HIV and Specific Populations

Does HIV affect older people?

Yes, anyone can get HIV, including older people. According to the Centers for Disease Control and Prevention (CDC), in 2021, roughly 41% of the people in the United States with HIV were at least 55 years old.

As a group, people aged 55 years and older in the United States have the lowest incidence of estimated new HIV infections. Life-long treatment with HIV medicines (called antiretroviral therapy or ART) is helping people with HIV live long, healthy lives. Effective HIV medicines are increasing the number of older people who are living with HIV.

Do older people have the same risk factors for HIV as younger people?

Many risk factors for HIV are the same for people of any age. But like many younger people, older people may not have the knowledge, understanding, or awareness of their HIV risk factors.

In the United States, HIV is spread mainly by:

• Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV
• Sharing injection drug equipment (works), such as needles and syringes, with someone who has HIV

Some age-related factors can put older people at risk for HIV. For example, age-related thinning and dryness of the vagina may increase the risk of HIV in older women. Thinning and dryness of the vagina can cause small tears in the vagina during sex and lead to HIV transmission. Older people may also be less likely to use condoms during sex, because they are less concerned about pregnancy.

Talk to your health care provider about your risk of HIV and ways to reduce your risk.

Should older people get tested for HIV?

The CDC recommends that everyone 13 to 64 years old get tested for HIV, at least once, as part of routine health care, and that people at higher risk of HIV get tested more often (for example, every 3 to 6 months). Your health care provider may recommend HIV testing if you are over 64 and at risk for HIV.

For several reasons, older people are less likely to get tested for HIV:

• In general, older people are often perceived as being at low risk of getting HIV. For this reason, health care providers may not always recommend testing for older people for HIV.
• Some older people may be embarrassed or afraid to be tested for HIV.
• In older people, signs of HIV may be mistaken for symptoms of aging or of age-related conditions. Consequently, testing to diagnose the condition may not include HIV testing.

For these reasons, HIV is more likely to be diagnosed at an advanced stage in many older people. According to an HIV Surveillance Supplemental Report from CDC, in 2021, 34% of people aged 55 and older in the U.S. already had late-stage HIV (AIDS) when they received a diagnosis. That is, they received a diagnosis later in the course of their disease.

Diagnosing HIV at a late stage also means a late start to treatment with HIV medicines and their benefits and possibly leads to more damage to the immune system. Studies have shown that delaying treatment can increase the chances that people with HIV will develop AIDS and other serious illnesses. Late start to HIV treatment also increases the chance of getting immune reconstitution syndrome, which can cause worsening of some infections when people with HIV and low CD4 cell counts begin taking HIV medicines.

Ask your health care provider whether HIV testing is right for you. Use these questions from Health.gov to start the conversation: HIV Testing: Questions for the doctor.

Are there any issues that affect HIV treatment in older people?

Treatment with HIV medicines is recommended for everyone with HIV. As for anyone with HIV, the choice of an HIV treatment regimen for an older person is based on the person’s individual needs.

However, the following factors can complicate HIV treatment in older people.

• Conditions, such as heart disease or cancer are more common in older people and require additional medical care.
• Side effects from HIV medicines and other medicines may occur more frequently in older people with HIV than in younger people with HIV.
• The increased risk of drug interactions in an older person taking HIV medicines and medicines for another condition.
• Age-related changes that can affect an older person’s ability to think or remember (cognitive impairment), which can make it harder to stick to an HIV treatment regimen.

This fact sheet is based on information from the following sources: 

From CDC:

• HIV Surveillance Report, 2021
• HIV Surveillance Supplemental Report, 2022
• Getting Tested for HIV

From the NIH Office of AIDS Research:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • HIV and the Older Person

From the NIH National Institute on Aging:

• HIV, AIDS, and Older People

Also see the HIV Source collection of HIV links and resources.