For decades, HIV campaigns across sub-Saharan Africa have focused mainly on children and women of reproductive age, leaving older adults largely invisible in prevention, testing, and treatment strategies. Yet today, HIV is increasingly affecting people over 50.
This shift is partly due to the success of antiretroviral therapy (ART), which has extended the lives of millions living with HIV. As life expectancy increases, the epidemic has taken on an ageing face. However, most HIV programs have not evolved to address this new reality, overlooking a vulnerable and growing group.
Recent studies tracking over 7,000 adults aged 40 and above in South Africa and Kenya show that one in five older adults (22%) are living with HIV. Despite improved treatment access, new infections continue to occur, particularly among widows, rural residents, and those with little or no formal education. Misconceptions such as the belief that postmenopausal women are no longer at risk fuel low condom use, late testing, and silent transmission.
Stigma also plays a role. Many older adults came of age when HIV was surrounded by silence and shame, making it harder to discuss sexual health or seek testing. Encouragingly, self-reporting of HIV status improved from 55% in earlier studies to 77% in recent years, suggesting progress in awareness and treatment uptake.
Education emerges as a key protective factor. Those with no formal schooling are nearly four times more likely to contract HIV than those with secondary education or higher. Rural women are particularly vulnerable due to poor access to healthcare, fewer prevention campaigns, and entrenched stigma. Socioeconomic security, marriage, and employment are also linked to lower infection risks.
The growing intersection between HIV and non-communicable diseases such as diabetes, hypertension, and arthritis further complicates care for older people. Current health systems often treat these conditions separately, forcing older adults to navigate multiple clinics. Integrated, age-friendly services where HIV care is combined with chronic disease management are urgently needed.
To close the gap, routine HIV testing should extend to people over 50, prevention messages must include older adults, and healthcare workers need training to handle the specific challenges of ageing with HIV. Community-based care, peer-support groups, and integrated primary health models show promise but remain underfunded.
If older Africans are ignored, the UNAIDS 95-95-95 goals cannot be achieved. Including them in the HIV response is not just about saving lives it’s about equity, dignity, and ensuring that decades of progress are not undone.
