Five years ago, the international community working
in HIV and AIDS set a target of "universal access to comprehensive prevention programmes, treatment, care and support".

This week that community is meeting again, at the UN High Level Meeting, to review the world's progress in responding to the HIV epidemic and to agree the way forward.

But how can a response be effective when the global picture of the epidemic is skewed - missing out an entire set of people so acutely affected by it?

I am, of course, talking about older people who are left out of HIV statistics and targets.

New infections have led to increasing numbers of people aged 50 and over living with HIV.

However, this has not been recognised.

Neither the 2001 Declaration of Commitment, signed ten years ago at the groundbreaking UN General Assembly Special Session (UNGASS), nor the UN's 2006 Political Declaration on HIV/AIDS makes any reference to older people living with HIV.

In adopting the 2001 Declaration, member states committed that every two years they would report their progress in responding to the epidemic to the UN General Assembly, against 25 core indicators.

But none of these indicators explicitly includes people aged 50 and over, or requests HIV statistics to be broken down by age.

Three indicators - on access to testing, higher risk sex and condom use - are specifically restricted to people aged 15-49.

Requests for prevalence data are also limited to the 15-49 year age group.

Some countries provided HIV statistics

In 2010, member states submitted progress reports.

An analysis of the 119 reports submitted in English shows that some countries are submitting HIV statistics on people aged 50 and over, even though they are not required to do so.

The figures are startling - showing just how at risk older people are of infection. You can read some of the statistics at the bottom of this post.

Because there is no official requirement on how to present HIV statistics on older people, there is no consistency in the way countries do this.

But in total 57 of the 119 reports present HIV statistics on older people (or state that statistics are available) or make other references to older people - reflecting a growing understanding at national level that this age group needs to be given attention.

Despite this, UNAIDS' 2010 Global Report on the AIDS epidemic, which is based on the reports submitted by country governments, does not include any HIV statistics on people aged 50 and over, or make any other reference to older people, either as carers or as people living with HIV.

Why should older people be included in HIV statistics?
The fact is older people are hugely affected by HIV - as carers of family members with HIV and orphaned children, and as people at risk of infection themselves.

Millions of older men and women care for sons and daughters who are living with HIV or for orphaned grandchildren.

In Cambodia, for example, an older parent was the main carer for 80% of adult children who had died as a result of AIDS. [i]

In east and southern Africa, 40-60% of children orphaned as a result of AIDS are cared for by their grandparents, usually their grandmothers.[ii]

If older people are ignored in the response, how can the children in their care be properly fed, clothed and educated? How can they advise young people about safer sex or protect themselves? How can they receive the treatment, care and support they need?

The absence of older people in HIV statistics at global level implies there is no data at all and no recognition by governments of older people's issues.

It means no attention is paid to older people in the response to HIV, meaning many are unable to access services and support.

There is a clear mismatch between what is reported nationally and what is presented at global level.

It is crucial, therefore, that older people are recognised at this week's UN high-level meeting, and that they are included in any subsequent outcome document and any new commitments and targets, so that every single country has to include older people in its HIV statistics collection and programmes.

[i] Committed to caring: older women and HIV & AIDS in Cambodia, Thailand and Vietnam, Chiang Mai, HelpAge International, 2007, p.14

[ii] The state of the worlds children report: women and children, the double dividend of gender equality, UNICEF, 2007


Striking new HIV statistics

Where figures are presented by countries, they provide striking evidence of how older people are at risk from the epidemic:

•In Dominica, 17% of cumulative cases of AIDS (all cases diagnosed since the start of the epidemic) have been in people aged 50 and over.
•In the Netherlands, 28% of people living with HIV are aged 50 and over, and in Sweden and Barbados, 25 per cent.
•In Botswana, men aged 50-54 have the highest prevalence after the 35-39 and 40-44 year age groups, at just under 30 per cent (exact figures not given).
•In Swaziland, 28% of men aged 50-54 have HIV, compared with 20 per cent of men aged 15-49.
•In Sweden, 25% of newly reported cases of HIV and AIDS are in people aged 50 and over.
•In China, 11% of new HIV cases in 2009 were in people aged 50-64 and 4 per cent in people were aged 65 and over.
Some countries have collected HIV statistics on older people against the three indicators focused on the 15-49 year age group. For example:
•In Mozambique, the proportion of people tested for HIV who were 50 or over increased from 5% in 2006 to 7 per cent in 2009.
•In South Africa, the proportion of people aged 50 and over who use a condom has increased since 2005, although people in this age group are far less likely to use a condom than younger people.