Ageing with HIV: global report highlights the need to prepare health systems

The Lancet HIV Commission on Ageing ’s 2026 report highlights how profoundly the global HIV epidemic is changing.

In 2025, an estimated 11.5 million (29%) people living with HIV were aged 50 years and older.

This is projected to increase to 20.2 million by 2040.

That would account for more than half (51%) of all people living with HIV.

And, crucially, 96% will live in low- and middle-income countries.

Sub-Saharan Africa is continuing to shoulder the greatest burden of the global HIV epidemic.

Much of this change reflects the success of antiretroviral therapy (ART), which has enabled millions of people who acquired HIV earlier in life to grow older.

The challenge has gone beyond helping people live longer, to ensuring they age well – that they maintain good health, independence and quality of life throughout older age.

Older adults are also acquiring HIV and being diagnosed later in life.

But prevention and testing campaigns remain focused on younger people.

Older adults are often assumed to be at low risk because of the misconception that they are no longer sexually active.

Healthcare workers may be less likely to discuss sexual health, recommend testing or offer prevention options such as PrEP.

Moreover, older people may not see themselves reflected in HIV messaging that’s directed to younger people.

These assumptions contribute not only to delayed diagnosis and treatment, but also to discrimination within healthcare, where opportunities for prevention and early detection may be missed.