Ageing — a forgotten chapter in HIV
By Robin Muchetu
Mr Jacob Moyo* from Lupanda in Lupane district, Matabeleland North province is a frail 72-year-old man who has been on Antiretroviral Therapy (ART) for the past 20 years.
He has a chest problem and often complains about painful joints as a result of arthritis and poor eyesight due to diabetes. Age is also getting the better of him and he finds it difficult to travel to St Luke’s Hospital almost 30km from his village to collect his ARVs.
His 15-year-old grandson who is also on ART is not strong enough to endure the torturous distance to the clinic to collect drugs for both of them and so they rely on Community ART Groups (CAGs) for assistance.
CAGs are self-formed groups of stable patients on ART from a community in the same geographic location. Group members take turns to collect antiretroviral medicines at the clinic and perform community-based delivery of medications, provide adherence support and monitor treatment outcomes.
However, because Mr Moyo is too ill, old and without a care giver, he sometimes misses out on treatment and check-ups as he cannot visit a health care institution regularly. This is the challenge that is being faced by ageing people living with HIV in Zimbabwe; they have not been fully catered for in strategies that assist members of the community like them.
The Zimbabwe Population-based HIV Impact Assessment (Zimphia) that was conducted in 2015 showed that a significant number of people above 50 years were living with HIV and Aids and as they continue on ART, other health problems that are associated with the elderly increase.
National Aids Council (Nac)Bulawayo provincial co-ordinator Mrs Sinatra Nyathi said there was an emerging challenge with ageing and HIV despite consistence in taking their medication.
“With effective ART, people living with HIV are also living longer and experiencing Non-Communicable Diseases (NCD’s) associated with ageing.
“Blood pressure, diabetes, arthritis, depression, HIV related cancers and other health issues increase, so what we are doing is to encourage the elderly to be screened for the NCD’s and other diseases that are associated with old age as they go for check-ups so that we do not only concentrate on HIV but we look at the health totality of the person,” she said.
She added; “We realise that they continue to take ARVs but there are other diseases that are induced by the drugs such as some types of diabetes that are actually caused by the prolonged use of ARVs. All the same we are saying they must be checked regularly.”
Asked on defaulting rates of the elderly living with HIV, she said there were rare cases.
“We do not experience a lot of defaulting in the elderly. Usually defaulting comes when they fail to get money for review or to go and collect drugs, not necessarily because of behaviour.
“They are a group that understands their condition unlike the adolescence who are a challenge. At times they (youths) face stigma and discrimination, they suffer from burn out syndrome and they get tired of taking drugs and they stop,” she said.
Mrs Nyathi said the other challenge was that old people were also taking care of grandchildren and children who were also infected so at times it becomes a triple burden.
However Nac has stepped in to assist such people.
“We have programmes now where we are saying we get one out of a family to come to the clinic and get medication for everyone. That one person can collect drugs for all of the people and we usually encourage that they be seen by the doctors for check-up. The next round another one comes to represent the family and so goes the circle,” she said.
This, she says, also ensures that they save on transport money too as Nac is trying to reduce the out of pocket burden at family level for HIV treatment.
“This has helped a lot in terms of bus fare and time where all five or so family members cannot miss work or other issues because they have to collect drugs but instead rotate as a family on who will collect medication,” she added.
The Ministry of Health and Child Care, she said, has introduced the Differentiated Care Model where those that have been consistent in getting their medication do not have to go to the health care institution every month, they can go after six months which reduces the burden on the clients and the health care institution too in that they do not have to attend to a lot of people at the same time.
Mr Stanley Takaona the president for the Zimbabwe HIV and Aids Union lamented the challenge where the aged were being sidelined in programming.
“In our Zimbabwe National Aids Strategy Programme (ZNASP) it has been talked about but not implemented much. If you look at health facilities in rural set ups, the documents say a clinic must be 10km from the next, but at 75 years or so an aged person may not be able to walk that distance in the rural areas due to illness. Most of the clinics are way far than that 10km distance,” he said.
He said drugs must come to the people.
“What must be done is that they now need to have the medicines coming to them. We are definitely not doing much implementation in that area; we are not planning adequately for HIV and ageing.
“Even those that are not old may not be able to travel those distances to access drugs and other services. As activists we once advocated for drugs to be taken to those that are old, I for one have been taking ARVs for 20 years and I am almost 60 years old now, what of one who is 80, what do they do looking at the distance one has to walk in the countryside?
“We have many elderly people on ART but no clear plan for them in Zimbabwe, South Africa has started making positive strides in that area and that is a positive move,” he said.
He said some of the old people do not even qualify for CAGs as they cannot even take a turn to go and collect drugs for others and in some cases they stay alone and cannot be represented.
Mr Takaona said the Government must make more serious efforts to consider the aged on ART. Strategic planning, he said, must involve everyone.
“Most of them have been on therapy for 20 to 30 years and now that they are older we abandon them, it is reversing gains made already in HIV treatment as they may not be able to go to the clinics to get drugs and services,” he said.
He reiterated the need to rope in those that were old and living with HIV and Aids into programmes by the Government and other organisations that were concerned with their well-being so as to preserve all the gains made in tackling HIV. Sunday News