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Published in: AIDS and Behavior 1/2017

01-07-2017 | Original Paper

The HIV Epidemic in Sub-Saharan Africa is Aging: Evidence from the Demographic and Health Surveys in Sub-Saharan Africa

Authors: Sebastian Vollmer, Kenneth Harttgen, Tobias Alfven, Jude Padayachy, Peter Ghys, Till Bärnighausen

Published in: AIDS and Behavior | Special Issue 1/2017

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Abstract

We use the individual-level data from all available Demographic and Health Surveys (DHS) from 27 sub-Saharan African countries conducted between 2003 and 2012 (40 population-based and nationally representative surveys in total) to calculate HIV testing consent rates and HIV prevalence for each country separately, as well as for the pooled sample. The pooled sample comprised of 427,130 individuals. In most countries HIV prevalence in adults aged 45 years and above is higher than in the total population. We further show that over the past decade HIV prevalence has increased in older age groups, while it has decreased in younger ones. While the age patterns of HIV consent rates vary across the 27 countries included in our sample, analysis of the pooled sample across all countries reveals a u-shaped relationship with lowest consent rates around age 35 years and higher consent rates among younger and older people. We argue that future DHS and other population-based HIV surveys should offer HIV testing to all adults without age limits.
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Literature
1.
go back to reference Mills EJ, Bärnighausen T, Negin J. HIV and aging–preparing for the challenges ahead. New Engl J Med. 2012;366(14):1270–3.CrossRefPubMed Mills EJ, Bärnighausen T, Negin J. HIV and aging–preparing for the challenges ahead. New Engl J Med. 2012;366(14):1270–3.CrossRefPubMed
3.
go back to reference UNAIDS. UNAIDS report on the global AIDS epidemic. Geneva: UNAIDS; 2013. UNAIDS. UNAIDS report on the global AIDS epidemic. Geneva: UNAIDS; 2013.
4.
go back to reference Zaidi J, Grapsa E, Tanser F, Newell ML, Bärnighausen T. Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment. AIDS. 2013;27(14):2301–5.CrossRefPubMedPubMedCentral Zaidi J, Grapsa E, Tanser F, Newell ML, Bärnighausen T. Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment. AIDS. 2013;27(14):2301–5.CrossRefPubMedPubMedCentral
5.
go back to reference Bärnighausen T, Tanser F, Newell ML. Lack of a decline in HIV incidence in a rural community with high HIV prevalence in South Africa, 2003-2007. AIDS Res Hum Retroviruses. 2009;25(4):405–9.CrossRefPubMedPubMedCentral Bärnighausen T, Tanser F, Newell ML. Lack of a decline in HIV incidence in a rural community with high HIV prevalence in South Africa, 2003-2007. AIDS Res Hum Retroviruses. 2009;25(4):405–9.CrossRefPubMedPubMedCentral
6.
go back to reference Bärnighausen T, Wallrauch C, Welte A, et al. HIV incidence in rural South Africa: comparison of estimates from longitudinal surveillance and cross-sectional cBED assay testing. PLoS ONE. 2008;3(11):e3640.CrossRefPubMedPubMedCentral Bärnighausen T, Wallrauch C, Welte A, et al. HIV incidence in rural South Africa: comparison of estimates from longitudinal surveillance and cross-sectional cBED assay testing. PLoS ONE. 2008;3(11):e3640.CrossRefPubMedPubMedCentral
7.
go back to reference Asamoah-Odei E, Garcia Calleja JM, Boerma JT. HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. Lancet. 2004;364(9428):35–40.CrossRefPubMed Asamoah-Odei E, Garcia Calleja JM, Boerma JT. HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. Lancet. 2004;364(9428):35–40.CrossRefPubMed
8.
go back to reference Boerma JT, Ghys PD, Walker N. Estimates of HIV-1 prevalence from national population-based surveys as a new gold standard. Lancet. 2003;362(9399):1929–31.CrossRefPubMed Boerma JT, Ghys PD, Walker N. Estimates of HIV-1 prevalence from national population-based surveys as a new gold standard. Lancet. 2003;362(9399):1929–31.CrossRefPubMed
