during the Bhekisisa and the Southern African HIV Clinicians Society webinar — something that, for a public health issue that might be ignored because its fallout wasn't immediately visible — could just make the problem so much worse. Fewer people on ARVs leads to more people with diabetes When people with HIV are not on treatment, or if they don't use their ARVs correctly, the virus gets a chance to make copies of itself in their bodies and attack their immune systems. That's when their immune systems get weak, and some then fall ill with diseases that scientists call opportunistic infections. The most common opportunistic infection for people with untreated HIV is tuberculosis (TB). And that's where the catch for one of the world's fastest-rising noncommunicable diseases, diabetes, lies: there's a link between TB and diabetes. Diabetes — a condition in which someone has too much sugar in their blood because their body doesn't get or respond to the signal from the hormone insulin to absorb glucose — kills more people in South Africa than any other disease. In 2020, it claimed 32,100 lives — about 40% of them before they turned 65. The condition is one of four noncommunicable diseases World Health Organization (WHO) member countries agreed to tackle. The goal is to lower deaths by 25% by the end of this year. But South Africa is far off track and that goal will now be even harder to achieve. TB changes how someone's body reacts to insulin. That's why some people with TB — who have never been diagnosed with diabetes — are found to have lots of sugar in their blood. In some cases, this is temporary and normalises after TB treatment. But the germ still increases the odds of developing diabetes later on. In fact, among people who have high sugar levels in their blood when getting diagnosed for TB, studies show that between 8% and 87% are eventually diagnosed with diabetes. But, the opposite is also true: people with diabetes have a higher chance of falling ill with TB. So, in short: when there's less money to help people with HIV get diagnosed or to make it easy for diagnosed people to get on to treatment, and stick to it, more people get TB. And when more people have TB, diabetes becomes more common, because some people with TB are more likely to get diabetes. At the same time, people with diabetes who get TB, have a higher chance of falling very ill with TB, because diabetes makes their immune systems even weaker. Fewer women on ARVs means more with cervical cancer Last week, the Clinical HIV Research Unit at Wits University in Johannesburg shut its cervical cancer screening and prevention clinic at Helen Joseph Hospital, one of the biggest units in the country, following the termination of US funding. 'This closure will significantly impact cervical cancer prevention efforts in South Africa, which faces one of the highest rates of cervical cancer in the world,' the unit said in a press release. Cervical cancer is the second most common cancer among South African women, after breast cancer, but it's the leading cause of cancer-related deaths — even though it's preventable through vaccination and regular screenings such as pap smears and testing for the human papillomavirus (HPV), which causes most cervical cancer cases. 'With timely screening and early detection being key to preventing cervical cancer, the closure of this screening unit at Helen Joseph Hospital leaves a major gap in services and will further strain the health service,' the unit's communication department said. Women with untreated HIV infection are much more likely to develop cervical cancer after being infected with cancerous forms of the HPV virus, because their immune systems are too weak to clear the virus without treatment. Cervical cancer is the most common cancer among black South African women, who are also the group with the highest HIV infection rate in the country. About a quarter of people with HIV in South Africa are not on antiretroviral treatment. USAid programmes that have now been discontinued helped to find them by sending community health workers into communities to test people for HIV and find people who had already been diagnosed with HIV, but fell off treatment. The ending of USAid programmes has resulted in fewer HIV testing and treatment services, which in turn affects how many women become vulnerable to developing cervical cancer. Depression and anxiety will become more common Mental health conditions are also noncommunicable diseases. If more people with HIV are left without treatment as a result of US government funding cuts, mental health conditions like depression and anxiety will likely become more common. Why? Because Pepfar funded counsellors who would find people with HIV and get them on treatment immediately after they were tested. Without ART, some people develop HIV encephalopathy, a condition that damages brain tissue through inflammation from the virus. Encephalopathy raises the chances of depression or anxiety because it harms the areas of the brain that control movement, emotions and memory. People with HIV already face stigma that causes stress and anxiety that can lead to depression. 'There's still the shame, stigma and moral issues that come with HIV,' says Francois Venter, an HIV doctor and the director of Ezintsha at the University of the Witwatersrand. Depression makes it harder for people to stick to their treatment. Studies show that people with HIV and depression are more likely to stop taking their medication — weakening their bodies and raising the chances of them dying from opportunistic infections. Fewer nurses means noncommunicable diseases fall through the cracks Noncommunicable diseases are underdiagnosed in South Africa, experts say. 'If we went into the community aggressively looking for high sugar and blood pressure, we would do such a better job,' says Venter. 'Instead, we sit back and wait([until people turn up at clinics), which is why we do so badly with diabetes and hypertension.' Even at clinics, people are rarely tested, mostly because there are too few nurses at our clinics. On top of noncommunicable diseases, they also have to help treat HIV and gender-based violence, and see that pregnant women and newborn babies are healthy. And after February's US funding cuts, we have even fewer nurses. According to health department data, Pepfar funded 2,320 nurses, of which just over half (those programmes that received their funds through USAid) have now been laid off. Right now, the rest (programmes funded through the Centres for Disease Control and Prevention), only have jobs until the end of September. Pepfar also funded 2,705 lay counsellors, health department data shows. Without this staff who went into communities to screen people for HIV, TB and other diseases, patients now have to travel to clinics for help, which means more patients for nurses. And when nurses have more work, they have less time to treat each patient, which, says Venter, makes it even harder to pick up on noncommunicable diseases. 'Because of that, the actual interaction would take probably an hour and a half. When you've got a mile-long queue outside your door, you just don't have that time.' 'So they (nurses) go for the absolute basic stuff.' DM
