SPOTLIGHT: How SA aims to keep people with HIV healthier for longer

South Africa has released its first set of clinical guidelines specifically addressing the needs of older people living with HIV. These guidelines, published in the Southern African Journal of HIV Medicine, aim to help maintain the health and quality of life for this ageing population. The Southern African HIV Clinicians Society developed the guidelines, drawing on the expertise of a dozen experts from fields such as infectious diseases and palliative care.

The guidelines are crucial for South Africa due to the country's aging population of people living with HIV. As of 2025, there are approximately 1.9 million individuals over the age of 50 living with HIV, making up 24% of the estimated 7.9 million HIV-positive people in the country. This number has more than doubled since 2015, when only 800,000 people over 50 were living with HIV. By 2035, the number is projected to rise to over 3.6 million.

The guidelines aim to raise awareness among healthcare workers about the unique needs and challenges faced by older people with HIV. They emphasize the importance of a holistic, geriatric approach to HIV care, taking into account the increased risk of comorbid conditions, polypharmacy, and the potential for earlier onset of non-HIV-related diseases.

The guidelines also address social and behavioural challenges, such as lower rates of HIV testing and prevention tool use among older people, who may be perceived as less susceptible to infection.

By providing a comprehensive schedule for assessment and screening, and focusing on geriatric syndromes like frailty and cognitive impairment, the guidelines seek to ensure that healthcare settings are equipped to manage the holistic needs of older people with HIV. This includes addressing mobility issues, medication management, and ensuring that these patients receive appropriate care and support alongside their HIV treatment.