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

在抗逆转录病毒治疗时代，撒哈拉以南非洲的艾滋病毒感染通常被视为一种与老年人无关的疾病，因为它是在青年时期感染的，其后果是在中年时期遭受的。这一观点体现在艾滋病毒调查和监测中的年龄资格限制，以及艾滋病毒预防计划的目标是青年或工作年龄的成年人。虽然全球证据强烈表明老年人继续从事危险性活动，最近在SSA的一个农村社区进行的一项研究表明，50岁以上的成年人中艾滋病毒感染率很高，但SSA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。在SSA扩大抗逆转录病毒治疗（ART）的覆盖范围可能大大提高了感染艾滋病毒的成年人的预期寿命。我们对SSA老年人感染艾滋病毒人数的增加知之甚少，老年人的治疗和服务需求可能与青年人口不同。此外，接受抗逆转录病毒治疗的艾滋病毒感染老年人口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能够降低老年人感染艾滋病毒的风险，并减少艾滋病毒流行对SSA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SSA老年人新发艾滋病毒感染和艾滋病毒治疗可及性的因素，以及艾滋病毒感染和治疗对健康、社会、行为和经济结果的影响。设计了三个具体目标来检验中心假设并实现提案的目标。它们是:

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.