9.
go back to reference Garcia-Calleja JM, Gouws E, Ghys PD. National population based HIV prevalence surveys in sub-Saharan Africa: results and implications for HIV and AIDS estimates. Sexual Transm Infect. 2006;82(Suppl 3):64–70. Garcia-Calleja JM, Gouws E, Ghys PD. National population based HIV prevalence surveys in sub-Saharan Africa: results and implications for HIV and AIDS estimates. Sexual Transm Infect. 2006;82(Suppl 3):64–70.
10.
go back to reference ICF International. Prevalence estimates from the demographic and health surveys. Calverton: ICF International; 2012. ICF International. Prevalence estimates from the demographic and health surveys. Calverton: ICF International; 2012.
11.
go back to reference Braunstein SL, van de Wijgert JH, Nash D. HIV incidence in sub-Saharan Africa: a review of available data with implications for surveillance and prevention planning. AIDS Rev. 2009;11(3):140–56.PubMed Braunstein SL, van de Wijgert JH, Nash D. HIV incidence in sub-Saharan Africa: a review of available data with implications for surveillance and prevention planning. AIDS Rev. 2009;11(3):140–56.PubMed
12.
go back to reference Misiri HE, Edriss A, Aalen OO, Dahl FA. Estimation of HIV incidence in Malawi from cross-sectional population-based sero-prevalence data. J Int AIDS Soc. 2012;15(1):14.CrossRefPubMed Misiri HE, Edriss A, Aalen OO, Dahl FA. Estimation of HIV incidence in Malawi from cross-sectional population-based sero-prevalence data. J Int AIDS Soc. 2012;15(1):14.CrossRefPubMed
13.
go back to reference Negin J, Cumming RG. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Organ. 2010;88(11):847–53.CrossRefPubMedPubMedCentral Negin J, Cumming RG. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Organ. 2010;88(11):847–53.CrossRefPubMedPubMedCentral
14.
go back to reference Wallrauch C, Bärnighausen T, Newell ML. HIV prevalence and incidence in people 50 years and older in rural South Africa. S Afr Med J. 2010;100(12):812–4.CrossRefPubMedPubMedCentral Wallrauch C, Bärnighausen T, Newell ML. HIV prevalence and incidence in people 50 years and older in rural South Africa. S Afr Med J. 2010;100(12):812–4.CrossRefPubMedPubMedCentral
15.
16.
go back to reference Harling G, Newell ML, Tanser F, Bärnighausen T. Partner age-disparity and HIV incidence risk for older women in rural South Africa. AIDS Behav. 2015;19(7):1317–26.CrossRefPubMedPubMedCentral Harling G, Newell ML, Tanser F, Bärnighausen T. Partner age-disparity and HIV incidence risk for older women in rural South Africa. AIDS Behav. 2015;19(7):1317–26.CrossRefPubMedPubMedCentral
17.
go back to reference Harling G, Newell ML, Tanser F, Kawachi I, Subramanian SV, Bärnighausen T. Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2014;66(4):443–51.CrossRefPubMedPubMedCentral Harling G, Newell ML, Tanser F, Kawachi I, Subramanian SV, Bärnighausen T. Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2014;66(4):443–51.CrossRefPubMedPubMedCentral
18.
go back to reference Nicolosi A, Buvat J, Glasser DB, Hartmann U, Laumann EO, Gingell C. Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviors. World J Urol. 2006;24(4):423–8.CrossRefPubMed Nicolosi A, Buvat J, Glasser DB, Hartmann U, Laumann EO, Gingell C. Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviors. World J Urol. 2006;24(4):423–8.CrossRefPubMed
19.
go back to reference Nicolosi A, Laumann EO, Glasser DB, Moreira ED Jr, Paik A, Gingell C. Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology. 2004;64(5):991–7.CrossRefPubMed Nicolosi A, Laumann EO, Glasser DB, Moreira ED Jr, Paik A, Gingell C. Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology. 2004;64(5):991–7.CrossRefPubMed
20.
