FOCUS on AIDS and the elderly

They are the forgotten victims of the HIV/AIDS virus that is devastating Africa. Amid the terrible social and economic destruction, all too often it is the elderly who are left to pick up the pieces. Mullnesh Alemu is 69 and looks after four orphaned grandchildren. A year ago the virus killed her unmarried daughter. "It is so hard to survive," she told IRIN. "If it was just me I could live on begging and bread but I have to feed the children." Mullnesh lives in Ethiopia - one of the countries hardest hit by the virus and where, according to recent ministry of health statistics, there are one million AIDS orphans. It is also one of the poorest countries in the world where overstretched social services and health care are already at breaking point. "All the children are looking to me for support," she said from her tiny home in Addis Ababa. "I am their mother, their father and their uncle – without me they have nothing. But now I am old, my eyesight has gone and I cannot help them any more." Her plight and the abject poverty she now lives in, is a far cry from when her own children were alive. Her son Bogali was 20 and used to send her money until he was killed during the border war with Eritrea, leaving his three children and no mother. The war pension she receives after he died totals 14 Ethiopian birr a month – around US $1.50 - and is hardly enough to feed the children, let alone clothe them. Her daughter Frezewied turned to prostitution to try and escape from the wretched poverty – only to become pregnant and then eventually die from AIDS. Frezewied’s four year-old son Tolcha would sit by her bedside, gradually watching his mother die from the virus in squalid conditions. Mullnesh used to spin cotton to pay for food and clothing but now cannot see properly. Occasionally when she has the strength, she will carry 50 kg bundles of firewood for sale in the city, earning four birr a day (less than US$0.50). UNDER-REPORTED IMPACT Ethiopia is one of the countries hardest hit by the epidemic, and has the third highest population in the world living with the virus. "In the last decade, the HIV/AIDS epidemic has had a devastating but under-reported impact on older people's lives and on those who depend on them," said Peter Bofin, head of HelpAge International in Ethiopia. "Older people have long been overlooked when it comes to fighting the impact of AIDS and are now falling sick as a result. Education campaigns have also ignored them." "Almost no statistics have been compiled on the numbers of elderly people with the disease," added Bofin, whose organisation is lobbying governments to raise awareness of the plight of older people. "The economic impact is also startling. Across the continent, the elderly now care for up to eight million children orphaned by the AIDS virus, with little or no help." He said that those left to care for the orphans of AIDS victims face unimaginable hardship – both financially and psychologically. "Older people are faced with the double burden, emotionally and economically, of caring for their sick children, seeing them die as well as then often caring for the orphans that remain." Many families are forced further into debt as they struggle to pay for school fees and funeral expenses, as well as losing the desperately needed income of their children. The virus is also radically transforming the age profile across parts of the world. Life expectancy has plummeted. In sub-Saharan Africa, the ratio of older to younger people will change from 1:14 to 1:3 by the year 2050. INFORMATION DESPERATELY NEEDED One of the first organisations to work with people living with AIDS – starting 10 years ago - is the Medical Missionaries of Mary Counselling and Social Services Centre of the Ethiopian Catholic Church. They say that not only are millions dying from the virus in Africa, it is radically transforming the culture and structure of communities.

Kasech Musa

Kasech Musa, a medical sister trained in community care, says that as the burden on communities increases, they are broken down and no longer look to each other for support. "Communities are breaking apart," she said. "The community cannot cope anymore with the strains. People are helping their neighbours less and less because they do not have enough themselves anymore, or have also been affected by HIV and AIDS." "Care and counselling for the survivors is desperately neglected with little or no information on which to act," she added. HelpAge also believes that national and international research and responses to the virus have primarily focused on the young and middle aged. "Older people are now primary carers for those sick with HIV/AIDS – and for their orphans," Bofin said. "The risk of personal infection older people face has been underestimated. They urgently need information to protect themselves during sexual activity or as carers, and to help manage the epidemic in their communities." ENORMOUS BURDEN Often diagnosis of the AIDS virus in older people is more difficult because the symptoms are blamed on illnesses associated with aging, aid organisations say. The strength of community ties in Africa, and specifically countries like Ethiopia, has only served to worsen the impact on older people as they are expected, without question, to take on the burden. They have also found themselves stigmatised in their villages and towns by communities unwilling to accept the AIDS virus and terrified of its invisible spread. Many are too frightened to admit their children are victims of the disease. At funerals, friends and relatives are unwilling to discuss the cause of death. HelpAge argues that the key to tackling the problem is providing support and health care to the elderly to help them meet the needs of those affected. Organisations are slowly starting to take note and realise that the elderly have been carrying an enormous burden. The plight of the elderly was raised in the final declaration of the UN General Assembly’s special session on HIV/AIDS in June – at which HelpAge was present - and the international community has pledged to address the problem. The impact of AIDS on the older community has also been placed high on the agenda of the World Assembly on Ageing to be held in Madrid in April 2002. But still, HelpAge says that much remains to be done. It says many organisations are thwarted by the lack of information on the crisis. "The real impact of HIV/AIDS on older people is still not sufficiently recognised by the UN, international development agencies and NGOs alike," Bofin stressed. "More acknowledgement and action is needed. We need research on infection rates on people older than 49, recognising that older people are still sexually active and so are exposed to the virus – not just in their role as carers. We also need to recognise their crucial position in being able to raise awareness about AIDS within their communities." For Mullnesh help maybe too late. She has already seen her children die. "For me the only escape is when I die, that is when I will be able to rest," she says. "But who then will look after my grandchildren. They will be left to the streets."