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Public research showcase reveals how to age successfully in Africa

- Wits University

A ‘whole of society’ approach is needed to address health issues as populations in Africa age.

Research from rural Mpumalanga that explores health impacts on ageing populations was presented at Wits University on Tuesday, 6 February 2024. [Click here to watch the livestream recording. Passcode: y+mPHg2n].

Findings can inform health and development policies to achieve better outcomes for those ageing in South Africa and beyond. 

Ageing and Dementias in Southern Africa: Addressing inequities over the life course showcases the latest research from the HAALSA community study in Agincourt, Mpumalanga. HAALSA, underway for some 10 years, stands for Health and Ageing in Africa: Longitudinal Studies in South Africa.

Now in its fourth successive iteration (i.e., a longitudinal study), HAALSA is an enduring research project by the SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), the Harvard Center for Population and Development Studies, the Southern Africa Labour and Development Research Unit (SALDRU) at UCT, and the South African Population Research Infrastructure Network (SAPRIN).

HAALSA takes a ‘whole of society approach’ to address vital issues as populations age in African contexts. Since 2014, the research has examined the intersection and impact of HIV/AIDS, chronic non-communicable diseases, and multimorbidity on older people in rural Mpumalanga. In the next study phase, cognitive change, and dementias – affected by these conditions – will be a central focus, and their impacts on social and economic productivity.

Professor Steve Tollman of Wits-Agincourt says: “By ‘whole of society’, we mean a comprehensive approach to healthy and productive development right across the life course - from the earliest years, into adulthood and later.

Ending neglect of HIV in older adults 

Some of these findings include the fact that sexually risky behaviour in older people can lead to HIV acquisition and transmission. However, there is a dearth of HIV prevention programmes targeting older people, as well as high levels of stigma.

In a recent trial comparing three different types of home-based HIV testing – rapid testing with counselling, HIV self-testing, or both rapid testing with counselling and self-testing – results suggested a preference for HIV self-testing, identified no negative impacts of HIV self-testing on linkage to care for HIV, and found those in the self-testing arms reported significantly lower depressive symptoms.

Professor Kathleen Kahn of Wits-Agincourt, who led the home-based HIV testing trial, says, “We are now evaluating the need for PrEP [pre-exposure prophylaxis] among people over 40 years. Initial analyses suggest that 44% of people in this age group may benefit from PrEP, based on current South African guidelines. We now plan work to better understand and test ways to deliver this highly effective prevention tool to those older adults who need it.” 

How cash transfers and social grants help the elderly

Further fascinating insights from early investigations reveal that cash transfers and social grants may enhance older people’s health and cognition (this is thinking, attention, language, learning, memory, and perception – all essential to effective functioning).

Tollman says, “In this newly funded phase - supported by the US National Institutes of Health partnering with our key South African funding partners – we plan to expand the focus on cognitive ageing and dementias. The resulting evidence from HAALSA will not only convey insights from a region of the world where ageing is not well understood but can be harmonized with other studies of dementia and ageing in low-, middle-, and high-income countries, helping to shed light on the nature of ageing within a global context.”

The expansion of HAALSA nationally – with partners at SALDRU-UCT and SAPRIN-SAMRC/DSI – will enable further longitudinal and nested studies to address questions that no one study can answer alone.

As of now, data and evidence generated over 10 years from rural Mpumalanga is embedded within a Health and socio-Demographic (HDSS) platform and can then reveal critical insights into the state of growing old in Africa – and, importantly, how science suggests we do this equitably and successfully.