go back to reference Diokno AC, Brown MB, Herzog AR. Sexual function in the elderly. Arch Intern Med. 1990;150(1):197–200.CrossRefPubMed Diokno AC, Brown MB, Herzog AR. Sexual function in the elderly. Arch Intern Med. 1990;150(1):197–200.CrossRefPubMed
21.
go back to reference Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. New Engl J Med. 2007;357(8):762–74.CrossRefPubMedPubMedCentral Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. New Engl J Med. 2007;357(8):762–74.CrossRefPubMedPubMedCentral
22.
go back to reference Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A. Changes in sexual behavior of HIV-infected older adults enrolled in a clinical trial of standalone group psychotherapies targeting depression. AIDS Behav. 2015;19(1):1–8.CrossRefPubMedPubMedCentral Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A. Changes in sexual behavior of HIV-infected older adults enrolled in a clinical trial of standalone group psychotherapies targeting depression. AIDS Behav. 2015;19(1):1–8.CrossRefPubMedPubMedCentral
23.
go back to reference Lovejoy TI, Heckman TG, Sikkema KJ, et al. Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS Behav. 2008;12(6):943–56.CrossRefPubMedPubMedCentral Lovejoy TI, Heckman TG, Sikkema KJ, et al. Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS Behav. 2008;12(6):943–56.CrossRefPubMedPubMedCentral
24.
go back to reference Bärnighausen T, Biraro S, Bwanika J, et al. Diverse age patterns of HIV incidence rates in Africa. In: XVII International AIDS Conference, 3–8 August 2008, Mexico City; 2008. Bärnighausen T, Biraro S, Bwanika J, et al. Diverse age patterns of HIV incidence rates in Africa. In: XVII International AIDS Conference, 3–8 August 2008, Mexico City; 2008.
25.
go back to reference Bor J, Herbst AJ, Newell ML, Bärnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science. 2013;339(6122):961–5.CrossRefPubMed Bor J, Herbst AJ, Newell ML, Bärnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science. 2013;339(6122):961–5.CrossRefPubMed
26.
go back to reference Mills EJ, Bakanda C, Birungi J, et al. Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Ann Intern Med. 2011;155(4):209–16.CrossRefPubMed Mills EJ, Bakanda C, Birungi J, et al. Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Ann Intern Med. 2011;155(4):209–16.CrossRefPubMed
27.
go back to reference Hontelez JA, de Vlas SJ, Baltussen R, et al. The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS. 2012;26(Suppl 1):S19–30.CrossRefPubMed Hontelez JA, de Vlas SJ, Baltussen R, et al. The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS. 2012;26(Suppl 1):S19–30.CrossRefPubMed
28.
29.
go back to reference Tanser F, Bärnighausen T, Grapsa E, Zaidi J, Newell ML. High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Science. 2013;339(6122):966–71.CrossRefPubMedPubMedCentral Tanser F, Bärnighausen T, Grapsa E, Zaidi J, Newell ML. High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Science. 2013;339(6122):966–71.CrossRefPubMedPubMedCentral
30.
31.
go back to reference Vollmer S, Alfven T, Padayachy J, Harttgen K, Ghys PD, Bärnighausen. T. HIV surveys in older adults: better data, better health. Lancet HIV. 2015; 2:e40–e41. Vollmer S, Alfven T, Padayachy J, Harttgen K, Ghys PD, Bärnighausen. T. HIV surveys in older adults: better data, better health. Lancet HIV. 2015; 2:e40–e41.
32.
go back to reference WHO/UNICEF/UNAIDS. Global update on HIV treatment 2013. WHO: Geneva; 2013. WHO/UNICEF/UNAIDS. Global update on HIV treatment 2013. WHO: Geneva; 2013.
33.
go back to reference Mills EJ, Rammohan A, Awofeso N. Ageing faster with AIDS in Africa. Lancet. 2011;377(9772):1131–3.CrossRefPubMed Mills EJ, Rammohan A, Awofeso N. Ageing faster with AIDS in Africa. Lancet. 2011;377(9772):1131–3.CrossRefPubMed
34.
go back to reference Justice AC. Commentary: treated HIV infection is a chronic disease: the case against cause of death analyses. Int J Epidemiol. 2010;39(1):146–8.CrossRefPubMed Justice AC. Commentary: treated HIV infection is a chronic disease: the case against cause of death analyses. Int J Epidemiol. 2010;39(1):146–8.CrossRefPubMed
