Aging with HIV: Global report highlights the need to prepare health systems

The Lancet HIV Commission's 2026 report reveals the dramatic shift in the global HIV epidemic, particularly among older adults. In 2025, an estimated 11.5 million (29%) people living with HIV were aged 50 years and older, a number projected to surge to 20.2 million by 2040, accounting for over half (51%) of all individuals with HIV. However, 96% of these older adults will reside in low- and middle-income countries, predominantly in Sub-Saharan Africa.

This demographic shift is largely a result of antiretroviral therapy (ART) success, allowing those who contracted HIV earlier to live longer. Nevertheless, the challenge now extends beyond extending lives to ensuring quality aging, i.e., maintaining good health, independence, and quality of life throughout older age.

A major issue is the underestimation of HIV risk in older adults, often due to misconceptions about their sexual activity. Health professionals may overlook discussing sexual health, recommending testing, or offering prevention options like PrEP to this demographic. Older people may also not identify with HIV messaging aimed at younger individuals, leading to delayed diagnosis and treatment, as well as potential discrimination within healthcare systems.

The Lancet Healthy Longevity study, based on data from over 7,000 adults aged 40 and older in Kenya and South Africa, underscores these concerns. The study found that older adults are more susceptible to delayed HIV diagnosis, exacerbated by ageism and stigma, which can lead to avoidance of testing and discussions about sexual health.

Additionally, the study emphasizes the importance of tailoring HIV prevention and screening for this age group, considering age-related comorbidities, and integrating HIV services with general healthcare.

To effectively address the changing HIV landscape, health systems must adapt by bringing together HIV care, chronic disease management, mental health services, and healthy-aging care. This integration is crucial, especially in rural areas where access to multiple services could be challenging. The Lancet Commission's roadmap offers a crucial guide for responding to this evolving epidemic, but its success hinges on obtaining localized evidence, particularly from low- and middle-income countries where the majority of older HIV patients reside.