AIDS and declining support for dependent elderly people in Africa: retrospective analysis using demographic and health surveys

Abstract

Objectives: To determine the relation between the HIV/AIDS epidemic and support for dependent elderly people in Africa.

Design: Retrospective analysis using data from Demographic and Health Surveys.

Setting: 22 African countries between 1991 and 2006.

Participants: 123,176 individuals over the age of 60.

Main outcome measures: We investigated how three measures of the living arrangements of older people have been affected by the HIV/AIDS epidemic: the number of older individuals living alone (that is, the number of unattended elderly people); the number of older individuals living with only dependent children under the age of 10 (that is, in missing generation households); and the number of adults age 18-59 (that is, prime age adults) per household where an older person lives.

Results: An increase in annual AIDS mortality of one death per 1000 people was associated with a 1.5% increase in the proportion of older individuals living alone (95% CI 1.2% to 1.9%) and a 0.4% increase in the number of older individuals living in missing generation households (95% CI 0.3% to 0.6%). Increases in AIDS mortality were also associated with fewer prime age adults in households with at least one older person and at least one prime age adult (P<0.001). These findings suggest that in our study countries, which encompass 70% of the sub-Saharan population, the HIV/AIDS epidemic could be responsible for 582,200-917,000 older individuals living alone without prime age adults and 141,000-323,100 older individuals being the sole caregivers for young children.

Conclusions: Africa's HIV/AIDS epidemic might be responsible for a large number of older people losing their support and having to care for young children. This population has previously been under-recognised. Efforts to reduce HIV/AIDS deaths could have large "spillover" benefits for elderly people in Africa.

Fig 1 AIDS mortality rate and the proportion of older people living alone without any adults between the ages of 18 and 59. The line represents unadjusted linear regression showing higher fractions of unattended elderly people associated with higher AIDS mortality rates. The primary analysis uses a probit regression

Fig 2 AIDS mortality rate and the proportion of older people living in missing generation households—that is, households where older people live with children under the age of 10 and without any adults between the ages of 18 and 59. The line represents unadjusted linear regression showing higher rates of elderly individuals living in missing generation households associated with higher AIDS mortality rates. The primary analysis uses a probit regression