Continued neglect of ageing of HIV epidemic at UN meeting

On June 10, 2011, the UN HIV/AIDS meeting in New York, USA, concluded with a set of commitments including to redouble efforts to achieve universal access to prevention, treatment, and care. As you report (June 18, p 2055),1 integration was highlighted as the way forward for the epidemic’s response. The declaration, however, missed an opportunity to acknowledge the integration needed to address the reality that, as more people are put on treatment and as survival on treatment is enhanced around the world, a growing proportion of people living with HIV will be classified as elderly.2

UN data have focused on those aged 15–49 years but, across the world, the epidemic is affecting those aged 50 years and older more than ever before. By 2015, at least half of those living with HIV in the USA will be aged 50 years and older. In sub-Saharan Africa, there are 3 million people living with HIV aged 50 years and older, representing more than 13% of the region’s HIV cases.3

With the ageing of the epidemic, HIV/AIDS has become a complex chronic disease characterised by increasing rates of comorbid conditions including liver and renal disease, cancers, osteoporosis, and neurocognitive and cardiovascular diseases.4 The vertical AIDS funding approach has meant that AIDS clinics have training and resources to deal with AIDS-specific conditions, but lack access to effective diagnostics and treatments for these comorbid disorders.

The UN meeting was tasked with charting the future course of the global HIV response, yet failed to mention the ageing of the pandemic. It acknowledged the need for a more integrated approach, but centred mainly on infectious diseases and reproductive and child health. The call for integration is appropriate, but should focus on strengthening the response to non-communicable diseases in developing countries, building on existing efforts to develop HIV chronic-care models.5