Research on aging, dementia and care in later life · free to read and cite

Research · for HIV & sexual health organisations

Growing Older with HIV: Later Diagnoses, More Conditions, Gaps in Care

Published 2026-10-16

Effective HIV treatment has turned a once-fatal infection into a long-term condition, and the people living with it are growing older. Worldwide, the share of people living with HIV who were aged 50 or over doubled from 8% in 2000 to 16% in 2016[1]; in England, more than half of people in HIV care are now 50 or over[2]. The health services, social care and support around them have not caught up.

Many of the people now in their 50s, 60s and 70s with HIV were diagnosed when there was no effective treatment, and lived through years of losing friends and partners. Others are newly diagnosed in later life, often late, because few people think to offer an older person an HIV test. Both groups are reaching the age when heart disease, diabetes, memory problems and frailty become common, and many are doing so with less money, fewer family ties and more stigma than their peers. This study brings together evidence from several countries on what aging with HIV looks like, and on where services are falling short.

52%of people receiving HIV care in England in 2024 were aged 50 or over, up from 32% in 2015[2]
61%of people aged 65 and over newly diagnosed with HIV in England in 2024 were diagnosed late, against 42% of all new diagnoses[2]
80%of the estimated 5.7 million people living with HIV aged 50 or over in 2016 lived in low- and middle-income countries[1]

The share of people living with HIV aged 50 or over has doubled, and is still rising

UNAIDS estimates that 41.0 million people were living with HIV worldwide in 2025, and 32.1 million were receiving antiretroviral therapy[4]. Treatment is the reason more of them are reaching later life. Using the Spectrum modelling software, researchers estimated that 5.7 million people living with HIV were aged 50 or over in 2016, that their share of everyone living with HIV had risen from 8% in 2000 to 16%, and that it was projected to reach 21% by 2020, assuming treatment coverage kept rising[1]. Eighty per cent of them lived in low- and middle-income countries, with Eastern and Southern Africa home to the largest number[1]. That matters: the conversation about aging with HIV is often led by wealthy countries, but most older people living with HIV live elsewhere.

In countries with long-established treatment programmes, the shift is further on. In England, 52% of the 103,689 people seen for HIV care in 2024 were aged 50 or over, compared with 32% in 2015[2]. In France’s Dat’AIDS cohort at the end of 2015, 43.8% of people were aged 50 to 74 and a further 1.5% were 75 or over[5]. In the United States, adults aged 50 and over make up nearly half of people living with HIV, according to a 2023 analysis by the Centers for Disease Control and Prevention[6]. A modelling study of the Dutch ATHENA cohort projected that the share of people on treatment aged 50 or over would rise from 28% in 2010 to 73% in 2030, with the median age rising to 56.6[7].

In rural South Africa, the Health and Aging in Africa (HAALSI) study tested a population sample of 5,059 people aged 40 and over and found that 23% were living with HIV, with no difference between women and men[8]. These figures come from different years, methods and age cut-offs and should not be read as a single trend, but they all point the same way.

Share of people living with HIV aged 50 and over, worldwide, 2000, 2016 and projected 2020Modelled global estimates: 8% of people living with HIV were aged 50 or over in 2000, 16% in 2016, and a projected 21% by 2020.0%5%10%15%20%25%8%200016%201621%2020(projected)
Estimates from the Spectrum AIDS Impact Module; the 2020 figure is a projection assuming antiretroviral therapy coverage of 81% by 2020. Source: Autenrieth et al., PLoS One 2018.

Older people are more often diagnosed late, when HIV is harder to treat

Treatment works best when it starts early. England defines a late diagnosis as one made when the CD4 count, a measure of immune health, is already below 350 cells per cubic millimetre of blood within 91 days of diagnosis[2]. In 2024, 42% of adults newly diagnosed in England were diagnosed late. Among people aged 65 and over, the figure rose from 53% in 2023 to 61% in 2024, though these percentages rest on small numbers: 51 of the 84 people in that age group whose CD4 count was known[2]. New diagnoses also fell in every age group among gay and bisexual men in 2024 except those aged 65 and over, where they rose from 13 to 28[2].

