Triple burden: Challenges older HIVAids survivors have to grapple with

“I got HIV 33 years ago, as we age there are old age diseases and Non-Communicable Diseases that affect most of us. We are not just fighting the disease but also old age and other chronic illnesses,” says 55-year-old Patricia Asero Ochieng’ who first discovered she had the virus in 1990

Meeting her at the 7th edition Maisha Conference, Patricia, a former bodybuilder, towers over most people around her. Her easiness during the interview is a clear indicator of her prowess in sensitising the community about HIV.

Patricia, who also has heart complications, says that she has grown with HIV, from a period where it was considered a death sentence to now a time when there ARVs, and people can openly talk about having the virus.

“Research is still ongoing but there are cases where young women are reaching premature menopause., so we do not know if it is the virus or the drugs, experts are still doing research,” she says

Patricia adds that their body structures have changed. She used to be a bodybuilder in her younger years.

“We had nicely shaped bodies, now we’ve added too much weight,” she says

Due to financial constraints, others fail to do the recommended annual medical checkups, hence discovering they have other health complications for example liver complications when it’s too late.

“We heard that taking ARVs will give us bone issues, kidney issues. But because we wanted to be alive, we took the risk. We have reached a point where we cannot walk properly,” she says

Persistent stigma

“In the 90s, there was so much fear and stigma. Once you had HIV it was over, because there were so many billboards about HIV showing skeletons and caskets. So I knew it was over for me, I gave my mother my daughter,” she says

The rate of mother-to-child HIV transmission is at 8.3 per cent as at the close of 2022.

Patricia says that she only told her parents and close friends, who advised her not to tell anyone else.

“The stigma was worse than the Covid period. If you died, you would be wrapped in paper bags and buried. There was so much misinformation. We heard that people went to have their blood “cleaned”. We heard others were taking drugs. We didn’t even know much about the drugs but we knew only the wealthy could afford them,” she says

Due to a lack of sensitisation, the baby she gave birth to was infected with HIV. Things have changed since the mother-to-child transmission has reduced.  

Patricia says that in 2001, generic medications to suppress the HIV virus were taken to Nyumbani Children’s Home.

“The treatment was that people with a CD4 count of below 200 will be allowed to use the ARVs, then later they said 500 and below. But now it is test and start. So even in treatment, we have seen the progress,” she says

On whether research has been done on the effects of ARVs, Dr Lazarus Momanyi, a technical advisor at the National Aids and STIs Control Programme (Nascop), during the 7th edition Maisha Conference said that some of the studies done in Western Kenya by a team from the University of Nairobi have shown that liver impairment amongst people living with HIV is much high.

 “One of the really sad stories about this is despite us clearly recommending in our guidelines as a person living with HIV, you need to have an annual lab panel of tests that include liver function tests, a test of your urine. Unfortunately, people are not having these tests done, and therefore, if you are to screen people living with HIV, you will find a number of them have renal impairment which if not treated or managed could require dialysis or renal replacement,” she says

Dr Momanyi added that they are having discussions on county levels to have some of those tests included in the National Health Insurance Fund (NHIF). 

Body changes

However, Dr Momanyi says that over time, they focused more on putting people on treatment and forgot about changes in the body.

“Every time you come to the facility and your viral load is LDL, we are very happy. We clap for you but we forget there could be other changes in the body. Every time you swallow an ARV, it has to be metabolised by your liver. It has to be excreted out of your body through the kidney, and then through the urine. All these organs over time wear and tear, the body is like a machine. There is a lot of wear and tear,” he says

There is discrimination against older people because of negative and inaccurate stereotypes.

On discrimination by some of the healthcare workers, Dr Momanyi said that a lot of training and sensitisation needs to be done to improve healthcare services.

Dr Jude Otogo, the executive director of the non-profit Regional Centre on Healthy Ageing, said that in older age there is a triple burden: Non-communicable diseases, communicable diseases and disabilities.

“With time our cells stop diving so we become more predisposed.  Older persons who are HIV + have a higher prevalence of non-communicable diseases. Management of IV in parallel to the management of non-communicable diseases,” he said

Dr Otogo said self-medication is highly contributed by access to health services, it is very easy for someone to go to a pharmacy than walk 3-4 kilometres to a health facility.

“We have to make conventional health care services more accessible and affordable. We need a Universal Health Care coverage that is fit for an ageing population,” he says

Addressing ageism

Dr Otogo added that there are World Health Organisation recommendations to address ageism. Also, there are approaches to addressing discrimination that reduce the burden lead to self-medication.

According to the Constitution, an older person is anyone aged 60 years and above. They make up a population of 2.7 million, according to the 2019 census report.

Charity Mwende Kilu, the Assistant Director for Social Development in the State Department for Social Protection and Senior Citizen Affairs, said they already have a policy for older persons which includes thematic arears on health that provide interventions needed.

“We are promoting institutional care and support for older persons. The Government came up with the guidelines on the establishment and management of these institutions. The only challenge is that we have not been able to enforce because we lack the legal framework. The Ministry is coming up with older persons bill so that it can allow us to enforce some of the vises that are happening in these institutions,” she says

Kilu said that the have come up with trained volunteered counsellors who are used as entry points to help reach families where older persons are being abused.

“We have registered older persons’ groups, who providing peer support and income generating activities. Those who are sick help each other” she says

Kilu said that since the older person is being neglected at family levels. They started positive parental Programmes that involves intergenerational dialogues. The most affected are male older persons.

 Medical Services Principal Secretary Harry Kimtai says Kenya bears the 7th highest burden of HIV globally with approximately 1.4 million individuals living with HIV.

Kenya has effectively reduced annual new HIV infections by 78 per cent, plummeting from 101,500 cases in 2012 to approximately 622,154 cases in 2022.