Ageing with HIV: Redesigning healthcare policies that are supportive for healthy ageing

A guest post by Julia van Koeveringe, alumna of last year’s 2021-22 MPP cohort


After completing a Master’s in Global Health, I enrolled in the Master of Science in Public Policy and Human Development programme at UNU-MERIT to learn more about policy making and development. I am now working as a researcher for IKNL, an organisation concerned with cancer data, research and policy. Specifically, I’m working on a project that focuses on palliative care and the informal side of care to improve patients’ quality of life.

In this blog post, I share some insights from my research.

Change is needed in HIV healthcare

Healthcare policies and health systems ought to be responsive of changing disease trends. With increased access to effective HIV therapy, and a greying population with increased non-AIDS related conditions, traditional forms of HIV care need revisiting.

Last month, an article that I co-authored (‘The challenge of dealing with non-AIDS comorbidities for people living with HIV’) was published in Global Public Health, the international journal for research, policy and practice. Combining theories on public policy making with skills on academic research in vulnerable settings, as part of the UNU curriculum, has brought this piece together; aiming to enhance improvement on SDG3: Healthy Living For All, in particular with regards to ending the epidemic of AIDS.

For many years, People Living with HIV (PLHIV) have been a neglected group in research and development. Economic and political interests of pharmaceutical companies and countries have obstructed effective healthcare and stirred the political agenda for health policies for long. These insights led me to believe that continuous and impartial research on emerging trends is needed to respond to changing healthcare needs.


Ageing with HIV: opportunities and challenges

People Living with HIV (PLHIV) nowadays grow much older due to the availability of effective HIV treatment (ART – antiretroviral therapy). This ‘greying’ of HIV prevalence however poses emerging challenges for health systems. Non-AIDS defining HIV-associated conditions (NARC), which are associated with long term use of ART and accelerated ageing due to HIV, are now the leading cause of death in PLHIV. However, age-related needs, chronic diseases and HIV status are often addressed as separate diseases in lower resource settings, even though they all impact one another.

My research focused on the interaction between HIV, ageing-related diseases and non-communicable diseases. I investigated the perceived risk of healthcare providers on ageing-related comorbidities their patients living with HIV in Arba Minch, Ethiopia. Ethiopia has a large and still vulnerable population living below the poverty line. HIV/AIDS remains one of the key challenges to development in the country. It impacts both the workforce and life expectancy in Ethiopia.

I think it is very important to be on top of emerging health trends and respond adequately to changing needs. In addition, I think that the lived experiences of health care providers and patients themselves are most important in studying a topic. As a Master of Science in Global Health graduate, I have obtained a lot of knowledge about the optimalisation of healthcare systems, policies and interventions, but I think it is even more important to include the perspectives of the ones that need to benefit from the system. Therefore, together with two PhD students from Mekelle University and Arba Minch University, we inquired about the challenges that HIV care providers face with regards to the ageing trend of their patients.

Key findings from our research

Our study, carried out in four different hospitals in Arba Minch (Ethiopia), revealed four key findings:

  1. Providers and patients indicated the need for more information and counselling on the risk of NARCs and its relation to HIV management.
  2. The HIV-centred approach of current health systems in Ethiopia inhibits healthcare professionals from focusing on co-occurring disease trends. Although living with HIV is becoming more manageable, patients struggle with the increasing burden of NARCs about which they are very worried.
  3. Participants highlighted the need for a blended healthcare system in which NARCs and HIV are managed simultaneously in an integrative health system, in which various specialists work together instead of in isolation.
  4. Participants expressed that they face financial constraints which limit them from managing their health status appropriately.


It is of utmost importance to sustain the global achievements in HIV care and therefore adapt traditional models of care to the emerging challenges of a ‘greying’ and growing population; a commitment to the Sustainable Development Goals means a commitment to ensure healthy ageing for all.