Late diagnosis costs lives, and the toll rises with age. Among adults diagnosed late in England in 2023, one-year all-cause mortality was 103 deaths per 1,000 among people aged 65 and over and 56 per 1,000 among people aged 50 to 64, against 29 per 1,000 among people aged 65 and over who were diagnosed promptly[2]. Some of these deaths reflect other illnesses that become more common with age, so the figures are not a measure of HIV deaths alone.

Deaths from any cause within a year of HIV diagnosis, per 1,000 adults, England, 2023Among adults diagnosed with HIV in England in 2023, one-year all-cause mortality was 103 per 1,000 for people aged 65 and over diagnosed late, 56 per 1,000 for people aged 50 to 64 diagnosed late, and 29 per 1,000 for people aged 65 and over diagnosed promptly.0306090120Aged 65+, diagnosed late103Aged 50-64, diagnosed late56Aged 65+, diagnosedpromptly29
All-cause mortality, not HIV deaths alone. Late diagnosis = CD4 count below 350 cells/mm³ within 91 days of diagnosis. Source: UK Health Security Agency, HIV annual data 2025 report.

Testing is part of the gap. In the United States in 2019, adults aged 50 and over received 16.8% of the 2,452,507 HIV tests funded by the Centers for Disease Control and Prevention, even though older adults make up nearly half of people living with HIV. Of the older adults newly diagnosed through those programmes, 68.4% were linked to HIV care within 30 days; and among 2,858 older adults who already knew they had HIV, 46.2% said they were not in HIV care when tested[6]. In rural South Africa, HAALSI researchers concluded that prevention initiatives tailored to older adults are “urgently needed”[8]. Once people are diagnosed and in care, though, age is no barrier to being treated: in England in 2024, 99% of people in HIV care were on treatment in every age group except 15 to 24 year olds[2].

Other long-term conditions arrive sooner and in greater numbers

Living longer with HIV means living longer with everything else that comes with age, and the evidence suggests it comes in larger measure. In southern Brazil, researchers compared 208 people living with HIV aged 50 and over with 208 matched people without HIV (median age 57). Multimorbidity, meaning two or more long-term conditions, affected 63% of those with HIV against 43% of those without, and the typical person with HIV had two other conditions where the typical control had one[9]. Longer time with HIV and longer time on treatment were both associated with more multimorbidity[9].

Multimorbidity among people aged 50 and over with and without HIV, southern BrazilAmong 208 people living with HIV aged 50 and over and 208 matched people without HIV, 63% of those with HIV had two or more long-term conditions, compared with 43% of those without.0%20%40%60%80%Living with HIV63%Matched people without HIV43%
Cross-sectional study, South Brazilian HIV Cohort, Porto Alegre; multimorbidity = two or more comorbid conditions. Source: Maciel et al., International Journal of Infectious Diseases 2018.

The Dutch ATHENA modelling study projected that the share of people on HIV treatment with at least one non-communicable disease, such as heart disease, diabetes, kidney disease or a non-AIDS cancer, would rise from 29% in 2010 to 84% in 2030, with 28% having three or more. It projected that 54% would be taking medicines for other conditions in 2030, up from 13% in 2010, and that 40% could face complications with the then-recommended first-line HIV regimens because of drug interactions and contraindications[7]. These are projections from a model built on Dutch data from 1996 to 2010, not measurements.

