Surviving AIDS, now aging with HIV

nFIRST PERSONn COMMENTARY

The early 1980s were a very dark time for anyone whose life was touched by HIV/AIDS. It was characterized as a death sentence for a reason: individuals often lived only 1–2 years after diagnosis (Health Union, 2024). The epidemic strained our healthcare systems, overwhelmed hospital doctors and nurses, and caused long-term economic and societal burdens. It strained families, turned friends into caregivers, and the spread of fear drove people living with HIV/AIDS into social withdrawal. In some ways, that paradigm shifted with the advent of highly active anti-retroviral therapies (HAART) in the mid-1990s. In 2026, that same person diagnosed with HIV now has a life expectancy approaching that of the general population (Myhre & Sifris, 2026). It is now commonly characterized as “graying with HIV” (TGOA, 2026), but challenges still confront Californians living with HIV, and they can be profound.

Many HIV long-term survivors never imagined they’d say the words “aging” and “HIV” in the same sentence. According to government figures, over half of Americans diagnosed with HIV are aged 50 and older (HIV.gov, 2026)— 70% by 2030. The average U.S. life expectancy is 79.0 years (CDC, 2024). Today, a newly diagnosed 20-year-old can look forward to living into their early 70s—averaging between 70.8 and 74.6 years—as long as they start treatment promptly and adhere to it (Myhre & Sifris, 2026). 

However, aging with HIV comes new challenges. Aging-related physical limitations and emerging comorbidities, such as cardiovascular disease (Ghandakly, 2025) and diabetes (NIH, n.d.), present burdens in everyday life. These challenges are exacerbated by fewer available aging-focused services (Donley, 2022), caregiver fatigue (Cleveland Clinic, 2023), and ongoing HIV-related stigma (CDC, 2024).

A new annual report published by HealthHIV, State of Aging with HIV, finds that one-third of respondents reported mobility limitations due to HIV-related frailty, yet three-fourths had not been screened for fall risk, and nearly half reported visible body changes such as weight gain or loss. Perhaps most concerning was that less than half rated their overall physical health as “good” when asked to compare it to people their age who are not living with HIV (HealthHIV, 2026).

In many ways, that report illustrates how the HIV/AIDS epidemic has evolved from trying to survive AIDS then, to struggling with HIV now. Progress, but with a price.

Let’s be clear, progress has been made. In California, people living with HIV can now legally adopt without fear of discrimination (Anderson-Minshall, 2015), serve in the U.S. military (MMAA, 2024), allow for HIV-positive to HIV-positive (P2P) organ transplantation (White House, 2013), and, of course, the Americans with Disabilities Act extended protections in the workplace, sports, and society at large. However, any progress achieved over the last few decades must not diminish the real challenges being faced by Californians aging with HIV.

UCLA-led research on aging with HIV has found that the virus accelerates biological changes linked to normal aging, occurring within only two to three years after acquiring HIV (UCLA Health, 2022). UCLA and other studies show that people living with HIV often develop certain health conditions earlier than those without HIV. This accelerated aging results from chronic immune activation, inflammation, and even side effects from antiviral medications (Botey-Bataller, 2025). Aging with HIV often means comorbidities presenting themselves earlier in life.

In 2024, Jennifer O. Lam, PhD, MPH, and her research team at Kaiser Permanente found that the risk of dementia among adults with HIV over age 50 is higher (2.5%) compared to their HIV-negative counterparts (1.3%). Dr. Lam reported dementia diagnoses occurring about 10 years earlier in the HIV-positive group (Lam, 2022). Encouraging, though, more recent data suggest that the trend is changing. New research from a retrospective cohort (2000-2023) by Lam’s team found that “among 24,762 people with HIV and 494 963 people without HIV (86.9% men, 45.5% White, 23.1% Black, 20.3% Hispanic), incident dementia diagnoses declined from 2000 to 2023 in both people with and without HIV (-7.68 and -2.70% per period, respectively)” (Lam, 2026).

The risks for cancer are even greater. For example, Californians living with HIV face increased risks of developing certain types of cancers, including Kaposi sarcoma (KS), Non-Hodgkin lymphoma (NHL), cervical cancer, lung cancer, anal cancer and liver cancer (National Cancer Institute, n.d.). In addition to these AIDS-defining cancers, HIV-positive Californians are approximately 19 times more likely to be diagnosed with anal cancer, three times more likely to be diagnosed with liver cancer, twice as likely to be diagnosed with lung cancer, twice as likely to be diagnosed with oral cavity/pharynx cancer and eight times more likely to be diagnosed with Hodgkin lymphoma than the general population (Hernández-Ramirez et al., 2017). Prostate cancer is now projected to be the most common malignancy among individuals living with HIV (Markowski et al., 2024). It is also noteworthy that residents of California living with HIV are significantly more likely to succumb to their cancers compared to patients without HIV. 

Aging-related challenges aside, medical and therapeutic advances have largely leveled the playing field, now allowing Californians aging with HIV to live a normal life expectancy. There is more to holistic health than simply breathing or performing activities of daily living. Mental and spiritual health are equally important, as is societal acceptance. Californians aging with HIV confront layered challenges with mental and spiritual health.

Depression, affecting about 39% of people with HIV, worsens health outcomes, reduces quality of life and can shorten lifespan (Tran, 2019). The National Institutes of Health (NIH) has studied the relationship between depression and health-related quality of life, finding that people living with HIV aged 56–65 years with elevated depressive symptoms report the lowest health-related quality of life (NIH, 2020).

HIV long-term survivors (LTS)—diagnosed before 1996 or living with HIV for over a decade—often face worsened mental health challenges, such as heightened anxiety. The Well Project notes long-term survivors spent their early adulthood fearing death and losing friends, causing lasting trauma that affects mental and physical health, finances and quality of life (TWP, 2025). Just ask California’s own Tez Anderson, who coined the term AIDS survivor syndrome. Anderson describes the condition as a unique “psychological syndemic” in which two or more interconnected factors work together to amplify each other’s severity (Anderson, 2022). AIDS survivor syndrome is often compared to post-traumatic stress disorder.

The HealthHIV study referenced earlier included one alarming number: 5%. That is the percentage of the survey respondents who said they had zero support system. That number jumps to 30% for people with a support system of two people or fewer (HealthHIV, 2026). It is a glaring reminder that the HIV isolation symbolic of the early 1980s still exists for far too many, even 46 years later.

Progress, but with conditions. That is how to best summarize the challenges facing Californians living with HIV in modern times. They are living longer in a world with growing societal acceptance of the disease. Conversely, they are facing mounting barriers to their physical, mental and social health. In recognition of Older Americans Month, an unknown author’s quote summarizes aging with HIV: “Balance isn’t a destination; it’s a journey of constant adjustment.” 

R E F E R E N C E S

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