Older People and their role in Care Giving in Kenya Background The first case of HIV in Kenya was reported in 1984 and in 1999 the disease was declared a national disaster. Over the years, the responsibility of caring for the growing number of orphaned children and PLHIV is increasingly falling on older people. This places enormous financial and social responsibilities on the older people who in many instances are facing a myriad of challenges some of which include declining incomes due to reduced productivity and age related complications. This technical brief is derived from a situational analysis financed by the National AIDS Control Council (NACC) and conducted in 2011 by HelpAge International. The analysis was carried out in 2 Provinces (i), Nyanza (Nyando District) and (ii) Central (Thika West and Gatundu Districts). The study covered a total of 690 HIV and AIDS affected households. All Respondents were above 50 years of age of which 62% were women. The study documented overwhelming evidence that older people, particularly women, in HIV and AIDS affected households are highly vulnerable to extreme poverty. In most instances they were found to have few productive assets and limited access to financial, medical and other support services. The study also found regional differences with regard to HIV with Nyando recording higher prevalence rates and lower levels of knowledge compared to Thika District. This brief highlights the principal findings of the study as well as the gaps that were identified for future consideration in the fight against HIV.

1. Technical Brief No. 5
Older People and their role
in Care Giving in Kenya
AIDSTechnical Brief No.5
Background
The first case of HIV in Kenya was
reported in 1984 and in 1999 the disease
was declared a national disaster. Over
the years, the responsibility of caring for
the growing number of orphaned children
and PLHIV is increasingly falling on older
people. This places enormous financial
and social responsibilities on the older
people who in many instances are facing
a myriad of challenges some of which
include declining incomes due to reduced
productivity and age related complications.
This technical brief is derived from a
situational analysis financed by the
National AIDS Control Council (NACC)
and conducted in 2011 by HelpAge
International. The analysis was carried
out in 2 Provinces (i), Nyanza (Nyando
District) and (ii) Central (Thika West and
Gatundu Districts). The study covered
a total of 690 HIV and AIDS affected
households. All Respondents were above
50 years of age of which 62% were
women.
The study documented overwhelming
evidence that older people, particularly
women, in HIV and AIDS affected
households are highly vulnerable to
extreme poverty. In most instances they
were found to have few productive assets
and limited access to financial, medical
and other support services. The study
also found regional differences with
regard to HIV with Nyando recording
higher prevalence rates and lower levels of
knowledge compared to Thika District.
This brief highlights the principal findings
Contents
Background 1
Knowledge of HIV and
AIDS among Older People 2
Perceptions of Personal
Risk of HIV Infection
among Older People 2
Personal Risk of HIV
Infection among Older
Carers of PLHIV 2
Older Carers in HIV
and AIDs Affected
Households Experience
Acute financial Stress. 3
Social Isolation, Emotional
and Physical Strain
Experienced by Older
Carers of PLHIV and
Orphans 3
Gaps and Challenges 4
References 4
• 1984 the first case of HIV was reported in Kenya
• 1999 HIV declared a national disaster (GoK)
Only 10% of caregivers can meet
all the needs of OVCYs under their care
Only about 24% of
care givers receive
some form of assistance
from development actors
of older caregivers of
PLWHA live in poverty
earning less than
US$58/month
90% 62.3%of HIV and AIDS infected
households have low levels
of formal education
60%of respondent lacked
adequate and accurate
information on HIV
transmission and prevention
HIV prevalence
among 55 – 64 year age
group estimated at
KateHolt-HelpAgeInternational
Eliza Masika, 72, poses for a photograph at her
home in Kasese, Uganda on the 30th July, 2009.

2. 2 Technical Brief No. 5
of the study as well as the gaps that were identified for
future consideration in the fight against HIV.
Knowledge of HIV and AIDS among
Older People
Majority of the respondents were aware about the
main modes of HIV transmission with over 50% citing
unprotected sexual intercourse with an infected partner.
Awareness on other modes of infection was relatively
low and there were glaring misconceptions about the
transmission of HIV among older people.
