Silence, Downgrading and Dependency: the Lives of Older People Living with Hiv in Senegal

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Maruf Hassan
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Silence, Downgrading and Dependency: the Lives of Older People Living with Hiv in Senegal

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In Africa, thanks to the effectiveness of antiretroviral (ARV) treatments which have been generalized since the 2000s, more and more people are aging with HIV. It is estimated that the number of people living with HIV over the age of 50 is expected to triple within 10 years, reaching 6 to 10 million in sub-Saharan Africa . They experience the universal physiological effects of aging, combined with those of long-term drug treatment and viral infection. Aging with HIV in Africa is becoming an increasingly frequent experience – somatic and social, individual and collective. Senegal was the first country in French-speaking Africa to have made antiretrovirals (ARVs) available in 1998. In 2022, people over the age of 50 living with HIV (PAVVIH) represent more than a third of the 31,637 people treated . Some have been there for over 20 years. How do these people and their loved ones experience aging with HIV? How does society manage their health? An anthropological study "Old age and HIV" is currently underway in Dakar and Yaoundé (Cameroon) among people over the age of 70, living with HIV, their relatives and caregivers to analyze the experience and perceptions of HIV. aging with HIV. The first results of the study in Dakar are presented here.

Living with HIV for the long term "We live with it, it's no longer a problem for us, we got used to it, we almost forget that we are sick," says Aminata, aged 70, who has been receiving antiretroviral treatment for 21 years (every first names are fictitious). [ Nearly 80,000 readers trust The Conversation newsletter to better understand the world's major issues . Subscribe today ] In the 2000s, taking HIV treatment was very restrictive. The number of tablets was high – up to 20 tablets a day – and some treatments had distressing side effects. Twenty years later, these treatments, made free, have been simplified and are often limited to taking a single tablet daily. Generally screened when they were in serious condition, these people have regained health and “normal” life; some call themselves “survivors”. They demonstrate very good adherence to care and ARV treatment. But with age, they are faced with various age-related pathologies that occur earlier than in people not infected with HIV. The most common are high blood pressure, diabetes and their complications (heart disease, eye disease, stroke, etc.). These diseases complicate phone number list their medical follow-up and force them to attend various health facilities, in addition to their six-monthly visit for HIV. . Some APHAs testify to difficulties in following treatments for these other diseases which they consider to be less of a priority, especially since the drugs are often expensive.

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At the time of diagnosis, people sometimes confided in a few relatives: the spouse, the person who accompanied them to the consultations or who financed the care. Subsequently, few have revealed it to other people. In general, people consider that “HIV is a disease that should not be disclosed”, because “this disease is not pretty”. The fear of a moral judgment on the circumstances of the contamination remains the main reason for maintaining secrecy. In 2022, HIV remains a stigmatizing disease. Older women living with HIV are often widowed because their spouse died of HIV and because of the age difference related to the context of polygamy. They experience pressure to remarry from family and society, but few of them agree to remarry, for fear that their new spouse will disclose their illness. The children of APHAs are also poorly informed, even if they are adults. “I live as if I didn't have this disease, I keep it to myself, even to my children, I didn't say anything” says Ibrahima, aged 72; others put up with a form of unsaid: “I have never discussed the disease with my children; they know because in 2000 it was my eldest daughter who accompanied me to the hospital, but I never faced them to talk about it,” explains Ousseynou, 84, who has been on ARVs for 22 years. This reluctance is increased in people screened at an advanced age, because of the taboo on the sexuality of the elderly.
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