Daily Maverick
15-05-2025
- Health
- Daily Maverick
South Africa's HIV treatment triumph faces new challenge — the rise of age-related illnesses
The success of South Africa's HIV treatment programme — the largest in the world — 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 — also called noncommunicable diseases — on top of having to receive HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment started in 2004 and in 2025 we've got about 6-million people on ARVs — means that most people with HIV and who take ARVs correctly now live just as long as those without the virus. 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 chances of developing health problems like high blood pressure, heart disease and diabetes rise, which means that people with HIV might live long lives, but not necessarily healthy ones. With nearly two-thirds of all people with HIV living in sub-Saharan Africa, the continent will keep on bearing the brunt of the epidemic — despite massive gains in curbing new infections over the past 15 years — if health systems aren't geared to handle a growing number of people who have both HIV and a chronic illness like heart disease or diabetes. Experts raised the alarm about this 'inevitable price of success' more than a decade ago. Yet, write the authors of an editorial in a March issue of 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 may not be done at all. And with many countries' governments, including South Africa's, 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. In the wake of funding cuts, employing health workers to capture and manage health data would be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute, during a webinar hosted by 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 just 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. Doubled in a decade 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 40-49 years, though, was about 1.3 million strong, which works out to 22% of the total. A decade later, the 50-plus 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 40-49 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, experts say, of people with HIV living longer, new infections still happening in older people and fewer new cases in the younger group. If this trend continues, there could be three times as many HIV-positive people over 50 by 2030 as in 2015. 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 20-34 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 35-49 years group will keep on growing in the next five years, modelled data shows, 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's been expanding for some time already, the group will edge closer and closer to top rank over the coming years. Living long, but not necessarily healthy This is where the warning lies. Data from 2020 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. 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, obesity and high blood pressure — on top of receiving HIV care. In fact, in a large study in Mpumalanga, in which most people were in their late 40s to early 70s, about half had at least two age-related illnesses. 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 was. About 10% of women had bad chest pain, called angina (which happens when the heart doesn't get enough oxygen-rich blood), and up to 11% of people had high cholesterol. High blood pressure combined with high cholesterol is bad for your heart. It can damage your arteries, and especially those that supply oxygen-rich blood to the heart. In turn, this ups the chances for 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. 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, which includes conditions like diabetes, stroke and heart disease. Age-related health problems like heart disease, diabetes and being overweight are often linked to inflammation. This is a natural response of the immune system when tissues are damaged, like when we get older. However, inflammation is even more common with HIV-infection — because of the body's immune response, damage caused by the virus itself and also the effects of ARV treatment — and studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure than what is seen in younger HIV-positive people. 'In future, every clinic nurse will have to be Nimart trained,' said Ndiviwe Mphothulo, the president of the Southern African HIV Clinicians Society at last week's webinar. Nimart nurses — short for Nurse-Initiated Management of Antiretroviral Treatment — are specially trained in how to prescribe ARVs and how to manage long-term patients. 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. DM
The Citizen
15-05-2025
- Health
- The Citizen
ARV defaulters urged to resume treatment
The KZN Department of Health is on a quest to find nearly 117 000 people on antiretrovirals (ARVs) and bring them back to treatment by the end of the year. Health MEC Nomagugu Simelane said the province has about 1.5 million people who are stable on ARVs, saying that the department is now on a mission to find thousands more who have stopped treatment for various reasons. Simelane explained that the province is participating in the newly-launched Close the Gap campaign, a collaboration between the National Department of Health and the South African National Aids Council. Speaking on the Department's KZN Health Chat multimedia programme last Friday, Simelane said the campaign aimed to reach 1.1 million people across the country who know their HIV status, but are not on treatment. The MEC said although more than 200 000 people in KZN are estimated to be lost to treatment, they have set a target of finding 117 616 of them by year-end and returning them to care. 'We are determined to bring people back on treatment. As we always say, no one should ever die just because they've stopped taking medication that can suppress HIV to the point of being undetectable. We know that some people stop taking their ARVs due to treatment fatigue, which we strongly discourage. In some ways, we are victims of our success as a province. People take their medication until they feel so well that they think they can stop,' she said. Simelane added that they only feel better because of the treatment. 'So, we urge everyone to stick to their treatment and for those who've stopped, to come back and re-enrol. If we don't, resistance can develop, making treatment less effective and putting our lives at risk,' she said. She also cautioned that excessive alcohol use can lead to defaulting on treatment. 'Being a teetotaler doesn't make you ibhari (a bumpkin) or unfashionable. There is nothing wrong with not drinking. But if you must drink, do so in moderation – especially if you are on ARVs. Drinking too much makes it harder to keep track of time, let alone remember to take your medication. We plead with our compatriots to take care and protect their health,' she said The MEC said while the department intensifies its Close the Gap efforts, anyone wishing to return to the ARV programme is encouraged to visit their local clinic and speak to a healthcare worker. HAVE YOUR SAY Like the South Coast Fever's Facebook page At Caxton, we employ humans to generate daily fresh news, not AI intervention. Happy reading!