Clinic studies show what this looks like now. In Spain’s FUNCFRAIL cohort of 796 people aged 50 and over, 65% had three or more other conditions, at least one geriatric syndrome, or frailty; 71.7% of those who were frail rated their quality of life as fair or poor[10]. In France, 18.4% of people with HIV aged 75 and over had four or more other conditions, compared with 4.3% of those aged 50 to 74, yet both groups achieved similarly high rates of viral suppression[5]. In rural South Africa, people with HIV who also had a cardiometabolic condition such as high blood pressure or diabetes progressed less far through the stages of HIV care than those without (relative risk 0.86)[11], a sign that services organised around one condition at a time can leave people behind. In the UK, Terrence Higgins Trust calculated that respondents to its Uncharted Territory survey had on average three times as many long-term conditions as the general population[3].

Loneliness, poverty and stigma shape later life with HIV

The social side of aging with HIV is as important as the clinical one, and the evidence here comes mostly from surveys of people in care, in a small number of high-income countries. In the UK, Terrence Higgins Trust’s peer-led study Uncharted Territory (2017) involved 307 people living with HIV aged 50 and over, including 246 completed surveys; respondents were aged 50 to 82, and 32% had been diagnosed before effective treatment arrived in the UK in 1996[3]. It found that:

  • 58% were living on or below the poverty line, against 48% found living in poverty in the charity’s separate 2010 survey, and by the charity’s comparison poverty among people living with HIV aged 55 and over was double the level in the general population[3];
  • a third were socially isolated and 82% experienced moderate to high loneliness; by the charity’s comparison they were at least three times as likely as the general population to experience high levels of loneliness[3];
  • 58% had moderate to high levels of HIV self-stigma, which decreased with age and rose with isolation, loneliness and lower income[3].

Age was not all bad news: 77% of respondents aged 65 and over rated their wellbeing as good or very good, against 34% of those aged 50 to 60[3]. The study was a self-selected survey rather than a representative sample, and trans people were not represented in it[3].

What people living with HIV aged 50 and over reported, UK survey, 2017Among UK survey respondents living with HIV aged 50 and over: 82% were concerned about getting adequate social care in future; 82% experienced moderate to high loneliness; 81% were concerned about managing daily tasks in future; 79% were concerned about memory loss; 58% lived on or below the poverty line; 58% had moderate to high HIV self-stigma.0%25%50%75%100%Worried about futuresocial care82%Moderate to highloneliness82%Worried about managingdaily tasks81%Worried about memory loss79%On or below the povertyline58%Moderate to high HIVself-stigma58%
Peer-led, self-selected survey of 246 people living with HIV aged 50 and over across the UK; not a representative sample. Source: Terrence Higgins Trust, Uncharted Territory, 2017.

Studies elsewhere find similar patterns. In San Francisco, 58% of 356 people living with HIV aged 50 and over reported some loneliness and 12% severe loneliness, and loneliness was associated with depression, functional impairment and poorer quality of life[12]. In Ontario, Canada, people aged 55 and over reported lower overall and internalised HIV stigma than adults under 40, but age did not predict stigma experienced from others or anticipated stigma once other factors were accounted for[13]. Interviews with older women in the southern United States found that many felt isolated because they were reluctant to disclose a diagnosis they saw as “more shameful at their older ages”[14], and a study of 35 midlife and older Black women in Maryland described stigma based on gender, race, age and HIV together as “a central feature” of their lives[15]. Many older gay and bisexual men also carry the experience of being LGBTQ+ in later life, covered in our study of LGBTQ+ older people; on loneliness and poverty more widely, see older people living alone and older people on low incomes.

Care and support services were not built for this generation

HIV services were designed for younger people with a single serious condition. Older people living with HIV increasingly need care that joins up HIV specialists, primary care, geriatric medicine and social care, and the evidence suggests that join-up is often missing. The Dutch modelling team concluded that HIV care “will increasingly need to draw on a wide range of medical disciplines”[7]. A 2023 scoping review screened 5,702 studies looking for models of geriatric care for older people with HIV and found only 13 that described one, most from North America; it concluded that people aged 50 and over “have been left behind” in recent HIV treatment and prevention campaigns and that no gold-standard model of care has yet been defined[16].

