Matlho Kabo, Lebelonyane Refelwetswe, Driscoll Tim, Negin Joel
a PhD Candidate (Medicine) at School of Public Health, Sydney Medical School , University of Sydney , Sydney , Australia.
b MD, MPH, is Principal Researcher and Coordinator of the Botswana Combination Prevention Project - Ministry of Health , Gaborone , Botswana.
SAHARA J. 2017 Dec;14(1):31-37. doi: 10.1080/17290376.2017.1374879.
The roll out of antiretroviral therapy in Botswana, as in many countries with near universal access to treatment, has transformed HIV into a complex yet manageable chronic condition and has led to the emergence of a population aging with HIV. Although there has been some realization of this development at international level, no clear defined intervention strategy has been established in many highly affected countries. Therefore we explored attitudes of policy-makers and service providers towards HIV among older adults (50 years or older) in Botswana.
We conducted qualitative face-to-face interviews with 15 consenting personnel from the Ministry of Health, medical practitioners and non-governmental organizations involved in the administration of medical services, planning, strategies and policies that govern social, physical and medical intervention aimed at people living with HIV and health in general. The Shiffman and Smith Framework of how health issues become a priority was used as a guide for our analysis.
Amidst an HIV prevalence of 25% among those aged 50-64 years, the respondents passively recognized the predicament posed by a population aging with HIV but exhibited a lack of comprehension and acknowledgement of the extent of the issue. An underlying persistent ageist stigma regarding sexual behaviour existed among a number of interviewees. Respondents also noted the lack of defined geriatric care within the provision of the national health care system. There seemed, however, to be a debate among the policy strategists and care providers as to whether the appropriate response should be specifically towards older adults living with HIV or rather to improve health services for older adults more generally. Respondents acknowledged that health systems in Botswana are still configured for individual diseases rather than coexisting chronic diseases even though it has become increasingly common for patients, particularly the aged, to have two or more medical conditions at the same time.
HIV among older adults remains a low priority among policy-makers in Botswana but is at least now on the agenda. Action will require more concerted efforts to recognize HIV as a lifelong infection and putting greater emphasis on targeted care for older adults, focussing on multimorbidity.
与许多几乎全民都能获得治疗的国家一样，博茨瓦纳推行抗逆转录病毒疗法已将艾滋病毒转变为一种复杂但可控制的慢性病，并导致出现了一批携带艾滋病毒的老龄人口。尽管国际层面已部分认识到这一发展情况，但许多受影响严重的国家尚未制定明确的干预策略。因此，我们探讨了博茨瓦纳政策制定者和服务提供者对老年人（50岁及以上）中艾滋病毒问题的态度。
我们对15名来自卫生部、参与医疗服务管理的医生以及非政府组织的相关人员进行了定性面对面访谈，这些人员参与了针对艾滋病毒感染者及一般健康状况的社会、身体和医疗干预的管理、规划、战略和政策制定。我们以希夫曼和史密斯关于健康问题如何成为优先事项的框架为分析指南。
在50 - 64岁人群中艾滋病毒感染率达25%的情况下，受访者被动地认识到携带艾滋病毒的老龄人口所带来困境，但对该问题的严重程度缺乏理解和认知。一些受访者中存在对性行为持续的潜在年龄歧视污名。受访者还指出，国家医疗保健系统在提供服务时缺乏明确的老年护理。然而，政策制定者和护理提供者之间似乎存在一场争论，即适当的应对措施是应专门针对感染艾滋病毒的老年人，还是更广泛地改善老年人的医疗服务。受访者承认，博茨瓦纳的医疗系统仍然是针对单一疾病配置的，而非针对并存的慢性病，尽管患者（尤其是老年人）同时患有两种或更多疾病的情况越来越普遍。
在博茨瓦纳，老年人中的艾滋病毒问题在政策制定者那里仍然未被列为优先事项，但至少现在已被提上议程。要采取行动，需要更协调一致的努力，将艾滋病毒视为一种终身感染，并更加重视针对老年人的靶向护理，重点关注多种疾病并存的情况。
