In high-income countries, over half of people living with HIV are now aged 50 or older, and this number is only growing. By 2030, 70% of people living with HIV in the US will be over 50. While antiretroviral therapy has dramatically extended lives and reduced new infections, health, care and prevention systems have not caught up to this new norm.

Older adults with HIV face rising challenges: increasing rates of comorbidities, financial insecurity, social isolation, and persistent stigma. In Europe, 20% of new HIV diagnoses are now in people aged 50+, with some countries reporting rates even higher. Yet older people remain overlooked in prevention and testing strategies.

In this report, we explore the health, economic and social barriers to ageing well with HIV in high-income countries, drawing on global data, expert insight and lived experience, alongside analysis with our Healthy Ageing and Prevention Index. Despite major progress in treatment, healthcare is fragmented, stigma is still widespread, prevention efforts often ignore older people altogether, and social services don’t always meet the needs of people living longer with HIV.

This needs to change. We need health systems that are fit for the future and designed to meet the needs of people ageing with HIV. That means joining up care, revamping prevention and testing, and tackling stigma head-on. This report offers five key recommendations for governments to better support people ageing with HIV:

• Creating national action plans for HIV and ageing
• Modernising testing and prevention
• improved data collection, disaggregated by age and gender
• Including the voluntary and community sector in the HIV response
• Decriminalising sex work and personal drug use