Old but not cold: older people also at risk

James Kioko*, 55, a manager at a 4-star hotel in the Kenyan capital, Nairobi, dismisses condoms as "dirty, fuelling prostitution and causing marriage break-ups".

"I don't want to know anything about them," he added, echoing the opinion of many Kenyans in the over-50 age bracket, who have not had the benefit of an AIDS information campaign specifically targeting them.

Although 1 in 14 HIV-positive people globally is over the age of 50, this age group has largely been left out of HIV programmes, and older people are generally considered to be at risk mainly in their role as caregivers of HIV-positive children and grandchildren.

"Older people's susceptibility to the disease, and the need for them to be included in HIV and AIDS strategies, is not forthcoming," said the charity, HelpAge International (HAI), in a statement on World AIDS Day 2006.

"Data on infection rates is only collected for country comparisons on women and men aged 15-49, so the spread of HIV among older age groups continues to go undetected and unreported."

UNAIDS recognised that a significant number of HIV-positive people were over the age of 50; in 2006 it began presenting its estimates for 'all adults over the age of 15', and not only those between the ages of 15 and 49.

Despite the fact that many people continue to be sexually active well past their fifties, myths and misinformation on HIV/AIDS persist among older people, who are unclear as to the methods of transmission, prevention and protection.

"HIV has no age limit so long as one is sexually active," HAI's regional programme manager, Amleset Tewodros, told IRIN/PlusNews. "It is a misconception that after 60 years or so, people are not active and therefore not prone to HIV. It is very hard to get the HIV prevalence among this group; health providers ordinarily do not push for their testing."

A recent report found that voluntary counselling and testing centres are not older-person-friendly. "Services are not easily accessible due to long distances and mobility problems hindering the aged from reaching the sites," said the 2007 Draft Report on Kenya's implementation of the African Union Policy and Plan of Action on Aging.

"Older people do not often get relevant and up-to-date information on HIV/AIDS; lack of adequate information means that older people are not able to provide suitable care, as well as protect and prevent themselves from getting infected," the report commented.

Older, but not out of commission

Dr Sobbie Mulindi, an HIV/AIDS strategic planner and consultant to the World Health Organisation, said men aged 50 years and older often had disposable income that they used to lure younger sexual partners, making them a bridge for spreading the virus among younger people.

"I have never seen a condom"

Pauline Okech, in her 50s, has never been tested for HIV, but her fears about whether she could be HIV-positive are justified. "I have a husband who loves women very much," she told IRIN/PlusNews. "He engages in sex with them regularly and gives no damn about my protests." "He has gone ahead to inherit four women after their husbands died," she said. "The last to be inherited died last year [and] the talk in the village is that the men and woman all died of the 'bad disease'". The 'bad disease' is AIDS. A mother of three children, she said that on top of his constant infidelity, her husband subjected her to regular beatings that eventually forced her to escape from Kenya's western province of Nyanza to her current home in Nairobi's sprawling Korogocho slum. Okech, who never went to school, said she never resisted sex with her husband; she had no power over matters in the bedroom, and even if she had had such negotiating power, she had no means of protection. "I do not how I can protect myself from sexually transmitted infections. I only hear of, but have never seen, a condom, and neither do I know how to use it."

Mulindi also noted that a lack of HIV-positive role models among the older generation was a possible reason the pandemic has continued to be considered a 'young people's problem'.

In areas with high HIV prevalence, like western Kenya's Nyanza Province, Mulindi said harmful cultural practices, such as polygamy and wife inheritance, were responsible for placing older people at increased risk of HIV.

Performance-enhancing drugs like Viagra were also fuelling the pandemic's spread, keeping older men virile for longer than they otherwise would have been. Often these older men did not use protection in their sexual outings with "ndogo ndogos" (young girls), Mulindi said.

Pharmacist James Mwangi* agreed. "The aphrodisiacs are commonly used by the older-generation males who have accepted that their libido has diminished. The biggest danger is that they don't use protection when they go out to enjoy [sex]."

Mwangi noted that performance-enhancing drugs were "prescription only", but lower-income earners could obtain cheap generics from unscrupulous chemists. Viagra, for instance, might cost close to US$10 per pill, while generics cost less than $1, putting them within reach of most of the population.

Light at the end of the tunnel

Mulindi challenged the government’s National AIDS Control Council (NACC) to draw up a strategy for dealing with HIV/AIDS among older people. "At this point we do not specifically target them in our national strategic plan, but we have already decided to alter this during our upcoming mid-term review," Harriet Kongin, head of stakeholder coordination at NACC, told IRIN/PlusNews.

Kongin added that programmes for the over-50s would include prevention programmes such as condom education, as well as encouraging older people to be tested and making VCT centres more user-friendly.

HAI's Tewodros said other initiatives, such as training older people in home-based care, peer education and counselling, would also give them easier access to HIV information.

wm/kr/kn

*Names have been changed