- South Africa will soon have the world’s largest population of people aging with HIV.
- We conduct a mixed methods study examining HIV risk and protective factors among adults over 40.
- A gendered, life course and contextual theoretical approach to HIV vulnerability is presented.
- Factors such as celibacy, sexual desire, labor migration, poverty and pensions are considered.
- HIV prevention programming for older adults attentive to life course stage and context is needed.
South Africa has the highest number of people living with HIV in the world (over 6 million) as well as a rapidly aging population, with 15% of the population aged 50 and over. High HIV prevalence in rural former apartheid homeland areas suggests substantial aging with HIV and acquisition of HIV at older ages. We develop a life course approach to HIV vulnerability, highlighting the rise and fall of risk and protection as people age, as well as the role of contextual density in shaping HIV vulnerability. Using this approach, we draw on an innovative multi-method data set collected within the Agincourt Health and Demographic Surveillance System in South Africa, combining survey data with 60 nested life history interviews and 9 community focus group interviews. We examine HIV risk and protective factors among adults aged 40–80, as well as how and why these factors vary among people at older ages.
- South Africa;
- Life course;
- Global health