The Lancet HIV journal released a projection showing that, by 2040, more than half of all people living with HIV globally will be aged 50 or older. The estimate reaches 20.2 million individuals, a milestone never before reached in the four‑decade history of the epidemic.
Aging of the HIV-positive population
The shift stems from the widespread use of antiretroviral therapy since the mid‑1990s. The introduction of highly active antiretroviral therapy (HAART) in 1996 turned HIV from a fatal illness into a manageable chronic condition, dramatically increasing life expectancy. As treated patients survive longer, the average age of the HIV‑positive population rises.
Americo Nunes Neto, a 64‑year‑old activist who has lived with HIV for 38 years, recalled being told in 1998 that he had only six months to live. Today he emphasizes that his identity extends beyond the virus and that he lives an active life, dancing and watching films in his spare time.
Implications for treatment and care
The Lancet report, authored by researchers from more than 40 institutions, urges health systems to move beyond simply suppressing the virus. Lead authors Amy Justice of Yale University and Keri Althoff of Johns Hopkins University recommend monitoring physiological age, minimizing polypharmacy, and promoting mental health and healthy lifestyles.
Justice noted that, at age 65, people living with HIV often exhibit a physiological age more than 11 years above their chronological age due to long‑term effects of the virus even when viral load is suppressed. She advocated four pillars alongside antiretroviral therapy: digital support, mental‑health services, community networks, and specialist care for aging and chronic diseases.
The World Health Organization recommends at least 150 minutes per week of moderate aerobic activity, muscle‑strengthening exercises on two days, and balance training on three days for older adults.
Brazilian context and challenges
Brazil is among 21 countries that recorded a rise of more than 20 % in new HIV infections, according to UNAIDS data presented at the AIDS 2026 conference. Sandra Wagner Cardoso, a researcher at the Oswaldo Cruz Foundation (Fiocruz) and co‑author of the Lancet article, pointed out that access to treatment through the Unified Health System (SUS) remains uneven, especially for riverside and remote populations.
She argued that while urban users of SUS enjoy higher survival rates, those far from referral centers need better organization, training, and possibly decentralization of care to guarantee timely diagnosis and treatment initiation.
The report highlights that, globally, 96 % of the projected over‑50 HIV population will reside in low‑ and middle‑income countries, underscoring the urgency of adapting health‑service models in places like Brazil where socioeconomic disparities affect access to comprehensive care.