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Ageing during the AIDS epidemic in rural Uganda: the impact on older people

J. Seeley1, G. Tumwekwase2, E. Kabunga2, R. Nalugya2, T. Kiwanuka2, B. Wolff2, S. Foster3, H. Grosskurth4

1University of East Anglia, School of Development Studies, Norwich, United Kingdom, 2MRC/UVRI Research Unit on AIDS in Uganda, Social Science, Entebbe, Uganda, 3Boston University School of Public Health, Department of International Health, Boston, United States, 4MRC/UVRI Research Unit on AIDS in Uganda, Head of Unit, Entebbe, Uganda

Background: The impact of HIV/AIDS on older people is often portrayed as bound up in the care of grandchildren left when their parents die. Anecdotal evidence however suggests various other ways in which HIV may also affect the elderly, but few studies have examined the agency of the elderly in actively coping with these problems. This study aimed to elucidate factors which both assisted and hindered their ability to cope with HIV/AIDS.
Methods: The MRC/UVRI Research Unit on AIDS has since 1989/1990 collected demographic data from a population cohort of 18,000 people in South-West Uganda. Among that cohort 3% of people are aged over 70. Longitudinal data from ethnographic studies in 1991/1992 and 2006/2007 with 26 households drawn from the cohort provide data on eight older people (seven women and one man) who are now over 70, illustrating the challenges that they face in a world changed by AIDS.
Results: Seven of the eight had lost children and grandchildren to AIDS, the majority of whom had provided support for the elderly person. Five of the elderly had orphan grandchildren they had taken in. The nursing care of four, who were infirm, had been adversely affected by the premature deaths of their children. Four had lost substantial income because of AIDS-related costs. However, the majority had found support and companionship from other relatives and friends as well as drawing on their own emotional and material resources. The older man was actively seeking a new wife. All continued to provide advice, and some support, to others in the community.
Conclusions: Many older people’s lives have been deeply affected by the AIDS epidemic in Uganda through the loss of partners and younger relatives. Higher socioeconomic status and reciprocal relationships were particularly valuable in sustaining older people; elders without these two factors fared particularly badly.

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