With HIV/AIDS leading to growing numbers of adult deaths, the extended family is likely to play an increasingly important role in caring for the sick and orphaned. It has been hypothesized that this burden falls most heavily on the elderly, which could have an adverse effect on their welfare. Yet very little research has been carried out in this area. Data collected by the Kagera Health and Development Survey, carried out in 1991-94 by the World Bank in Kagera Region, Tanzania, are well suited to analyse the impact of AIDS mortality at the family level and on the welfare of the elderly

As background for the ADF 2000, UNAIDS supported further analysis of these data to explore (among other things) the impact of HIV/AIDS on the elderly, and the coping mechanisms employed by that age group. This paper presents the findings of that analysis, which show that the impact on the physical well-being of the elderly is less in Kagera than may have been expected in such a high-prevalence area. The policy implications are that household wealth and community infrastructure—such as the access to health services and improved roads—may play a more important role in the welfare of the elderly than does the death of an adult. This has farreaching
consequences for the planning of services in the AIDS era and suggests the need for a cross-sectoral approach to ensure adequate access to public services.