Issues such as witchcraft, kissing and sharing food as
modes of HIV transmission were the subject of heated
discussions in Nyando. About 20% of respondents (11%
in Thika and 35% in Nyando) thought that there is a
cure for HIV and AIDS. This, among other observations
revealed glaring information gaps and misconceptions
on HIV and AIDS issues in both Provinces. These
findings were confirmed by field workers in the areas
who attributed this to low literacy levels.
Box 3: Understanding of HIV and AIDS among older People
“Old people here are getting more enlightened about AIDS matters. But
still there are some who still believe that witchcraft and curses cause
AIDS. Others get confused because of being bombarded with a lot of
information without proper explanation. With low education a lot of
explanation is needed.” HIV and AIDS Educator, Nyando District
Awareness with regard to prevention of HIV was found
to be relatively high although some peculiar views were
documented. Condoms were often considered “difficult
to use”, celibacy was considered almost impractical and
faithfulness to one spouse was considered problematic
for men.
Mass media was cited as the main source of information
about HIV and AIDS. Other sources included health
facilities, churches/mosques, public forums and
friends. There was however a pressing need for more
information about Anti-retroviral Treatment, nutrition,
counseling, care and management of HIV and AIDS.
0
10
20
30
40
50
60
70
Source of
Information
Preffered
source of
Information
Figure 1: Source of HIV and AIDS information by percentage of respondents
Perceptions of Personal Risk of HIV
Infection among Older People
Over 75% of respondents thought people in their age
group were at risk but only 34% considered themselves
to be at risk of HIV infection. In Thika District 17.6% of
respondents felt they had a moderate chance of infection
compared to 33.3% in Nyando. Only a minority considered
themselves “high risk”. The reasons provided for the
“high-risk” perception were mainly having multiple
sexual partners and not using condoms. 15.8% of
respondents confirmed having multiple sexual partners
while 12.3% acknowledged not using a condom even
with sexual partners whose status they did not know.
Box 4: Condoms as a method of protection questioned
“I don’t think these condoms can guarantee a person protection against HIV
infection. I hear that even those who use them can also catch the disease.
This disease is difficult to understand”. Older Male, Thika West
Those respondents who considered themselves not to
be at risk of HIV infection reported the main reasons to
be celibacy (38.9%) and being faithful to their sexual
partners (42.6%). However, misconceptions were evident
concerning HIV infection among some sexually active
older respondents.
Box 5: Misconception about Personal Risk
“I know I cannot get infected with HIV. This is because my wife is now
very old and not sexually active. Even when I want to have sex, I look
for equally old women who no longer have sex. I also look for younger
women who are ugly. You see, with such women you are assured to be
the only one sleeping with them.” 57 year old married man, Gatundu
North.
Findings from the baseline showed that older people
were practicing inter-generational sex and often
engaging in high-risk behavior with multiple sexual
partners. The perception of relative risk to HIV infection
was much lower in Nyando District compared to
Gatundu North. The Kenya AIDS Indicator Survey
(KAIS, 2012) shows that HIV prevalence for persons
aged 55 – 64 is at 4.2% compared to 3.3% in the KAIS,
2007 Survey. This illustrated a gradual increase in HIV
infections among older people.
Box 6: Faithfulness as a method of protection questioned
“You know men can never be faithful. As a woman I can easily stay at home
and wait for my husband. For him, the time he steps out of the door, he
now focuses on other women, How can being faithful to a man help?” Older
female, Nyando
>>> Personal Risk of HIV Infection
among Older Carers of PLHIV
Over 29% of respondents thought they were at risk
of being infected by people under their care. Home
Based Care workers emphasized that lack of adequate
information and protective gear puts older people at risk
of HIV infection from those under their care. Over 73%
of carers reported they had received some training on
how to care for PLHIV in various areas which included
nutritional needs, ART, hygiene and sanitation. 57% of
respondents indicated that they used protective gear in
nursing PLHIV.

3. 3Technical Brief No. 5
Older Carers in HIV and AIDS Affected
Households Experience Acute
financial Stress.
were head of
household &
almost 52%
were single
headed .
of older
caregivers of
PLHIV live in
poverty
earning less
than
US$58/month
92% of older people caring for orphans and PLHIV were
found to be living in poverty with the average income
estimated at Ksh5,000/US$58 per month. Small-scale
subsistence farming was cited as the main source
of income for 63% of respondents while only 2.6%
acknowledged receiving a monthly pension. 62% of the
households were single headed either due to separation
or death of a spouse.