Social care is a particular worry. In the Uncharted Territory survey, 81% of people living with HIV aged 50 and over were concerned about how they would look after themselves and manage daily tasks in future, 82% about whether they could get adequate social care, and a quarter said they would have no one to help them if they needed support with daily tasks[3]. The report described people facing discrimination from social care professionals because of their HIV status, including in residential care homes[3]. Primary care matters too: 87% had told their GP about their HIV status, but for 19% their GP had never given them the information they wanted on HIV and aging, and 79% were concerned about memory loss and cognitive impairment in the future[3]. For people with HIV who are also living with memory problems, our dementia library covers dementia and care homes.

What the evidence asks of us

The figures point to a set of changes that HIV services, health systems, social care providers, funders and governments can make. They draw on what the researchers and organisations behind the evidence above recommend.

  • Test older people, and count them. With 61% of people aged 65 and over newly diagnosed in England in 2024 diagnosed late, and one-year mortality after a late diagnosis higher in that age group than in any other age group[2], HIV testing and prevention campaigns should include older adults rather than stop at middle age, as researchers in the US and South Africa have urged[6][8]. Surveillance systems should report age bands above 50 so that the group is visible.
  • Plan for multimorbidity. Screening for frailty and geriatric syndromes in older people with HIV should be standardised, the Spanish FUNCFRAIL researchers argue[10], and models of care should build in collaboration, integration and holistic support[16].
  • Join up health and social care. The global estimates study called for integrated health and social services to meet the changing physical, psychological and social needs of people living with HIV aged 50 and over[1]. That includes making sure no one receiving social care, at home or in a care home, is treated differently because of their HIV status, as some UK respondents had been[3].
  • Tackle isolation, poverty and stigma as health issues. In San Francisco, low income and depression remained associated with poorer quality of life and function after adjustment[12]; stigma-reduction work, peer support and income support all belong in a response to aging with HIV.
  • Fund research where most older people with HIV live. In 2016, 80% lived in low- and middle-income countries[1], yet most evidence on models of care comes from North America[16].

Language: this piece says "older people" rather than "the elderly", and uses person-first language, "people living with HIV" and "older people living with HIV", as HIV organisations and networks of people living with HIV prefer, following the language guidance that UK HIV statistics now use after consultation with people living with HIV and community organisations. Older study titles in the sources keep their own wording.

Why we're publishing this

The first generation to grow old with HIV is living proof of what treatment can do, and it deserves services that plan for long lives, not short ones. Much of the evidence about this group sits in clinic cohorts, surveillance reports and charity surveys that rarely reach the people who commission care for older people. We have brought it together so that HIV and sexual health organisations, older people’s organisations, clinicians and commissioners can make the case for testing, joined-up care and social care that treats people living with HIV with the same respect as anyone else. The case is theirs, and the voices of older people living with HIV belong at the centre of it.

How to read this data

The global figures on people aged 50 and over are modelled estimates, not counts, and the latest age-specific global estimate we could verify refers to 2016, with a projection to 2020. England’s figures are official statistics for people seen in HIV care and people newly diagnosed; percentages for those aged 65 and over rest on small numbers and can swing year to year. Mortality figures are deaths from any cause within a year of diagnosis. The Dutch figures to 2030 are model projections from 1996–2010 data. The Brazilian, Spanish, French, Canadian and US studies are single cohorts or clinic samples; the Brazilian comparison uses matched controls, but cross-sectional studies show associations, not causes, and the South African relative risk describes progress through care, not the effect of any one condition. The UK Uncharted Territory survey is self-selected, dates from 2017 and did not include trans people. Studies use different age cut-offs (40, 50, 55, 60, 65 or 75), so figures are not directly comparable. Evidence is thinnest where most older people with HIV live: low- and middle-income countries, especially in Eastern and Southern Africa.

