All individuals, regardless of their age, have the right to make informed, autonomous decisions about their reproductive health; for people aging with HIV, these decisions can be more complex. Now, as HIV drugs are allowing many to lead longer, healthier lives, discussions about getting and being older with HIV need more attention – and that includes the disregard for the sexual health of people aging along the HIV continuum of care.
Aging comes with a myriad of age-based stereotypes, prejudices, and discrimination. As we observe Ageism Awareness Day, which takes place annually on October 9th, it’s important to note that older women are often ignored in discussions about sexual health and HIV prevention/care due to preconceived notions, even though more than half of the people living with HIV (PLWH) in the United States are 50 or older. Researchers are even estimating that 73% of PLWH will fall in the 50+ age range by 2030, and according to the the Centers for Disease Control and Prevention (CDC), people aged 50+ accounted for ~16% of the 38,043 new HIV diagnoses in 2022 among people ages 13 and older in the U.S. and 6 territories and associated states
People who have lived with HIV since the start of the epidemic face unique physical and psychological issues. As we know, people aging with HIV share many of the same health concerns as the general population: multiple chronic diseases or conditions, the use of multiple medications, changes in physical and cognitive abilities, increased vulnerability to stressors, and menopause. But, aging with HIV comes with a greater risk of health problems related to inflammation as a result of the long-term use of medications, and an increased risk for adverse drug reactions.
There are gaps in care and resources available for aging people to make decisions about their bodies and healthcare. Older people living with HIV experience both age-related biases and HIV-related stigma, making them less likely to disclose their HIV status and seek or be offered appropriate health care or social services. Additionally, HIV-specific and general healthcare systems lack the infrastructure and resources to adequately address the needs of this growing population. Furthermore, there’s a severe lack of prevention education, research, and clinical trials addressing the specific sexual health needs of older adults with HIV. This, in turn, means there are few interventions tailored to people aging with HIV.
These attacks extend to the political as well, as current attacks on Medicare, Ryan White, and the Affordable Care Act’s preventive services mandate as well as the introduction of H.R. 1 threaten to worsen these barriers. Funding constraints, an increasingly dysfunctional Congress, holes in the social safety net, untrained providers, decreased insurance coverage of specific services, and workforce shortages leave people aging with HIV vulnerable to poorer health, which could undermine the larger fight to end the HIV epidemic. This is only amplified by the fact that the U.S. health care system isn’t prepared to handle the needs of the more than half a million people — those already diagnosed and those newly diagnosed with HIV — who are 50+.
Overlooked and unaddressed sexual and reproductive health needs can negatively impact overall well-being, including physical, emotional, and social health. So, what can we do about it?
- Efforts to reduce both ageism and HIV-related stigma are necessary to create a more welcoming and supportive environment for individuals seeking sexual and reproductive health services. Routine sexual health assessments and STI screenings are a part of that, and they are crucial for early detection and treatment of HIV/AIDS – as HIV is more likely to be diagnosed at an advanced stage in many older people.
- Adopting a holistic approach to care that addresses physical, psychological, and social factors related to sexual health is essential for improving the well-being of older people living with HIV.
- Health professionals need specialized training and education on the unique intersections of HIV, sexuality, and aging, with the ultimate goal of improving access to critical health services.
- Open communication between patients and providers is essential in addressing sexual health concerns. This can be facilitated through mental health counselors, health educators, or peer counselors/support persons, and support groups. Self advocacy is also critical, especially in the patient care setting.
- Research, development, and implementation of targeted interventions is needed to address the unique intersections of HIV, sexual health, and aging. This includes testing for cancer, heart problems, bone disorders, and other health issues that are becoming more common among people living with HIV as they get older.
Mackenzie Flynn, our Policy and Annual Conference Manager, and Naomi Gaspard, from The AIDS Institute, presented “Feeling Knotty: Sexual Health and Aging” at the 2025 U.S. Conference on HIV/AIDS (USCHA), which was held in Washington, D.C. from Thursday, September 4 through Sunday, September 7, 2025. The theme of this year’s event was Aging with HIV, which was central across event programming through plenaries, workshops, institutes, and other conference aspects.