HIV prevalence and related behaviours of older people in Botswana - secondary analysis of the Botswana AIDS Impact Survey (BAIS) IV

• Published in: African journal of AIDS research : AJAR 2019-01, Vol.18 (1), p.18-26
• Main Authors: Matlho, Kabo, Randell, Madeleine, Lebelonyane, Refelwetswe, Kefas, Joseph, Driscoll, Tim, Negin, Joel
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - epidemiology; Adolescent; Adult; Aged; ageing and HIV; Aging; AIDS; AIDS/HIV; Anti-Retroviral Agents - therapeutic use; Antiretroviral therapy; Botswana - epidemiology; co-morbidities; Comorbidity; Condoms - statistics & numerical data; Epidemics; Female; HIV; HIV prevalence; Human immunodeficiency virus; Humans; Intervention; Male; Middle Aged; older adults in Botswana; Older men; Older people; Older women; Polls & surveys; Prescription drugs; Prevalence; prolonged ART use; Safe Sex - statistics & numerical data; Sexual behavior; sexual behaviour and characteristics; Sexual intercourse; Surveys and Questionnaires; Unsafe Sex - statistics & numerical data; Uptake; Young Adult
• ISSN: 1608-5906; 1727-9445
• DOI: 10.2989/16085906.2018.1552162

The focus of HIV interventions in Botswana, a country with the second highest prevalence of HIV in the world, remains targeted at those aged 15-49 years despite a growing cohort of older people living with the disease - driven largely by the successful roll-out of antiretroviral therapy (ART). Primarily utilising the Botswana AIDS Impact Survey IV, we set out to examine HIV related characteristics and behaviours of this often ignored older cohort (50-64 years) relative to younger (25-49 years) adults. Analysis revealed that more than 80% of older people living with HIV were on ART. HIV prevalence among this older cohort was 24.6% in 2013 compared to 35.1% among the younger cohort, p < 0.0001. Prevalence in older adults was higher among older males (27.8%) than females (21.9%), p = 0.02. Furthermore, 58.9% of older adults acknowledged being sexually active, with 59.0% of these admitting to inconsistent condom use during sexual intercourse. In addition to this low condom usage, older men (6.0%) were significantly more likely to be unaware of their HIV-positive status than older women (3.0%), p = 0.002. While HIV prevalence showed a dramatic increase among older men over time (17.2% in 2004, to 23.4% in 2008, to 27.8% in 2013), the trend was flatter among older women (16.3% in 2004, to 22.4% in 2008, to 21.9% in 2013). These trends are likely attributable to a large increase in ART coverage and uptake. Going forward, more targeted interventions acknowledging the ageing epidemic are important to consider.