Overlooked heroines

“I worry about my grandchildren. I know how quickly you can get infected with HIV,” reports Alice Makhaye. The 75-year-old woman lives in the Chesterville Township near Durban, South Africa. Two of her daughters have died of AIDS in the past few years, and her sons-in-law are also infected. Now, she is taking care of her three grandchildren herself. “I got infected when taking care of my daughters – I wasn’t paying enough attention. I didn’t know about AIDS back then and was not using plastic gloves.” She remembers having an open wound once, and thinks that was when it happened.

Often, elderly women get infected when taking care of the terminally-ill. They not only lack plastic gloves, clean water and the disinfectants, but also recognise the symptoms of their own infection too late. Local health care workers mistake early symptoms of HIV infection – such as fatigue, forgetfulness, shortness of breath, sleeplessness or weight loss – for mere symptoms of old age.

Alice Makhaye initially did not tell her neighbours anything when her daughters and sons-in-law became infected. She worried about becoming an outcast, but she eventually spoke out. “Sooner or later, word would have gotten out. You can see when young people are infected.”

Now that the stigma surrounding AIDS has lessened, the elderly lady at least no longer feels she has to deal with her problems on her on. She receives support from MUSA, a non-governmental organisation that has been calling attention to the needs of the elderly in KwaZulu Natal for years. MUSA is supported by HelpAge Deutschland. MUSA helps the elderly take care of adults infected with HIV/AIDS and their children. But the organisation is not strong enough to reach everyone who suffers a fate similar to Alice Makhaye's.

Up to now, international statistics on HIV/AIDS have systematically overlooked the elderly. Only people between the age of 15 and 49 are recorded. The elderly are simply not counted among the victims of the pandemic, and therefore do not receive assistance.

Weak immune systems

Only recently has there been an attempt to understand the situation of senior citizens better. According to UNAIDS, 2.8 million people over the age of 50 have HIV/AIDS worldwide. First research shows that the infection is spread evenly across all age groups over 50. Statistics from health centres in Kenya, Sudan, and Zimbabwe were analysed by HelpAge International, and the data show that rates of infection are actually higher among senior citizens than among younger age groups.

The elderly remain sexually active, and that is not different in developing countries. Women are especially vulnerable to HIV/AIDS. After menopause, vaginal skin becomes thinner and hence more vulnerable. People do without condoms once the risk of pregnancy no longer exists, which facilitates the transmission of the virus. Traditions such as ritual cleansing through sex after the death of the husband or the “inheritance” of wives also increase the risk.

Making things worse in poor countries, families with a number of infected members have to decide who to buy medicine for. The elderly are left to their own resources – regardless of whether they became infected during sex or while taking care of the infected.

Psychological pressure is great. The elderly suffer from feelings of guilt, social stigmas and isolation. In some regions, they are accused of being partly responsible for the death of a son or daughter because they tolerated “immoral” conduct. The more the elderly become outcasts, the thinner their social network becomes until they are unprotected and vulnerable. Elderly women are accused of being witches, physically abused, and driven out of their communities.

Nonetheless, awareness-raising campaigns almost exclusively focus on young people. Grandmothers, however, could – and should – play a crucial role in raising awareness among their grandchildren.

Pillars of society

Unfortunately, people in most of the countries affected have yet to realise that society would long ago have collapsed without the generation of grandparents. South of the Sahara, two thirds of HIV/AIDS patients are taken care of by their parents, who are often old and feeble themselves. Grandparents take care of more than half of all AIDS orphans. Elderly women do most of the job.

Many of them cannot handle both the care of their adult children and their grandchildren. Moreover, there are farm animals and fields to tend to. Often, the aged lack the strength to handle all of these tasks. They regularly spend every last penny on medicine, school uniforms, or caskets and funerals when someone passes away. Many of them go into debt. Elderly women also despair when their inheritance is withheld by the families of their deceased husbands or sons-in-law.

Politicians have to act quickly in the interest of the elderly and millions of AIDS orphans. Experience has shown that an intergenerational approach is needed in the battle against HIV/AIDS. All campaigns and policies must involve the elderly.

This generation also needs a way to earn its livelihood both for itself and the remaining family. In addition, neighbourhood funeral-societies need to be promoted to reduce the economic burden of death. Properly working irrigation systems would be of great help to grandparents and great aunts in their daily work – and so would bicycles. But the elderly also need access to state and private health services. And they need support to help them take care of those affected with AIDS at home and to feed the children.

Minimum incomes

Above all, social pensions systems and some type of state support for child care at home are urgently needed for all grandparents to become able to feed all of their grandchildren and send them to school. South Africa is already taking steps in this direction. Elderly women above the age of 60 receive a minimum income of around € 80. In addition, each orphan receives € 10.

Experience shows that the elderly are not the only ones who benefit from suchfunding; other family members also benefit, especially children. In South Africa, girls who live in households that enjoy such state support are three to four cm taller than girls who live in households headed by grandparents without such funding. Psychological effects are also important: the elderly regain some control over their lives.

Senior citizens use the minimum incomes not only for healthcare and food, but also for education. In Zambia, a GTZ project with such cash subsidies was quite successful. The number of AIDS orphans who dropped out of school was reduced.

Unfortunately, good policy often has an uphill battle against stubborn bureaucrats and widespread discrimination. In South Africa, MUSA repeatedly had to fight with officials who refused to disburse funds to eligible senior citizens without birth certificates. In such cases, MUSA had to take these senior citizens to a doctor for an assessment of their age based on their physical development. Alphabetisation classes and counselling for senior citizens help them understand and fill out documents.

Studies conducted by the International Labour Organisation (ILO) estimate that the cost of such a governmentally guaranteed pension system would not even amount to two percent of gross domestic product in most developing countries. But so far, too few countries have seriously taken up the battle against poverty among senior citizens. Cash transfers are a good remedy, and they are especially needed where the HIV/AIDS pandemic has returned grandparents to their former roles as crucial pillars of society.