AGING WITH HIV IN SUB-SHARAN AFRICA IN THE ERA OF ANTIRETROVIRAL TREATMENT

项目三：抗逆转录病毒治疗时代的撒哈拉以南非洲艾滋病毒感染者老龄化通常，撒哈拉以南非洲（SSA）的艾滋病毒感染被视为一种对老年人不重要的疾病，因为它是在青年时获得的，其后果在中年时遭受。这一观点表现在艾滋病毒调查和监测的年龄资格限制以及艾滋病毒预防方案针对青年或工作年龄的成年人。虽然全球证据有力地表明，老年人继续从事危险的性活动，最近在撒南非洲一个农村社区进行的一项研究显示，50岁以上的成年人艾滋病毒发病率很高，但撒南非洲缺乏关于老年人艾滋病毒流行率、发病率和风险因素的有力数据，我们对家庭成员感染艾滋病毒对老年人的影响知之甚少。撒哈拉以南非洲抗逆转录病毒治疗（ART）覆盖率的扩大可能会大大增加艾滋病毒感染成年人的预期寿命。我们对撒哈拉以南非洲地区感染艾滋病毒的老年人数量的增加知之甚少，老年人的治疗和服务要求可能与青年人不同。此外，接受抗逆转录病毒疗法的艾滋病毒感染老年人的经济和社会需求以及能力在很大程度上是未知的。我们的长期目标是了解卫生政策如何降低老年人感染艾滋病毒的风险，并减少艾滋病毒流行对撒哈拉以南非洲这一不断增长的人口年龄组的经济和社会福祉的影响。这里的总体目标是阐明导致新的艾滋病毒感染和艾滋病毒治疗在SSA的老年人获得的因素，以及艾滋病毒感染和治疗的影响，对健康，社会，行为和经济成果。三个具体的目标是为了测试中心假设，实现目标的建议。它们是： 1.确定艾滋病毒感染率和发病率，并确定艾滋病毒感染的危险因素在SSA的老年人。 2.确定撒哈拉以南非洲老年人获得艾滋病毒治疗和ART成功的程度和决定因素。 3.确定艾滋病流行对SSA老年人健康、社会、行为和经济结果的直接和间接影响，并确定ART如何改变这些影响。

Project 3: Aging with HIV in Sub-Saharan Africa in the Era of Antiretroviral Treatment Conventionally, HIV infection in Sub-Saharan Africa (SSA) has been viewed as a disease that is in-elevant to older adults, because it is acquired in youth and its consequences are suffered in middle age. This view is expressed in limits to age-eligibility in HIV surveys and surveillance and the targeting of HIV prevention programs to youth or working-age adults. While global evidence strongly suggests that older adults continue to engage in risky sexual activity and a recent study in one rural community in SSA shows high HIV incidence in adults over 50 years of age, strong data on HIV prevalence, incidence, and risk factors in older adults are lacking for SSA and we know little of the consequences for older adults of having family members living with HIV. Expansion of antiretroviral treatment (ART) coverage in SSA is likely to have dramatically increased the life expectancy of HIV-infected adults. We know little ofthe increase in the number of HIV-infected elderly people in SSA, and treatment and services requirements may be different for the elderly than for the youth population. Moreover, the economic and social needs, and abilities, ofthe HIV-infected elderly population receiving ART are largely unknown. Our long-term goal is to understand how health policy can reduce older adults' risk of acquiring HIV, and reduce the impact of the HIV epidemic on economic and social well-being in this growing population age-group in SSA. The overall objective here is to elucidate the factors leading to new HIV infection and HIV treatment access in older adults in SSA, and the effects of HIV infection and treatment, on health, social, behavioral, and economic outcomes. Three specific aims are designed to test the central hypothesis and achieve the goal ofthe proposal. They are: 1. Determlne HIV prevalence and incidence and identify the risk factors of HIV acquisition in older adults in SSA. 2. Identify the extent and determinants of HIV treatment access and ART success in older adults in SSA. 3. Establish the direct and indirect effects ofthe HIV epidemic on health, social, behavioral, and economic outcomes in older adults in SSA, and determine how ART modifies these effects.