Thanks to effective HIV treatment, millions of people living with HIV are growing old. Now a major global report warns that health systems, especially in Africa, are not ready for what that means.

The numbers

According to the Lancet HIV Commission on Ageing, published in The Lancet HIV:

  • In 2025, an estimated 11.5 million people living with HIV, or 29%, were aged 50 or older.
  • By 2040 that is expected to reach 20.2 million, more than half of everyone living with HIV.
  • About 96% of older people with HIV are projected to live in low- and middle-income countries, with sub-Saharan Africa carrying the heaviest burden.

More than one condition

Older people with HIV often also live with high blood pressure, diabetes, obesity and other chronic illnesses, as well as reduced mobility, depression and money worries.

Many end up taking several medicines at once. Researchers Luicer Anne Ingasia Olubayo and Francesc Xavier Gomez-Olive Casas of the University of the Witwatersrand warn that "several individually appropriate treatment guidelines can become unmanageable when applied to the same person."

The Kenyan link

Their work draws on data from more than 7,000 adults aged 40 and above in Kenya and South Africa, in both rural and urban areas, collected between 2013 and 2022. Across the study, widowed women had the highest HIV rate, at 30.8%.

What needs to change

The researchers recommend:

  • HIV prevention and testing aimed at people over 50, including sexual health talks and PrEP
  • offering HIV tests through hypertension and diabetes clinics
  • screening people on HIV treatment for chronic diseases and mental health
  • bringing HIV, chronic disease and healthy-ageing services together under one roof, especially in rural areas
  • basing care on a person's health, abilities and priorities, not just their age

Why it matters

Kenya has one of the world's largest HIV treatment programmes. Its success means more Kenyans living long lives with HIV, and the system now has to care for the whole person, not just the virus.