title: An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa.
abstract: BACKGROUND
  Despite the severe impact of HIV in sub-Saharan Africa, the health of older people aged 50+ is often overlooked owing to the dearth of data on the direct and indirect effects of HIV on older people's health status and well-being. The aim of this study was to examine correlates of health and well-being of HIV-infected older people relative to HIV-affected people in rural South Africa, defined as participants with an HIV-infected or death of an adult child due to HIV-related cause.
  
  
  METHODS
  Data were collected within the Africa Centre surveillance area using instruments adapted from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE). A stratified random sample of 422 people aged 50+ participated. We compared the health correlates of HIV-infected to HIV-affected participants using ordered logistic regressions. Health status was measured using three instruments: disability index, quality of life and composite health score.
  
  
  RESULTS
  Median age of the sample was 60 years (range 50-94). Women HIV-infected (aOR 0.15, 95% confidence interval (CI) 0.08-0.29) and HIV-affected (aOR 0.20, 95% CI 0.08-0.50), were significantly less likely than men to be in good functional ability. Women's adjusted odds of being in good overall health state were similarly lower than men's; while income and household wealth status were stronger correlates of quality of life. HIV-infected participants reported better functional ability, quality of life and overall health state than HIV-affected participants.
  
  
  CONCLUSIONS
  The enhanced healthcare received as part of anti-retroviral treatment as well as the considerable resources devoted to HIV care appear to benefit the overall well-being of HIV-infected older people; whereas similar resources have not been devoted to the general health needs of HIV uninfected older people. Given increasing numbers of older people, policy and programme interventions are urgently needed to holistically meet the health and well-being needs of older people beyond the HIV-related care system.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, R618 Enroute Somkhele, Mtubatuba 3935, South Africa. mnyirenda@africacentre.ac.za
authors.forename: Makandwe
authors.initials: M
authors.lastname: Nyirenda
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
authors.forename: Jane
authors.initials: J
authors.lastname: Falkingham
authors.forename: Portia
authors.initials: P
authors.lastname: Mutevedzi
authors.forename: Victoria
authors.initials: V
authors.lastname: Hosegood
authors.forename: Maria
authors.initials: M
authors.lastname: Evandrou
authors.forename: Paul
authors.initials: P
authors.lastname: Kowal
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D006299:Health Services for the Aged / Q000191:economics / Q000592:standards; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011159:Population Surveillance; D011788:Quality of Life / Q000523:psychology; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D044966:Anti-Retroviral Agents