HIV/AIDS and the living arrangements of older persons across the Sub-Saharan African region

ABSTRACT: Older adults in sub-Saharan Africa face harsh living conditions including severe poverty and an HIV/AIDS epidemic that results in unprecedented rates of mortality. Yet, because of a lack of available data and only a trickle of past studies, the impact of these conditions on living circumstances and subsequent quality of life is unclear. By reducing the availability of children and by increasing grand-parenting obligations, the HIV/AIDS epidemic, in particular, has been hypothesized to have impacts on living arrangements. This study utilizes cross-sectional and longitudinal Demographic and Health Survey (DHS) data from sub-Saharan African countries that are characterized by differing levels of severity of the HIV/AIDS epidemic. Individual level data is examined to assess regional living arrangement distributions. National level data from twenty-two countries is examined to tests hypotheses that the magnitude of the HIV/AIDS epidemic relates to being more or less likely to live with children and grandchildren, and more or less likely to live in specific types of arrangements, like in a skipped generation household. Longitudinal data from nine countries is used to test whether changes in these types of arrangements are more or less common where rates of HIV prevalence have been higher. Despite a small number of observations points, several fairly robust associations are found. For instance, older adults living in countries that have had a high accumulation of AIDS-related deaths are much more likely to live with a double-orphaned grandchild, while the average annual increase in the percent living with a double-orphaned grandchild over a decade or so is much higher in countries that have had higher AIDS prevalence. Although there are several possible explanations for these associations, they are consistent with hypotheses related to the loss of availability of children and the increase in grand-parenting obligations that accompany a severe HIV/AIDS epidemic. Results suggest that the AIDS epidemic could be negatively impacting quality of life for older adults in the region.