88% of respondents were caring for orphans in their
households in Nyando, compared to 44% in Gatundu
North. Collectively, 50.4% of households had more
than 1-2 orphans, 38.7% had 3-5 orphans and 10.9%
had more than 5 orphans. Approximately 76% of
respondents who reported caring for more than 5
orphans were located in Nyando District.
Box 1: Interview with an 82 year old carer of six orphans
A partially blind elderly woman suffering from mobility problems said
that due to the death of her children from AIDS, she had been left with
six orphaned grandchildren aged 3-9 years. Only two of them are at
primary school and she barely covers their costs. One 5 year old orphan
is HIV positive and takes ARVs. She can’t give him or the other orphans
adequate food. Her only source of income is rope weaving. On days
when she is too unwell to do weaving, the orphans go without food.
She receives no support from surviving relatives, as they themselves
are poor. A charity provides occasional food for the one child living with
HIV. The Catholic Church built her current house in 2006, but it is not
big enough for all of them to sleep in. Bedding consists of two old sacks
and a tattered bedsheet. The grandmother sends two children to sleep
in another village each night. She has received no support from other
agencies. Informal Interview, Kochogo South, Nyando district
Financial constraints were given as the main challenge
to accessing modern medicine by respondents taking
care of PLHIV. Only 24.5% of respondents reported
that they received some form of assistance for care of
orphans and/or PLHIV from organisations (government,
NGOs, individuals). Many more organisations were
found to be assisting respondents in Thika/Gatundu
North compared to Nyando. Over 80% of older carers
reported the major needs of orphans to be food, shelter
and clothing. School fees were highlighted to be the
greatest need by 95% of respondents. Only 10% stated
they could meet all the needs of orphans under their
care. There are district disparities evident with more
older carers in Nyando reporting financial constraints in
taking care of all needs of orphans.
Food insecurity and malnutrition was cited as the
causes of stunting and wasting in young children
and was seen to reduce effectiveness of anti-retroviral
therapy for PLHIV. Provision of food for PLHIV was
frequently cited as a burden for older, who were
themselves highly susceptible to malnutrition. Only
12.7% of older carers felt they had the capacity to
provide adequate nutrition for themselves and for
PLHIV.
“the problem of HIV and AIDS has overwhelmed and
impoverished many elderly people, especially women.
Small children are left in the care of their grandparents,
most of whom are poor and sick.”
Due to additional caring workloads, older carers
(especially women) have lesser time for income
generating activities. Further, older women carers
reported that they could not depend on their husbands
income and often found themselves struggling with
multiple roles. Some carers in Nyando reported they had
to take desperate measures such as leasing or selling off
their land to raise income to meet basic needs.
Older carers who in most instances had various age-
related ailments reported that ill health undermined
their capacity to adequately provide for their dependents
leaving them to rely on younger children to supplement
income or find food, as well as care for their sick parents
or siblings.
Social Isolation, Emotional and
Physical Strain Experienced by Older
Carers of PLHIV and Orphans
Older women accounted for 38.3% of caregivers of
PLHIV compared to 5.4% older men. The highest
proportion of PLHIV were the children of carers (33%),
with the remainder consisting of other family members.
Over 95% of carers mentioned that PLHIV under their
care received modern medicine from a government
hospital. However, over 25% of respondents cited
various occasions when there were no drugs readily
available and 28% experience financial constraints in
accessing modern medicine. Side effects of modern
medicine were highlighted as a challenge, as well as
stigma and discrimination from community members.
Study findings show that the highest levels of stigma
were reported in Gatundu North compared to Nyando
district. Over 40% of older carers stated they wanted to
keep secret the status of family members infected with
HIV. A significant number of older carers described
feelings of shame and isolation from their communities,
especially in Gatundu North district. Respondents
reported that social and emotional support from
neighbours and community leaders was often no longer
offered once their relatives were diagnosed with the
disease. Many older male and female carers commented
that they required emotional support, especially from
community leaders. Data from focus groups reveal that
in all surveyed districts, communities were reported to
be more sympathetic to older men as carers of orphans
than older women.
Many respondents reported they had suffered trauma

4. 4 Technical Brief No. 5
from taking care of their sick and dying relatives.
