“A frightening experience, especially at our age”: Examining the neglect and abuse of older persons in HIV prevention and care programs

Abstract

BackgroundAs the global population ages and the HIV pandemic matures, a growing number of older persons aged ≥50 years are becoming increasingly vulnerable to acquiring HIV. Unfortunately, older persons are often neglected and left out of sexual health programs and services. This study explored the experiences of older persons living with and without HIV in accessing prevention and care services and how those experiences translate into the neglect and abuse of older persons. The study also explored older people's perspectives on community responses to HIV in older people.MethodsThis qualitative analysis used data from 37 individuals who participated in focus group discussions conducted in 2017/2018 across two communities in Durban, South Africa. Using an interview guide and thematic content analysis, salient themes regarding attitudes to HIV in older persons and factors of access to HIV prevention and cares services for older persons were analyzed.ResultsThe study participant's mean age was 59.6 years. Major themes emerging from the data included factors impacting HIV prevention and transmission in older people; community responses to HIV contributing to the abuse of older people, and structural drivers of abuse in older people living with HIV (OPLHIV). Knowledge about HIV and how to protect themselves from HIV was limited among participants. Older persons were frightened to acquire HIV at an older age as they feared judgment and discrimination for getting HIV at that age. OPLHIV reported frequently experiencing community stigma and poor staff attitudes and practices at health facilities, such as a triage health delivery system that fueled community stigma. Participants also experienced neglect, verbal and emotional abuse at healthcare facilities.ConclusionAlthough there were no reports of physical and sexual abuse of older persons in this study, this study shows that despite decades of HIV programs in the country, HIV-related stigma, discrimination, and disrespect of older persons remain pervasive in the community and at health facilities. As an increasing number of people age and live longer with HIV, the neglect and outright abuse of older persons need urgent policy and program interventions.

“We will die having sex” – gender, health and cultural influences on sexual practices among older people in South Africa

“…The absence of condom discussions in our FGDs points to older people not paying much attention to safer sexual practices and HIV prevention. Unfortunately, healthcare providers have admitted to assuming older adults are asexual and find discussing sexual health problems with older persons difficult (Taylor and Gosney 2011;Nyirenda et al 2023). On the contrary, older adults do engage in sexual activity much more than is widely believed and some do remain very sexually active even to very advanced ages (Minichiello et al 2012;Wang et al 2015;Nyirenda et al 2018).…”

“…In addition to the age and residency criteria, participants therefore had to have participated in the initial study to be eligible for this qualitative study. Details about the inclusion and exclusion criteria for both the initial and follow-up study may be accessed from prior publications (Nyirenda et al 2023;Nyirenda et al 2022;Abbai et al 2018). Briefly, from among the 435 respondents in the initial study, a computer system was used to randomly select 37 respondents to participate in focus group discussions (FGDs).…”

Individual and Community-Contextual Level Factors Associated With Wellbeing Among Older Adults in Rural Zambia

“…As the global population ages, efforts to ensure older people’s wellbeing and quality of life, are becoming more prominent [ 1 ]. While rural areas worldwide face diverse and unique challenges providing social services due to resource constraints, geographical location, and diversity in cultural and social settings, the situation is more pronounced in developing countries [ 2 , 3 ]. Developing countries will generally experience faster growth in absolute numbers of older people than developed countries [ 4 ].…”