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Impact of AIDS on older people in Africa: Zimbabwe, a case study
World Health Organisation (WHO)
December 11, 2002

http://www.who.int/hpr/ageing/hivimpact.htm

The rising AIDS death toll and the consequent increasing numbers of AIDS orphans world-wide are having far-reaching health, economic and psycho-social impacts on society, particularly in Africa – where 71% of the 40 million people living with HIV/AIDS in 2001 were residing. Similarly, of the total number of children under the age of 15 years (14 million) who had lost their mothers or both parents to AIDS by 2001, around 90% were to be found in sub-Saharan Africa. Most of those living with HIV/AIDS are people in their economically active stages of life (15-49). A new WHO report "Impact of AIDS on Older People in Africa" launched on 11th December 2002, has investigated the burden of AIDS on Older People in Zimbabwe and concludes that, the increase in home based and orphan care due to AIDS places enormous burden older relatives, mostly older women, who have to provide this care within a context of decreased economic means, stigma, witchcraft accusations and other challenges they faced in their old age. It calls for practical and sustainable approaches that will improve the capacity of older people to enable them continue providing this important role.

Introduction
There is growing evidence that older people are increasingly being infected by HIV/AIDS. However, available data does not often include how the pandemic is affecting this population group. For example, in the USA, 10% of all reported AIDS cases occur in the population group of 50 years plus. Yet, while 83% of all AIDS deaths in the world have occurred in sub-Saharan Africa, very little is known about the epidemiology of HIV/AIDS among older people in this region.

Another issue of concern to this population cohort which needs equal attention is the role older people play as care providers for the chronically and terminally ill patients and the upkeep of children orphaned by AIDS.

UNAIDS and WHO estimated that, at the end of 1999, a total of 18.8 million people had died of AIDS. Of these, 14.8 million were in Sub- Saharan Africa. Furthermore, of the 13.2 million children under 14 years who had lost one or both parents to AIDS, 12.1 live in Sub- Saharan Africa.

In Africa and other countries with poor health infrastructure and non-existent state welfare support, the burden of care is undertaken by the family. Evidence from Africa and Asia, including a recent WHO study in Zimbabwe, conclude that this burden is borne primarily by older women. They are providing this care under extreme conditions of poverty, stigma and lack of support.

What WHO is doing
The project "Developing and validating a methodology to examine the Impact of HIV/AIDS on older caregivers" is set in four countries in Africa, Zimbabwe, Ghana, South Africa and Tanzania.

The main focus of the project is to identify barriers that prevent older people from providing adequate and fulfilling care to their children dying from HIV/AIDS and, subsequently, to their orphaned grandchildren. Its main expected outcome is the development of policies and programmes that would sustain older people as key assets in the care of the terminally ill patients and children orphaned by AIDS.

A mix of qualitative and quantitative research methods has been tested and applied in six provinces in Zimbabwe. The main project partners in country are: Ministry of Health and Child Welfare, University of Zimbabwe, HelpAge International, Department of Social Welfare, National AIDS Control Programme, the Central Statistics Office and WHO regional and country offices.

Preliminary project findings
In all 810 household interviews and 32 key informants/focus group discussions were conducted. Of these (79.3%) were people above the age 50 years. Two thirds of these are women. The majority of these older persons (52%) are peasant farmers, 22.9% are unemployed, 14.9% are self-employed and 6.3% are homemakers. The remaining 3.9% are farm workers, unskilled workers.

OLDER PERSON AS MAIN CARE GIVER IN THE HOUSEHOLD

In all 573 (84%) of the 685 households of older persons indicated that the older person is the main care giver, either of the terminally ill or of the orphans whose parents (one or both) have died of AIDS, a burden that is borne more by the over 60 year group. In these households with a total of 4540 people, 1815 (40%) are children orphaned by AIDS and most of the orphans (80.6%) are the grandchildren of the older carer.

The preliminary findings suggest that the main problems affecting the provision of care by older people are: loss of remittances and other financial support, of lack of food and clothing, high cost of medical fees during illness, inability to pay school fees for orphans, loss of economic support and diminished livelihood opportunities. In addition, Zimbabweans affected by AIDS were found to have limited access to and low utilisation of health services, due to the high cost of health care, transport difficulties, stigmatisation of the disease and poor health staff attitudes towards people living with HIV/AIDS. Most importantly, the findings indicate that the health of the "older carer" has taken a big blow. Older people are under serious physical and emotional stress and there are cases of physical violence, stigma and abuse resulting from witchcraft accusations.

Working in close collaboration with government departments, NGOs, academic institutions and other civil society organisations, the Ageing and Life Course team is aiming to facilitate processes to improve institutional and community understanding of the plight of older people and to target policy, programme and projects initiatives that would strengthen the capacity of older people as care providers to their HIV/AIDS affected families.

Voices of older people - are we listening?
"I am emotionally hurt when I look at the orphans, when the orphans cry, sometimes I cry along with them". (73 year old man, Bulawayo caring for 4 orphans aged; 3 months, 6 months, 2 and 4 years).

"I am so afraid of what the future has in store for these orphans. If I were to die and leave them, who would look after them?" (62 year old woman, Bulawayo guardian of 3 grandchildren who are all attending school).

"Looking after orphans is like starting life all over again, because I have to work on the farm, clean the house, feed the children, buy school uniforms. I thought I would no longer do these things again. I am not sure if I have the energy to cope". (65 year old man, Makoni, Manicaland the main carer of 3 school going aged children).

"The person with AIDS is very sick and at times loses his/her mind. When this happens it becomes impossible to provide effective care as the sick person may be abusive and violent" (59 year old woman, Mbare, Harare, she has cared for her dead children and is now taking care of 7 orphaned grandchildren).

"Nursing staff attitude towards us is very negative. They ignore and verbally abuse us. My child died on the stretcher while waiting for them to attend to us" (50 year old woman, Seke, Mashonaland East).

"The situation is very desperate, I am now forced to engage in selling illegal drugs to raise money to feed the orphans. I am no longer afraid of going to jail" (53 year old woman, Highfield, Harare who takes care of 6 orphans, three older ones aged 20, 17 and 14, are in school, the other three aged 8, 10 and 11are not enrolled in school).

Contact
Robert deGraft Agyarko
Ageing and Life Course (ALC)
World Health Organization
20 Avenue Appia, CH 1211 Geneva
Switzerland
Direct tel: (+41 22) 791 34 33
Fax: (+41 22) 791 48 39
Email: agyarkor@who.int

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