Aging with HIV in Sub-Saharan Africa: Health and Psychosocial Perspectives

Preface
	References
Contents
Contributors
Chapter 1: The Epidemiology of HIV in the Older African Population
	The HIV Epidemic in the Older African Population
		HIV Prevalence and Incidence in the Older Population
		HIV Mortality in the Older Population
	Beliefs, Risk Behaviour, and Preventive Measures Among Older People
	Older People, Care, and Stigma
		Older People Taking Care of HIV-Infected Family Members
		Who Takes Care of Older People Who Are HIV Positive?
		Stigma
	Getting Older with HIV
	Awareness and Testing
	Conclusion
	References
Chapter 2: Comorbid Conditions Occurring in Older Adults on Antiretroviral Therapy in Botswana: A Retrospective Cross-Sectional Cohort Study of Patient Data
	Introduction
	Method
		Settings
		Data
		Comorbidity Definitions
		Analysis
		Ethics
	Results
		Patient Characteristics and Descriptive Analysis
		Burden of Comorbidity Within Age Group and Gender
		Age-Group-Specific Associations Between Disease Characteristics and Multimorbidity
		Comorbidities Relative to Gender Among the Older Cohort (≥50 Years)
		Univariable and Multivariable Analyses on Patient Characteristics and Number of Comorbidities
	Discussion
	Conclusion
	References
Chapter 3: Reflecting on Health and Illness Through the Lens of the HIV Epidemic in Uganda
	Method
		Setting
		Study Methods
	Memories of Loss
	Memories and History to Guide the Present
	The Layering of Experience and New Knowledge
	Managing COVID-19 by Drawing on the Memories of HIV
	A Palimpsest of Epidemic Responses
	Conclusion
	References
Chapter 4: Sexual Health and Behavior Among Older Adults with HIV in Sub-Saharan Africa
	Introduction
		Research on Sexual Activity in Sub-Saharan Africa
			Condom Use
			Multiple Sexual Partners
			Sexual Health
		Purpose and Rationale
	Method
		Sources of Data
		Measures
			Sexual Activity and Sexual Health
			Covariates
		Design and Analysis
	Results
		Sample Characteristics
		Sexual Activity
		Multivariate Analyses on Sexual Activity and Condom Use
	Discussion
		Limitations
		Conclusion and Implications
	References
Chapter 5: “Ask Those Who Are Ahead About a Buffalo”: Well-being of African Grandparents with HIV
	Conceptual Model
	Study Purpose and Hypotheses
	Method
		Data Source
		Study Sample
		Measures
		Analytic Strategy
	Results
		Descriptive Statistics
		Unadjusted Model Analysis
		HIV Stigma: Hierarchical Regression and Moderation Analyses
		Depression: Hierarchical Regression
		Mediation Analyses
	Discussion
	References
Chapter 6: Mental Health in Older People Living with HIV in Sub-Saharan Africa: State of the Art and Future Research Recommendations
	Introduction
	Depression
		Prevalence and Age Effects on Depression
		Depressive Symptoms Presentation
		Factors Associated with Depression or Severe Depressive Symptoms
			Age Effects
			Other Sociodemographic Factors
			Comorbidities
			Stigma and Psychosocial Factors
		Psychotherapeutic Interventions
		Recommendations
	HIV-Associated Neurocognitive Disorders
		Prevalence
		Cognitive Profile
		Factors Associated with Cognitive Impairment
			Age Effects
			Other Factors
		Major Difficulties in Cognitive Evaluation
		Cognitive Interventions
		Recommendations
	Conclusion
	References
Chapter 7: “The Support Keeps Me Strong”: Social Support Among South Africans Ageing with HIV
	Introduction
	Method
		Participant Recruitment
		Interview Process
		Data Analysis
		Ethics Approvals
	Results
		Support from Children and Spouses
		Support from Other Family Members
		Support Outside of the Family
		Caring for Others When You Need Support
	Discussion and Conclusions
	References
Chapter 8: A Detailed Analysis of the Social Support Networks of Older Adults with HIV in Uganda and South Africa
	Introduction
		Social Support Among Older Adults in Sub-Saharan Africa
			Provision of Assistance and Reciprocity
			Contextual Factors Affecting Social Support
			Importance of Perceptions of Social Support
		Purpose and Rationale
	Method
		Sources of Data
		Measures
			Social Support
		Covariates
		Design and Analysis
	Results
		Sample Characteristics
		Social Network Composition
		Frequency of Contact and Feelings of Closeness with Family
		Frequency of Contact with Friends and Neighbors
		Providing Care to Grandchildren or Other Adults
		Assistance and Support Received from Social Network
		Regression Analyses of Instrumental and Emotional Support Sufficiency
	Discussion
		Social Networks
		Caregiving and Other Support
		Social Factors and Social Support
		Sources of Social Support
		Sufficiency of Support
		Limitations
		Conclusions and Implications
	References
Chapter 9: Reprogramming HIV Prevention and Service Provision for Older Adults in Western Kenya
	Introduction
	HIV Prevention and Service Provision in Kenya
		HIV Prevention Among Older Adults
		HIV Screening and Testing in Older Adults
		HIV Treatment and Care for Older Adults Living with HIV
	Suggestions for HIV Reprogramming
		Creating HIV Awareness Among Older Adults
		HIV Screening and Testing Focusing on Older Adults
		Comprehensive Care and Management for Older Adults Living with HIV
	Conclusions
	References
Chapter 10: Beyond Policy Fixes to a New Politics of Care: The Case of Older People Living with HIV in Sub-Saharan Africa
	The Context of Aging in Sub-Saharan Africa
		Population Aging
		State of the Region
	Structural Barriers to Social Protection
		Economic Well-being
			Lack of Pensions and Other Income Support
			Financial Strain Among Older People Living with HIV: Local Perspectives
		Health Care
			Access to Health Care
			Structural and Psychosocial Barriers to Health Care: Local Perspectives
			Difficulty in Addressing Comorbidities: Local Perspectives
		Systems of Social Care
			Adequacy of Informal and Formal Social Supports
			The Invisibility of Older People Living with HIV in Service Provision: Local Perspectives
	Policy or Politics?
		The Political Economy of Care
		Reorganizing the AIDS Response Around a Politics of Care
	References
Chapter 11: Concluding Thoughts
	References
Index