Jan-Walter De Neve1,2, Omar Karlsson3,4, Lelani Coetzee5,6, Henning Schröder1,7, S V Subramanian8,9, Till Bärnighausen1,2,10, Sebastian Vollmer2,11. 1. Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany. 2. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 3. Centre for Economic Demography. 4. Department of Economic History, Lund University, Lund, Sweden. 5. Department of Economics, University of Göttingen, Waldweg, Göttingen, Germany. 6. Department of Economics, University of Pretoria, Hatfield, South Africa. 7. Faculty of Medicine, University of Cologne, Albertus Magnus Platz, Cologne, Germany. 8. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston. 9. Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA. 10. Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa. 11. Center for Modern Indian Studies, University of Göttingen, Waldweg, Göttingen, Germany.
Abstract
OBJECTIVES: To determine whether national antiretroviral therapy (ART) coverage is associated with changes in the living arrangements of older adults. DESIGN: Retrospective analysis using 103 nationally representative surveys from 28 African countries between 1991 and 2015. METHODS: The sample consisted of individuals aged at least 60 years. We investigated how three measures of living arrangements of older adults have changed with ART coverage: the number of older individuals living without working-age adults, the number of older individuals living with only dependent children (i.e. 'missing generation' households), and the number of working-age adults per household where an older individual lives. RESULTS: Our sample consisted of 297 331 older adults. An increase in ART coverage of 1% was associated with a 0.7 percentage point reduction (P < 0.001) in the probability of an older adult living without working-age adult and a 0.2 percentage point reduction (P = 0.005) in the probability of an older adult living in a 'missing generation' household. Increases in ART coverage were also associated with more working-age adults in households with at least one older adult. In our study countries, representing 75% (749 million) of the sub-Saharan population, an additional 103 000-358 000 older adults could be living with working-age adults as a result of increased ART coverage (1%). CONCLUSION: The scale-up of ART has likely led to substantial increases in co-residence between older and working-age adults in Africa. Returns to investments in HIV treatment will be too low, if the social benefits from these changes in living arrangements of older adults are not taken into account.
OBJECTIVES: To determine whether national antiretroviral therapy (ART) coverage is associated with changes in the living arrangements of older adults. DESIGN: Retrospective analysis using 103 nationally representative surveys from 28 African countries between 1991 and 2015. METHODS: The sample consisted of individuals aged at least 60 years. We investigated how three measures of living arrangements of older adults have changed with ART coverage: the number of older individuals living without working-age adults, the number of older individuals living with only dependent children (i.e. 'missing generation' households), and the number of working-age adults per household where an older individual lives. RESULTS: Our sample consisted of 297 331 older adults. An increase in ART coverage of 1% was associated with a 0.7 percentage point reduction (P < 0.001) in the probability of an older adult living without working-age adult and a 0.2 percentage point reduction (P = 0.005) in the probability of an older adult living in a 'missing generation' household. Increases in ART coverage were also associated with more working-age adults in households with at least one older adult. In our study countries, representing 75% (749 million) of the sub-Saharan population, an additional 103 000-358 000 older adults could be living with working-age adults as a result of increased ART coverage (1%). CONCLUSION: The scale-up of ART has likely led to substantial increases in co-residence between older and working-age adults in Africa. Returns to investments in HIV treatment will be too low, if the social benefits from these changes in living arrangements of older adults are not taken into account.
Authors: Sydney Rosen; Bruce Larson; Alana Brennan; Lawrence Long; Matthew Fox; Constance Mongwenyana; Mpefe Ketlhapile; Ian Sanne Journal: PLoS One Date: 2010-09-14 Impact factor: 3.240