Older persons (ops) are being diagnosed with HIV. This coupled with people living longer due to improved care and treatment for HIV and AIDS, absolute numbers of older people with HIV is increasing. Mildmay Uganda (MU) has ever enrolled over 26,000 clients, 11% of whom are 50 yrs and above (with 76%, 19% and 4% aged 50-59, 60-69 and 70+ years respectively). 49.5% are female, 50.5% are males, 50.5% are married and 25 % are widowed the rest are single. About 5% of the Ops in HIV are also carers of HIV positive own or grand children.

A descriptive exploratory study employing collection and analysis of qualitative and quantitative data was conducted in Budaka, Kamwenge and Luwero districts to assess inclusion of ops into HIV responses during the health systems strengthening strategy in Uganda. HIV positive ops and HIV care services providers were interviewed; ART and treatment guidelines were reviewed.

Specific challenges of HIV positive OPs include late diagnosis for HIV due to stigma and misdiagnosis ; 70% of ops had their CD4 done within the same year of enrollment and the average CD4 was 289, median 210 (IQR 32-927), 55% at WHO stage 2 and 32% at Stage 3 and 4 at enrollment. Ops have limited independence in Activities of daily living affecting their self care and productivity leading to poor health and food insecurity. Senile and HIV Associated Dementia and stress affect some of the ops adherence to medication. Over 3% of the Ops attended the psychiatric clinic with depression related conditions. Multiple diseases are common among the ops; 26% of the ops had at least one episode of hypertension and 2.6% an episode of Diabetes Mellitus leading to pill burden. Age and HIV related hearing and Vision loss and sometimes total blindness are common. Sexual desire was common yet many were widowed. Analysis of sexual activity for especially the singles and widowed indicated that 35% are sexually active,83% of whom are male but 30% of the married had not disclosed to their sexual partners. Social support was also a challenge, 25% of the ops relied on neighbors or maids for help. HIV service providers expressed challenges in prescribing ART and other HIV related treatments to ops.

The health systems strengthening approaches need to include human resource for comprehensive HIV care of ops’ specific concerns.