35.
go back to reference Bärnighausen T, Welz T, Hosegood V, et al. Hiding in the shadows of the HIV epidemic: obesity and hypertension in a rural population with very high HIV prevalence in South Africa. J Hum Hypertens. 2008;22(3):236–9.CrossRefPubMed Bärnighausen T, Welz T, Hosegood V, et al. Hiding in the shadows of the HIV epidemic: obesity and hypertension in a rural population with very high HIV prevalence in South Africa. J Hum Hypertens. 2008;22(3):236–9.CrossRefPubMed
36.
go back to reference Obel N, Thomsen HF, Kronborg G, et al. Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study. Clin Infect Dis. 2007;44(12):1625–31.CrossRefPubMed Obel N, Thomsen HF, Kronborg G, et al. Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study. Clin Infect Dis. 2007;44(12):1625–31.CrossRefPubMed
37.
go back to reference Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metabol. 2007;92(7):2506–12.CrossRef Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metabol. 2007;92(7):2506–12.CrossRef
38.
go back to reference Chow FC, Regan S, Feske S, Meigs JB, Grinspoon SK, Triant VA. Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndr. 2012;60(4):351–8.CrossRefPubMedPubMedCentral Chow FC, Regan S, Feske S, Meigs JB, Grinspoon SK, Triant VA. Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndr. 2012;60(4):351–8.CrossRefPubMedPubMedCentral
39.
go back to reference De Wit S, Sabin CA, Weber R, et al. Incidence and risk factors for new-onset diabetes in HIV-infected patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Diabetes Care. 2008;31(6):1224–9.CrossRefPubMedPubMedCentral De Wit S, Sabin CA, Weber R, et al. Incidence and risk factors for new-onset diabetes in HIV-infected patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Diabetes Care. 2008;31(6):1224–9.CrossRefPubMedPubMedCentral
40.
go back to reference Guimaraes MM, Greco DB, Figueiredo SM, Foscolo RB, Oliveira AR Jr, Machado LJ. High-sensitivity C-reactive protein levels in HIV-infected patients treated or not with antiretroviral drugs and their correlation with factors related to cardiovascular risk and HIV infection. Atherosclerosis. 2008;201(2):434–9.CrossRefPubMed Guimaraes MM, Greco DB, Figueiredo SM, Foscolo RB, Oliveira AR Jr, Machado LJ. High-sensitivity C-reactive protein levels in HIV-infected patients treated or not with antiretroviral drugs and their correlation with factors related to cardiovascular risk and HIV infection. Atherosclerosis. 2008;201(2):434–9.CrossRefPubMed
41.
go back to reference De Luca A, de Gaetano Donati K, Colafigli M, et al. The association of high-sensitivity c-reactive protein and other biomarkers with cardiovascular disease in patients treated for HIV: a nested case-control study. BMC Infect Dis. 2013;13:414.CrossRefPubMedPubMedCentral De Luca A, de Gaetano Donati K, Colafigli M, et al. The association of high-sensitivity c-reactive protein and other biomarkers with cardiovascular disease in patients treated for HIV: a nested case-control study. BMC Infect Dis. 2013;13:414.CrossRefPubMedPubMedCentral
42.
go back to reference Cohen B, Menken J. Aging in sub-Saharan Africa: recommendation for futhering research. Washington, DC: National Academy of Sciences; 2006. Cohen B, Menken J. Aging in sub-Saharan Africa: recommendation for futhering research. Washington, DC: National Academy of Sciences; 2006.
Metadata
Title
The HIV Epidemic in Sub-Saharan Africa is Aging: Evidence from the Demographic and Health Surveys in Sub-Saharan Africa
Authors
Sebastian Vollmer
Kenneth Harttgen
Tobias Alfven
Jude Padayachy
Peter Ghys
Till Bärnighausen
Publication date
01-07-2017
Publisher
Springer US
Published in
AIDS and Behavior / Issue Special Issue 1/2017
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-016-1591-7

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