Health systems ‘unprepared to care for rising number of ageing people with HIV’

By Nilima Marshall, PA Science Reporter

Global health systems are unprepared to meet the needs of an ageing population living with HIV, experts have warned.

While people with the virus are living longer due to the success of preventative measures such as HIV testing, condom provision and drugs, new research indicates healthcare providers face a new challenge in caring for those with the lifelong condition.

An estimated 36.9 million people are now living with HIV globally, according to figures from UNAIDS, a branch of the United Nations which aims to end Aids as a public health threat.

Of them, 7.5 million are aged 50 years or older, which is more than double the 3.3 million from 10 years ago.

Professor Jeffrey V Lazarus, of the Barcelona Institute for Global Health in Spain, who led the research, said: “Life expectancy for people living with HIV has increased rapidly since the late 1990s.

“However, this means that health systems are responsible for the care of increasingly large numbers of ageing people with HIV.”

While new diagnoses of HIV in the UK have fallen to their lowest level in almost two decades, with around 4,484 cases reported in 2018, there are still 103,800 people living with the condition, according to Public Health England.

And more than 38,000 of them are aged over 50.

In a series of papers published in the journal The Lancet HIV ahead of World Aids Day on December 1, an international panel of academics say that healthcare systems are currently not equipped to manage the complex care needs of HIV-positive people as overall numbers continue to rise.

Older people, in particular, are more vulnerable, the researchers say, as they face additional health challenges associated with ageing.

In 2014, UNAIDS set a global 90-90-90 target, with a goal for 90% of people who are HIV-infected to be diagnosed, 90% of people who are diagnosed to be on treatment and 90% of those who receive the treatment to be virally suppressed.

Viral suppression involves taking drugs to keep the level of HIV in the body low and prevent the virus being passed on, known as anti-retroviral therapy (ART).

The authors are calling for the extension of this global target to include a “fourth 90” that focuses on quality of care, saying more needs to be done to address stigmas and discrimination associated with HIV.

Writing in a linked article, the editors of The Lancet HIV said: “In 2019 it is not enough that people living with HIV are alive. They should also be living well.

“As the healthcare needs of people living with HIV continue to move beyond specialist services, good quality care, free from stigma and discrimination, is essential.

“HIV status must not lead to exclusion from or denial of services. Achieving these aims will require changes across health and social care.”

Commenting on the research, Ian Green, chief executive of the Terrence Higgins Trust, said: “Thanks to rapid progress in HIV treatment we are now seeing the first generation of people to grow old living with HIV, which is great news – but it means we’re entering uncharted territory.

“That means the next challenge is how to ensure this cohort live well and have good quality of life.

“We know from our own research that there are many complex challenges those ageing with HIV can face including discrimination, isolation, depression and anxiety, as well as stigma and discrimination within healthcare settings.

“This is why there needs to be proper training to ensure health systems across the board are properly equipped to support older people with HIV to not just live, but live well.”