[Growing old with HIV in Senegal: an anthropological perspective for a public health policy].

Introduction: Thanks to the effectiveness of antiretroviral treatment (ART), more and more people in Africa are aging with HIV. In Senegal, 34% of people living with HIV (PLHIV) who received ART were 50 years of age or older in 2022. As people age, their medical, psychological, and social needs gradually change and increase. This article presents the results of an anthropological study that aimed to describe and analyze the living conditions and care of PLHIV aged 70 and over in urban areas, in relation to the health and social context. Materials and methods: The ethnographic study was conducted from 2022 to 2023 in the Dakar metropolitan area. The study focused on 31 older people living with HIV (OPLHIV), including 14 women, with an average age of 72 (maximum age 90). The median duration of ART was 16 years (maximum: 22 years). Six family caregivers, four community mediators, one nurse, and five doctors (including a geriatrician) were also interviewed, as well as the main national officials responsible for the fight against AIDS. Results: The OPLHIV who were interviewed reported habituation to HIV and demonstrated excellent adherence to ART. However, persistent social stigma surrounding HIV continues to affect their daily lives, leading to various forms of self-exclusion and strategies to keep their illness secret. Medically, they are all in virological remission; however, they face multiple comorbidities and functional disabilities that lead to increased healthcare costs. Economic insecurity and inadequate social protection systems lead to increased dependence on loved ones. Families are the main providers of care. However, the attention given to the elderly depends on the nature and quality of the relationships they have built throughout their lives. Conclusion: This research contributes to anthropology's analysis of healthcare systems and their capacity to care for specific populations. From a public health perspective, the findings of this analysis call for health facilities, community stakeholders, and health authorities to consider the unique health and social needs of OPLHIV to enable them to age with dignity.