Use this data

Free to cite with attribution to Understanding Aging. HIV and sexual health organisations, older people’s charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Suggested citation: Understanding Aging (2026). Growing Older with HIV: Later Diagnoses, More Conditions, Gaps in Care. https://understandingaging.org/research/older-people-living-with-hiv

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else’s health, including HIV testing or treatment, please speak to a GP, a sexual health or HIV clinic, or another qualified health professional.

Sources

  1. Autenrieth CS, et al. Global and regional trends of people living with HIV aged 50 and over: estimates and projections for 2000–2020. PLoS One, 2018. europepmc.org/article/MED/30496302
  2. UK Health Security Agency. HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2025 report. UKHSA, official statistics, 2025 (updated 2026). gov.uk/government/statistics/hiv-annual-data/…-2025-report
  3. Terrence Higgins Trust. Uncharted Territory: a report into the first generation growing older with HIV (executive summary). Terrence Higgins Trust, 2017. platform.tht.org.uk/…/Uncharted Territory - Executive Summary.pdf
  4. UNAIDS. Global HIV & AIDS statistics — fact sheet. UNAIDS, 2026. unaids.org/en/resources/fact-sheet
  5. Allavena C, Hanf M, Rey D, et al. Antiretroviral exposure and comorbidities in an aging HIV-infected population: the challenge of geriatric patients. PLoS One, 2018. europepmc.org/article/MED/30240419
  6. Marano-Lee M, Williams W, Huang T, Uhl G. Adults aged ≥50 years reached by the Centers for Disease Control and Prevention’s HIV testing programs in the United States and US dependent areas, 2019. Public Health Reports, 2023. europepmc.org/article/MED/36017552
  7. Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. The Lancet Infectious Diseases, 2015. europepmc.org/article/MED/26070969
  8. Rosenberg MS, Gómez-Olivé FX, Rohr JK, et al. Sexual behaviors and HIV status: a population-based study among older adults in rural South Africa. Journal of Acquired Immune Deficiency Syndromes, 2017. europepmc.org/article/MED/27926667
  9. Maciel RA, Klück HM, Durand M, Sprinz E. Comorbidity is more common and occurs earlier in persons living with HIV than in HIV-uninfected matched controls, aged 50 years and older: a cross-sectional study. International Journal of Infectious Diseases, 2018. europepmc.org/article/MED/29476902
  10. Brañas F, Torralba M, Antela A, et al. Effects of frailty, geriatric syndromes, and comorbidity on mortality and quality of life in older adults with HIV. BMC Geriatrics, 2023. europepmc.org/article/MED/36597036
  11. Chang AY, Gómez-Olivé FX, Manne-Goehler J, et al. Multimorbidity and care for hypertension, diabetes and HIV among older adults in rural South Africa. Bulletin of the World Health Organization, 2019. europepmc.org/article/MED/30618461
  12. Greene M, Hessol NA, Perissinotto C, et al. Loneliness in older adults living with HIV. AIDS and Behavior, 2018. europepmc.org/article/MED/29151199
  13. Emlet CA, Brennan DJ, Brennenstuhl S, et al. The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter? AIDS Care, 2015. europepmc.org/article/MED/25397643
  14. Grodensky CA, Golin CE, Jones C, et al. “I should know better”: the roles of relationships, spirituality, disclosure, stigma, and shame for older women living with HIV seeking support in the South. Journal of the Association of Nurses in AIDS Care, 2015. europepmc.org/article/MED/24630627
  15. Sangaramoorthy T, Jamison A, Dyer T. Intersectional stigma among midlife and older Black women living with HIV. Culture, Health & Sexuality, 2017. europepmc.org/article/MED/28418279
  16. Kokorelias KM, Grosse A, Zhabokritsky A, Sirisegaram L. Understanding geriatric models of care for older adults living with HIV: a scoping review and qualitative analysis. BMC Geriatrics, 2023. europepmc.org/article/MED/37422631