HIV and Aging Awareness Day: Honoring Progress and Addressing New Challenges

Most of the 1.2 million people living with HIV in the United States are now over the age of 50, and more than 175,000 are over the age of 65. For many people who were diagnosed prior to the introduction of revolutionary highly active antiretroviral therapy, life expectancy was measured in months, not decades. Now, with access to care and medication, people with HIV can enjoy lifespans comparable to the general population.

Nevertheless, people aging with HIV encounter unique barriers to health that demand innovative responses. On September 18 we observe HIV and Aging Awareness Day, a time to celebrate remarkable advances in HIV treatment and consider solutions for the evolving health and social needs of older adults with HIV.

For people with HIV, longevity is both cause for celebration and a source of new challenges. Conditions that typically affect people in their 60s and 70s— such as frailty, memory problems and dementia, kidney disease, and cancer — often appear years or even decades earlier in those living with HIV. Prevalence of these conditions is also higher; people living with HIV are twice as likely to develop cardiovascular disease, and are at three times the risk of bone fractures.

In addition to accelerated aging and associated conditions, older adults with HIV encounter psychosocial barriers to health. Stigma remains a major concern. Long-term survivors who have lived through years of HIV-related stigma now also face ageism. Stigma contributes to poor mental health, lower self-esteem, substance abuse, and social isolation. Furthermore, fear of discrimination can discourage individuals from disclosing HIV status to providers and seeking necessary services.

Innovative new models of care are springing up across the country to address the specialized needs of people aging with HIV. The Ryan White HIV/AIDS program, the leading federal program focused exclusively on HIV care, launched the three-year Aging with HIV Initiative in 2022 to gather evidence of best practices and promote the swift adoption of holistic care models. The initiative funds 10 demonstration sites nationwide to design, implement, and evaluate emerging strategies to improve the health and well-being of people 50 and older with HIV. The iCHANGE project, created by the Colorado Health Network with grant funding, combines public health and geriatric care principles to support physical and mental health while fostering social connection and patient engagement.

The Ryan White Initiative builds on various models developed over the past decade. In 2017 San Francisco's Ward 86—one of the nation’s first dedicated HIV clinics—launched the Golden Compass  program to meet the changing medical and psychosocial needs of its aging patient population. Golden Compass brings together geriatrics and HIV medicine to offer a tailored approach reflecting the input of the community and the preferences, priorities, and experiences of participants. The program includes an on-site cardiology clinic, geriatrics clinic, and pharmacist. Group classes for exercise and brain health strengthen mind and body and promote social connection. Early evaluations of the program show high levels of satisfaction from patients and improvements in self-reported health.

Continued investments in integrated models of care merging physical and behavioral health, infectious disease, and geriatrics are critical. This HIV and Aging Awareness Day, we recognize the contributions of older adults with HIV and the great strides made in HIV prevention and treatment. At the same time, we look forward to future innovations in holistic care.