On September 18, we recognize National HIV/AIDS Aging Awareness Day. This observance honors the history of activism and medical progress that has enabled people with HIV to live longer, fuller lives, while also drawing attention to the continued need for support and advocacy for older adults living with HIV.
Aging With HIV: A New Reality
Aging with HIV is a relatively new phenomenon. Today’s generation of Medicare beneficiaries with HIV lived through an era when a diagnosis almost always meant severe illness and premature death. Many remember peers and mentors who were killed by the virus as the political and medical establishments dragged their feet.
Aging with HIV is a relatively new phenomenon.
Thanks to advances in antiretroviral therapy, the outlook for people with HIV has improved dramatically. More than half of people living with HIV in the United States are now aged 50 and older, and a 2020 study found that 28% of people with HIV in the United States were Medicare beneficiaries. These demographic trends make clear that HIV prevention and treatment are increasingly a Medicare issue and responsibility, and Medicare must rise to its needs.
Getting Screenings and Medication Through Medicare
Medicare Part B covers annual HIV screenings for everyone between the ages of 15 and 65, and for those outside that age range who are at higher risk. Pregnant Medicare beneficiaries are eligible for up to three voluntary HIV screenings during pregnancy.
Following a significant rule change in 2024, Part B also covers FDA-approved pre-exposure prophylaxis (PrEP), a preventive antiretroviral regimen that prevents HIV infection in people at risk of contracting the virus. For those already living with HIV, Medicare Part D requires prescription drug plans to cover all approved antiretroviral medications.
Challenges Facing Older Adults With HIV
Older adults with HIV face unique medical and social challenges. Diagnosis is often delayed, as early symptoms may be mistaken for normal signs of aging and overlooked during diagnostic testing. As a result, older people who have HIV are more likely to be diagnosed when the illness is more advanced, meaning that treatment may be less effective or carry a risk of greater side effects.
They are also at higher risk of developing co-occurring conditions, such as cardiovascular disease and neurocognitive decline. Long-term treatment can complicate matters further, as interactions between antiretrovirals and medications for other conditions may cause harmful side effects.
Social stigma compounds these medical challenges.
Social stigma compounds these medical challenges. Older adults with HIV often face discrimination not only due to their diagnosis, but also because of homophobia, ableism, or prejudice against those suffering from addiction. This layered stigma can isolate people from their communities and cause them to delay needed care, which deteriorates both their mental and physical health.
Building Community, Fighting Stigma
Advocates stress that combating the spread and stigma of HIV, especially for older adults, must be an intersectional effort grounded in both health care and social support. This includes comprehensive medical care, social services, educational workshops, inclusive housing, and a continuously evolving infrastructure of community care. By centering dignity, inclusion, and community, we can better support older adults living with HIV and honor both the progress made and the challenges that remain.
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