AUTHOR=Nyirenda Makandwe , Sukazi Sizakele , Buthelezi Cebo , Hanass-Hancock Jill 

TITLE=“A frightening experience, especially at our age”: Examining the neglect and abuse of older persons in HIV prevention and care programs

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1061339

DOI=10.3389/fpubh.2023.1061339

ISSN=2296-2565

ABSTRACT=Background
As the global population ages and the HIV pandemic matures, a growing number of older persons aged ≥50 years are becoming increasingly vulnerable to acquiring HIV. Unfortunately, older persons are often neglected and left out of sexual health programs and services. This study explored the experiences of older persons living with and without HIV in accessing prevention and care services, and how those experiences translate into the neglect and abuse of older persons. The study also explored older people’s perspectives on community responses to HIV in older people. 
Methods
This cross-sectional study used a mixed methods approach. Data presented here are from 37 individuals who participated in focus group discussions conducted in phase 2 in 2017/2018 across two communities in Durban, South Africa. Using an interview guide and thematic content analysis, salient themes regarding attitudes to HIV in older persons and factors of access to HIV prevention and cares services for older persons were analysed. 
Results
Study participant’s mean age was 59.6 years. Major themes emerging from the data included: factors impacting HIV prevention and transmission in older people; community responses to HIV contributing to abuse of older people; and structural drivers of abuse in older people living with HIV (OPLHIV). Knowledge about HIV and how to protect themselves from HIV was limited among participants. Older persons were frightened to acquire HIV in older age as they feared judgement and discrimination for getting HIV at that age. OPLHIV reported frequently experiencing community stigma and poor staff attitudes and practices at health facilities, such as a triage health delivery system which fueled community stigma. Participants also experienced neglect, verbal, and emotional abuse at healthcare facilities. 
Conclusion
Although there were no reports of physical and sexual abuse of older persons in this study, this study shows that despite decades of HIV programmes in the country, HIV-related stigma, discrimination, and disrespect of older persons remain pervasive in the community and at health facilities. As an increasing number of persons age and live longer with HIV, the neglect and outright abuse of older persons needs urgent policy and program interventions.