The Lancet HIV Commission on Ageing’s 2026 report highlights how profoundly the worldwide HIV epidemic is altering.
In 2025, an estimated 11.5 million (29%) folks residing with HIV had been aged 50 years and older. That is projected to extend to twenty.2 million by 2040. That might account for greater than half (51%) of all folks residing with HIV. And, crucially, 96% will dwell in low- and middle-income nations. Sub-Saharan Africa is continuous to shoulder the best burden of the worldwide HIV epidemic.
A lot of this alteration reflects the success of antiretroviral remedy (ART), which has enabled hundreds of thousands of people that acquired HIV earlier in life to get older. The problem has gone past serving to folks dwell longer, to making sure they age nicely – that they keep good well being, independence and high quality of life all through older age.
Older adults are additionally buying HIV and being recognized later in life. However prevention and testing campaigns stay targeted on youthful folks.
Older adults are sometimes assumed to be at low threat due to the misperception that they’re now not sexually lively. Healthcare staff could also be much less prone to focus on sexual well being, advocate testing or provide prevention choices similar to PrEP. Furthermore, older folks might not see themselves mirrored in HIV messaging that’s directed to youthful folks. These assumptions contribute not solely to delayed prognosis and therapy, but in addition to discrimination inside healthcare, the place alternatives for prevention and early detection could also be missed.
African context
Our latest Lancet Healthy Longevity study, utilizing knowledge from the Africa Wits-Indepth Partnership for Genomic Research (AWI-Gen), offers an necessary longitudinal (long-term) African perspective that reinforces the Lancet Fee’s message. We analysed knowledge from greater than 7,000 adults 40 years and older in Kenya and South Africa, together with rural and concrete populations. The information was collected in 2013-2016 and 2019-2022. Information like this helps us study what’s altering over time: whether or not therapy outcomes are enhancing, and which teams stay missed.
Our findings additionally present that older adults are usually not one uniform inhabitants. HIV threat was formed by gender, schooling, socioeconomic circumstances and place.
Widowed girls had the best HIV prevalence, at 30.8%. This will likely replicate financial insecurity and protracted gender inequalities that proceed to affect HIV vulnerability later in life. Prevention should reply to those gendered and social realities.
Stigma and ageism compound the issue. The notion that HIV is a illness of youthful folks could make prognosis in later life really feel particularly shameful. Older adults might delay testing or keep away from discussing their sexual well being as a result of they don’t understand themselves – or are usually not perceived by others – as being in danger. This will have an effect on testing, disclosure, psychological well being and continued engagement with care.
Comorbidity
The Lancet Fee helps our findings that the inhabitants over 50 is extra prone to obtain a delayed HIV prognosis, and requires tailor-made HIV prevention and screening for this age group. It additional recognises the necessity for considerate screening and administration of age-related comorbidity. As well as it requires the combination of HIV companies with well being companies offered to most people.
A particular power of our work is that we don’t research HIV in isolation.
By way of the long-term analysis undertaken be the MRC/Wits Agincourt unit and AWI-Gen, we’ve got spent years inspecting ageing and well being in African populations. Our longitudinal knowledge permit us to think about HIV alongside hypertension, diabetes, weight problems and different persistent circumstances, and to analyze how these circumstances accumulate and work together as folks age.
An individual could also be taking ART with medicines for hypertension and diabetes whereas additionally dealing with lowered mobility, despair or monetary insecurity. A number of individually applicable therapy tips can grow to be unmanageable when utilized to the identical particular person. Care should contemplate physiological slightly than chronological age (what’s occurring to an individual’s physique, not simply how previous they’re in years), purposeful potential (what they’re nonetheless in a position to do), polypharmacy (being on a number of medicines) and what issues to the person.
Well being methods should additionally adapt to those new circumstances the place extra persons are residing with totally different persistent (long-term) circumstances. An older particular person mustn’t must attend separate clinics and make repeated journeys. That is significantly burdensome in rural areas. HIV, persistent illness and healthy-ageing companies should be introduced nearer collectively, with HIV testing accessible by persistent illness companies and HIV care routinely addressing noncommunicable illnesses and psychological well being.
Trying forward
The Lancet HIV Fee offers a well timed roadmap for responding to this altering epidemic, however its success will depend upon proof generated the place the necessity is biggest.
The worldwide worth of this proof is obvious. Traditionally, a lot of what’s identified about ageing with HIV has come from wealthier settings, but the overwhelming majority of older adults residing with HIV now dwell – or quickly will dwell – in low- and middle-income nations, significantly in sub-Saharan Africa. The HIV response should put together for folks rising older with HIV whereas recognising that older folks stay liable to buying it.
