Understanding the intersection of HIV and aging is essential particularly as states develop multisector plans for aging (MPAs). People aging with HIV include long-term survivors, individuals who acquired HIV at birth or in childhood and have lived with the virus their entire lives (lifetime survivors), as well as individuals diagnosed later in life. This diverse aging community faces unique clinical and social challenges, from managing multimorbidity and polypharmacy to navigating stigma and gaps in age-inclusive‑ care. Supporting healthy aging with HIV requires integrating geriatric-informed clinical care with policies that address these social and structural determinants, improving access to housing, transportation, and social support to ensure both longevity and quality of life.
Over four decades into the HIV epidemic, the demographics of people living with HIV in the United States has shifted. Advances in antiretroviral therapy have transformed HIV from a fatal disease into a chronic, manageable condition, enabling many individuals—when they have consistent access to care and treatment—to live well into older adulthood. By 2022, more than half of the estimated 1.2 million people living with diagnosed HIV were aged 50 and older, and this proportion continues to grow as effective treatment prolongs life, and new diagnoses occur among older adults. However, a 2024 CDC report found that 1 in 3 (33%) people aged 55 and older who were diagnosed with HIV in 2022 were already at late-stage disease (AIDS) at the time of diagnosis. This finding highlights persistent challenges with delayed HIV diagnosis among older people.
By 2022, more than half of the estimated 1.2 million people living with diagnosed HIV were aged 50 and older, and this proportion continues to grow as effective treatment prolongs life, and new diagnoses occur among older adults.
Integrating HIV into Multisector Plans for Aging
A multisector plan for aging (MPA) is a long-term, state-led strategic framework that brings together stakeholders across government, healthcare, social services, and community organizations to address the needs of older adults and people with disabilities. By aligning policies, services, and resources across sectors such as housing, transportation, and healthcare, MPAs promote coordinated, data-driven approaches to improve well-being and address social determinants of health.
Including people living with HIV in MPAs strengthens these efforts by addressing the unique and growing needs of this community. HIV inclusion promotes health equity by reducing stigma, improving access to culturally competent care, and ensuring that cross-sector strategies reflect the lived experiences of people aging with HIV.
Introducing a Toolkit
SAGE is a national advocacy and services organization for LGBTQ+ older adults. The SAGE Multisector Plan on Aging toolkit provides a practical framework for integrating HIV into multisector plans for aging through cross-sector strategies that address social determinants of health and reduce barriers such as stigma, discrimination, and gaps in care. It emphasizes meaningful involvement of people living with HIV, collaboration with HIV-focused organizations, and the importance of training and inclusive practices across systems.
The toolkit also highlights successful state models and offers actionable guidance—reflected in the six key recommendations below—to support more inclusive, equitable aging policies.
Six Key Recommendations for HIV Inclusion in Multisector Plans on Aging
1. Identify and Reduce Barriers to Accessing Services
Address HIV-related stigma and discrimination that limit access to care across healthcare and long-term care settings. Evidence from CDC health equity efforts and documented cases of discrimination in clinical and long-term care environments shows that stigma continues to delay testing, treatment, and service utilization, making barrier reduction a critical priority.
2. Promote HIV Inclusion Across Key Sectors
Expand HIV inclusion beyond health systems into transportation, employment, and housing. Programs such as the Ryan White HIV/AIDS Program and HOPWA demonstrate how cross-sector policies can improve access to care, housing stability, and economic security for older adults living with HIV.
3. Ensure Meaningful Involvement of People Living with HIV (MIPA)
Center the voices of people living with HIV in planning and decision-making, following principles established in the Denver Principles and MIPA frameworks, which originated from early HIV activism and call for the self-determination, leadership, and full participation of people living with HIV as equal partners in shaping policies, programs, and services that affect their lives.
4. Engage HIV-Focused Organizations and Aging Experts
Partner with HIV organizations, advocates, and aging experts to inform planning and implementation. Cross-sector collaboration, as highlighted in aging and HIV policy literature, strengthens culturally competent and community-responsive systems.
Integrating HIV into MPAs helps reduce silos, address stigma, and improve health and quality-of-life outcomes by recognizing the role of social and structural factors alongside clinical care.
5. Provide Ongoing Training and Education
Invest in workforce training to reduce stigma and improve HIV knowledge across sectors. Initiatives such as the AIDS Education and Training Centers and Clinical Education Initiative highlight the importance of equipping providers with culturally competent, HIV-informed knowledge and skills.
6. Align HIV-Inclusive Aging Plans with National Strategies
Integrate HIV into broader aging policies in alignment with national efforts like the Ending the HIV Epidemic initiative, ensuring coordinated, equity-driven approaches that address social determinants of health and improve long-term outcomes.
The Path Forward for HIV and Aging
Inclusive, multisector plans for aging are essential to building equitable and coordinated aging systems that meet the needs of the growing community of older adults living with HIV. Integrating HIV into MPAs helps reduce silos, address stigma, and improve health and quality-of-life outcomes by recognizing the role of social and structural factors alongside clinical care. Meaningful involvement of people living with HIV leads to stronger, more effective policies. Policymakers and advocates must prioritize engagement, partnerships, and the use of proven tools to advance HIV-inclusive aging systems. States developing and implementing MPAs, as well as other state aging initiatives, should integrate HIV considerations into their planning and implementation efforts to ensure inclusive and equitable systems for older adults living with HIV.
Mihret Walelgne Menberu is a Research Associate at the West Health Policy Center, where she supports research on healthcare costs, successful aging, and policies that strengthen access to affordable, high-quality care for older adults.
Terri L. Wilder, MSW, is the Manager of Health and Economic Security Policy at SAGE in New York City.
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