To our knowledge, there are no studies that have assessed the prevalence rates of HIV and its impact on the health and well-being of the elderly people in the Ghanaian setting despite the increasing growth of the elderly population and the significant role(s) they play in both social and family settings.
Undocumented reports indicating a rise of older people (>60 years old) on admission at both the SME Ward and the Medical Wards, Department of Medicine and Therapeutics, KBTH among the elderly raises a major public health concern in the era of global HIV/AIDS pandemic. Notably, HIV/AIDS was not included in the cause(s) of death among the elderly emphasizing the perception that the elderly are at a little or no risk of HIV infection.
Our results of 4.18 % sero-prevalence rate among the elderly people on admission at the Wards suggest that HIV may pose a significant problem and that the detection and diagnosis of HIV among elderly people may remain unrecognized during their lives. The reason(s) for the failure of “early” detection of HIV among the elderly cannot be discerned from our study. However, one of the reasons may be the misconception of the association of the elderly with HIV. In the Ghanaian traditional society, the elderly are held in high esteem because of the leading and significant roles they play as heads of families, “fountain(s)” of wisdom, and roles in conflict resolutions. As such, many Ghanaians mistakenly believe that elderly people are not at risk and do not engage in risky behaviours. Another reason may be the failure of clinicians and/or physicians to document factors, such as homosexuality, previous history of drug use, condom use, and multiple sexual partners that are associated with HIV in elderly people. Although only three study participants identified as homosexual, two of them tested positive for HIV-1, suggesting that known HIV risk factors are also relevant in an elderly population. In addition to just not considering HIV in older patients, it is also possible that clinicians attribute symptoms of opportunistic infections to common aging-associated co-morbid conditions. Further studies are needed to better define the sero-prevalence of HIV in Ghanaians aged 50 and older.
The participants in this study demonstrated a significant lack of knowledge about HIV/AIDS and STI acquisition and transmission as well as ignorance of their own HIV status and risk. These findings should prompt further efforts to educate older Ghanaians about sexual health and to increase awareness among health care providers that HIV/AIDS in the elderly population is a salient and underappreciated issue.
The overall sero-prevalence of HIV among the elderly patients on admission at KBTH (4.18 %) was higher than the sero-prevalence in the general population (1.37 %) and that of similar studies in Cameroon (2.6 %) [12]. The result is comparable to studies conducted in north-western Ethiopia (5 %) [21], but lower than the reported sero-prevalence of HIV in elderly individuals in Tanzania (15 %) [20]. The sero-prevalence of HIV infection among the elderly people admitted at both SME/Medical Wards, KBTH suggests that HIV is likely prevalent in the elderly inpatient populations in other districts. Further studies to be done among the elderly inpatient populations in other health facilities in Ghana to measure the sero-prevalence and define the risk factors associated with HIV infection in this valued group.
The risk of HIV did not correlate with increasing age, however, elderly people aged > 75 years on admission tended to have a higher proportion of HIV infection (Table 1). Similar findings were noted in a study conducted by Mtei & Pallangyo, 2001 in Muhimbili Medical Center, Dar es Salaam, Tanzania. The reason(s) for this disparity cannot be discerned from this study and hence, there is the need for further studies to be done to define the impact of HIV on the health and well-being of elderly people in the population.
Another finding of interest reported herein in this study is that a greater number of sero-positive participants (n = 33 out of 46) were in the informal employment sector. They consisted mainly traders who travelled long distances for several weeks to engage in trading activities. A higher HIV sero-positivity in traders may be attributed to separation from partners and family, peer influence, alcohol and drug use, low perceived vulnerability to HIV infection and freedom from social norms. The higher sero-prevalence among this group, especially traders who travel long distances and spend several weeks away from home is suggests that the traders may constitute a bridge or core population in the spread of HIV and other STIs which would be consistent with existing literature [24–26]. This finding presents another opportunity for further research to investigate the sero-prevalence of HIV in elderly traders and any correlation with geographic spread of the infection.
As documented in other studies, condom use was rare in this population of elderly inpatients [27–29]. Of the 46 participants who tested positive for HIV, 43 reported no history of condom use during sexual intercourse.
There are many limitations to this study. The small sample size, inability to collect information on sexual practices prior to admission, likely under-reporting of sexual activity, alcohol use and other risk behaviours as a result of the face-to-face interview, failure to explore or define the effects of separation from families and cultural factors in predicting risk behaviours of elderly people, and the inability to determine CD4 counts and viral loads all limit the interpretation and generalizability of the data. Further studies need to be done to verify the results presented herein and also determine the exact prevalence of HIV among the elderly in the country.