Feelings of desperation, grief, anxiety and stress were
highlighted in coping with death of loved ones and with
surviving orphans. Some older carers lamented that
in their old age, they were no longer able to meet the
demands of raising young children, some of whom have
been used to life outside of rural areas.
The health of older carers interviewed was commonly
poor, with some mentioning physical exhaustion
and neglect of their own health needs, forgoing food
and medicines for orphans and the PLHIV in their
household.
Box 2: Heavy burden of HIV and AIDS care on older women
“If you move around the homesteads where people are living with the
disease, you will find that most of those taking care of the sick are old
women.” Female participant, Nyando.
There is currently no support structure to aid older
carers in the physical aspects of their caring duties (e.g.
heavy lifting). Interviews with NGO staff indicated that
while many recognise physical hardships faced by older
carers, they are unable to assist them due to a lack of
resources. Informal discussions held with Home Based
Care teams and NGO staff highlighted that while the
provision of home care visits for PLHIV are intended to
benefit all members of HIV and AIDS affected families,
attention and support is not specifically provided to
older carers.
>>> Gaps and Challenges
This study found that the demanding tasks of caring
for sick relatives and for orphans compromises older
caregivers’ emotional well-being and reduces time
available for involvement in social and economic
activities. Also, older adults often lack adequate
knowledge, skills, and resources needed for caregiving,
and feel significant stress related to the demands in
their role as carers.
The evidence presented suggests that the groups
involved in this study who are vulnerable to malnutrition
and sickness (PLHIV, orphans and older carers,
many of whom are women) have not been sufficiently
covered or adequately targeted in current government
social protection programmes. Few social protection
interventions in Kenya directly target caregivers, and
those that do, appear to have low levels of coverage,
as reflected in this study. The major challenges to
be addressed for older carers of orphans are meeting
the prohibitive cost of school fees and reducing food
insecurity.
Poor coordination between actors implementing HIV
interventions and the generally low emphasis on the
social, emotional and physical needs of older carers,
orphans and PLHIV by development actors was seen to
be a major challenge in the fight against HIV.
Lack of adequate information on home based care as
well as limited access to equipment for carers was also
seen to be pressing challenges that may have exposed
carers to infection.
In most instances literacy levels of the older people were
seen to be very low thereby raising the need to factor
this in the design and delivery of HIV interventions.
Formerly, older people were considered a “low-risk”
group but the rates of infection are rising steadily in this
age group as indicated in KAIS, 2012. This affirmed
that the risk status of older people was increasing
thus needs targeted approaches to address especially
with regard to their pivotal role of care and support for
PLHIV.
References
1) HelpAge International. 2011. A Situational analysis on HIV
and AIDS Among Older People and Their Role in Care Giving.
Unpublished.
2) HelpAge International. Older People and HIV & AIDS in
Africa. Issue No.5 Article ‘Study reveals high rates of AIDS-
related mortality among older adults in rural Kenya’ based
on a study in Nyanza Province by J.Negin, J. Wariero, R.
Cumming, P. Mutuo and P.M. Pronyk
3) Ministry of Health, Kenya. Kenya AIDS Indicator Survey 2012
Preliminary Report p. 8
HelpAge International helps older people claim their rights, challenge discrimination
and overcome poverty so that they can lead dignified, secure, active and healthy lives.
HelpAge International Africa Regional Office
East, West and Central Africa Regional Development Centre, Off Lower Kabete Road, Off Shanzu Road,
P.O. Box 14888-00800, Westlands, Nairobi, Kenya
Tel: +254 20 2637854 | Mobile: +254 721 361 608 or +254 733 333 246
www.helpage.org
Registered charity number: 288180
Any parts of this publication may be reproduced for non-profit and educational purposes unless indicated otherwise.
Kindly credit HelpAge International and send us a copy of reprinted sections.
Published by CODIT Institute: Anyona S. Gichuru (Editor), Marystella Machimbo (Designer)
Copyright © 2015 HelpAge International
HelpAgeInternational
This technical brief was produced with financial
assistance of Sweden/Norad. However, the views
contained herein are the sole responsibility of HelpAge
International and may not be taken to reflect the position
of Sweded/Norad