News24
13-05-2025
- Health
- News24
Proportion of overs 50s with HIV doubled in 10 years. What does this mean for healthcare?
Today, people over 50 make up the second largest group of South Africa's HIV-positive population. Twenty years ago, they were the smallest proportion. As people age, their chance for developing health problems like high blood pressure, heart disease and diabetes rises, which means more and more people will have to be treated for these conditions - on top of getting HIV care. But without tracking the numbers - which will be challenging with the loss of thousands of US government-funded data capturers in the wake of foreign aid cuts - putting plans in place to care for an ageing HIV population will be hard. The success of South Africa's HIV treatment programme - the largest in the world - 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, - also called noncommunicable diseases - on top of having to receive HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa - public sector treatment started in 2004 and in 2025 we have around six million people on ARVs - means that most people with HIV and who take ARVs correctly now live just as long as those without the virus. READ | Fund research not Tesla trucks: The HIV casualties of Trump's war on science 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. If this trend continues, 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 nearly two-thirds of all people with HIV living in sub-Saharan Africa, the continent will keep on bearing the brunt of the epidemic - despite massive gains in curbing new infections over the past 15 years - if health systems are not geared to handle a growing number of people who have both HIV and a chronic illness like heart disease or diabetes. Experts have raised the alarm about this 'inevitable price of success' more than a decade ago already. Yet, write the authors of an editorial in a March issue of 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, including South Africa's, 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 likely be a low priority. In the wake of funding cuts, employing health workers to capture and manage health data would be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute, during a webinar hosted by Bhekisisa and the Southern African HIV Clinicians Society last Thursday - something that, for a public health issue that might be ignored because its fallout is not immediately visible - could just 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 is what the numbers show. Doubled in a decade The proportion of people with HIV and who are 50 or older is growing - and faster than increases in other age groups. About a quarter of South Africans with HIV are 50 or 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. READ | Fund research not Tesla trucks: The HIV casualties of Trump's war on science 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, experts said, of people with HIV living longer, new infections still happening in older people and fewer new cases 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. 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. Here is how SA's HIV population is 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. READ | The Global Fund will roll out the twice-yearly anti-HIV jab – with or without Pepfar The 35 to 49 year group will keep on growing in the next five years, modelled data shows, 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 has been expanding for some time already, the group will edge closer and closer to top rank over the coming years. Living long, but not necessarily healthy This is where the warning lies. Data from 2020 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. 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 likely have to be treated for noncommunicable diseases like heart conditions, diabetes, overweight and high blood pressure - on top of receiving HIV care. In fact, in a large study in Mpumalanga, in which most people were in their late forties to early seventies, about half had at least two age-related illnesses. 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 was. About 10% of women had bad chest pain, called angina (which happens when the heart does not get enough oxygen-rich blood) and up to 11% of people had high cholesterol. READ | Data rules: How numbers turned our HIV plans High blood pressure combined with high cholesterol is bad for your heart. It can damage your arteries, and especially those that supply oxygen-rich blood to the heart. In turn, this ups the chances for 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. 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, which includes conditions like diabetes, stroke and heart disease. Age-related health problems like heart disease, diabetes and overweight are often linked to inflammation. This is a natural response of the immune system when tissues are damaged, like when we get older. However, inflammation is even more common with HIV-infection - because of the body's immune response, damage caused by the virus itself and also the effects of ARV treatment - and studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure too than what is seen in younger HIV-positive people. 'In future, every clinic nurse will have to be Nimart trained,' said Ndiviwe Mphothulo, the president of the Southern African HIV Clinicians Society, at last week's webinar. Nimart nurses - short for Nurse-Initiated Management of Antiretroviral Treatment - are specially trained in how to prescribe ARVs and how to manage long-term patients. But, experts said, the flip side was also true if South Africa was to deal with the ageing HIV epidemic: every Nimart nurse would have to be equipped to deal with noncommunicable diseases in this population too. This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
TimesLIVE
13-05-2025
- Health
- TimesLIVE
The proportion of people of 50+ with HIV has doubled in 10 years. What does that mean for healthcare?
The success of South Africa's HIV treatment programme — the largest in the world — 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 — also called noncommunicable diseases — on top of having to receive HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment started in 2004 and in 2025 we've got around 6-million people on ARVs — means that most people with HIV and who take ARVs correctly now live just as long as those without the virus. 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 such as high blood pressure, heart disease and diabetes rises — which means that people with HIV might live long lives, but not necessarily healthy ones. With nearly two-thirds of all people with HIV living in Sub-Saharan Africa, the continent will keep on bearing the brunt of the epidemic — despite massive gains in curbing new infections over the past 15 years — if health systems aren't geared to handle a growing number of people who have both HIV and a chronic illness such as heart disease or diabetes. Experts raised the alarm about this 'inevitable price of success' more than a decade ago already. Yet, write the authors of an editorial in a March issue of 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, including South Africa's, 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 likely be a low priority. 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, during a webinar hosted by 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 just 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. Doubled in a decade 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 more than 700,000, which translates to about 12% of the total HIV-positive population. The age group 40—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. Though the 40—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, experts say, of people with HIV living longer, new infections still happening in older people and fewer new cases 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. 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—34 and assumed top rank. In the following years, the 50+ group increased too: people moved out of their late 40s 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—49-years group will keep on growing in the next five years, modelled data shows, albeit more slowly than before. Because people are living longer, the older group will grow too as people move into their 50s, and because it's been expanding for some time already, the group will edge closer and closer to top rank over the coming years. Living long, but not necessarily healthy This is where the warning lies. Data from 2020 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. 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. 1 in 7 people die of heart disease after age 45. Image: Thembisa Project So, as the peak of the HIV-infected population shifts into an older age band, more and more people will likely have to be treated for noncommunicable diseases such as heart conditions, diabetes, overweight and high blood pressure — on top of receiving HIV care. In fact, in a large study in Mpumalanga, in which most people were in their late 40s to early 70s, about half had at least two age-related illnesses. For example, in this sample of just more than 5,000 people, six in 10 had high blood pressure, with it being more likely the older someone was. About 10% of women had bad chest pain called angina (which happens when the heart doesn't get enough oxygen-rich blood) and up to 11% of people had high cholesterol. High blood pressure combined with high cholesterol is bad for your heart. It can damage your arteries, and especially those that supply oxygen-rich blood to the heart. In turn, this ups the chances for 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. 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, which includes conditions like diabetes, stroke and heart disease. Roughly 1.6-million people over 50 are on ARVs today. Image: Thembisa Project Age-related health problems such as heart disease, diabetes and being overweight are often linked to inflammation. This is a natural response of the immune system when tissues are damaged, like when we get older. However, inflammation is even more common with HIV-infection — because of the body's immune response, damage caused by the virus itself and also the effects of ARV treatment — and studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure too than what is seen in younger HIV-positive people. 'In future, every clinic nurse will have to be Nimart trained,' said Ndiviwe Mphothulo, president of the Southern African HIV Clinicians Society at last week's webinar. Nimart nurses — short for Nurse-Initiated Management of Antiretroviral Treatment — are specially trained in how to prescribe ARVs and how to manage long-term patients. This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
