HealthHIV Releases State of Aging with HIV Survey Results

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

HealthHIV has released its fifth annual survey on the State of Aging with HIV™, finding both positive and negative results from patients and providers alike. This report details survey findings and implications across five areas: HIV and Geriatric Care, Comorbidities, Behavioral Health, Access and Payment, and Workforce.

HealthHIV summarized the survey as follows:

"The survey revealed an HIV care system that delivers clinical wins. Over 98% of consumers reported being virally suppressed, and nearly 100% are taking antiretrovirals, the highest rates across five waves of the survey. The same data, however, show that the broader clinical reality of aging with HIV, multimorbidity, frailty risk, mental health burden, and the structural conditions of daily life, is not being managed with the same consistency."

Photo Source: HealthHIV

Key findings include:

Viral Suppression is High Among Older People Living with HIV/AIDS

Among People Living with HIV/AIDs (PLWHA) surveyed, 98% reported that their HIV was virally suppressed. This is significantly better than the national average of 62% (CDC, 2026).

While viral suppression was reported to be high, respondents indicated that age-related testing, screening, and other geriatric care were significantly lacking. Just 17% of respondents reported being screened for HIV-related medical frailty, with screenings for frailty declining from 25% of patients under the age of 65 being screened in 2022 to just 11% in 2026. HealthHIV found that patients with lower incomes were significantly less likely to be screened at all.

PLWHA Are Heavily Burdened by Comorbid Non-HIV Chronic Conditions

More than 80% of respondents indicated that they have at least one non-HIV-related chronic condition for which they are currently taking prescription medications, of whom 22% reported having to change their antiretroviral (ARV) medication due to a contraindication with another drug.

HealthHIV’s analysis of responses found that more than 25% of respondents have very high medical needs, but are underserved.

Photo Source: HealthHIV

Behavioral and Mental Health Issues Are Prevalent Among Older PLWHA

More than 75% of respondents indicated having moderate or high levels of stress, but fewer than 2% of respondents identified mental health as being an immediate need. Many respondents indicated that they had a “good” quality of life, but also carried high levels of stress. HealthHIV suggests that this finding indicates that respondents place more importance on the outward appearance of wellness while simultaneously ignoring or disregarding mental health as a part of a “good” quality of life.

Research has found that high levels of psychological stress can have negative impacts on PLWHA and their physical health and health outcomes. For example, traumatic and stressful life experiences have been associated with reduced adherence to treatment regimens, virologic failure, higher rates of mortality and opportunistic infections, increases in the use of recreational drugs in such ways that may result in behaviors detrimental to the health of both the patient and others, and arterial inflammation (Reif et al., 2013; Chow et al., 2023).

Access to and Paying for Medications and Treatment is Likely to Get Tougher for PLWHA in the Future

While existing programs and insurance coverage of ARV treatments are currently working, HealthHIV reports that those systems, like PLWHA who are aging, are becoming increasingly frail.

HealthHIV highlights reports that state AIDS Drug Assistance Program (ADAP) budgets are becoming increasingly strained, and that the reintroduction of waiting lists (Hopkins, 2026) in Iowa and Utah presages tough times ahead for PLWHA who are aging.

Photo Source: HealthHIV

According to the survey, fewer than half of respondents had retirement plans (largely because many didn't expect to live into their 50s), almost one-third reported food insecurity, and one in five avoided care due to cost.

Respondents to HealthHIV’s survey reported that transportation remains the strongest single barrier to accessing care and treatment, with lower-income patients being six times more likely to miss an HIV appointment because they cannot get to the appointment. Additionally, HealthHIV reports that more than half of Medicare enrollees still rely on the Ryan White HIV/AIDS Program (RWHAP) and ADAP to access HIV medications.

Providers Are Largely Unequipped to Effectively Treat Aging PLWHA

Providers who responded to HealthHIV’s survey reported that, while they understand that aging PLWHA face unique needs that require specialized care, they currently lack the staff, funding, or expertise to provide these services.

HealthHIV found that just 1.2% of provider respondents specialized in gerontology, compared with 21% with specializations in HIV medicine. Moreover, they found that workforce turnover is eroding the institutional knowledge and awareness of both the history of the HIV epidemic and the cultural and lived experiences of aging PLWHA.

Photo Source: HealthHIV

Regarding aging-care readiness among patients, providers reported troubling trends. Among them, only half were aware of the protections afforded to them under the Americans with Disabilities Act (ADA), a fact that is particularly important for end-of-life planning. Fewer than one-fourth of providers offer advance care planning, which is compounded by the fact that only 16% of caregivers report having adequate support.

In Closing

HealthHIV has made available the final report for its fifth State of Aging with HIV™ survey on its website at healthhiv.org/stateof/agingwithhiv/. On May 6th, HealthHIV hosted an educational webinar, and free access to this on-demand webinar is available online, along with the presentation slides. 

At this point in history, more than half of PLWHA are over the age of 50, making this research essential to maintaining a robust and effective HIV care continuum. 

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Centers for Disease Control & Prevention. (2026, March 16). Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection—Medical Monitoring Project, United States, 2023 Cycle (June 2023—May 2024). Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: HIV Data: Medical Monitoring Project. https://www.cdc.gov/hiv-data/mmp/behavioral-clinical-characteristics-pwh-2023.html

[2] Chow, F. C., Mundada, N. S., Abohashem, S., La Joie, R., Iaccarino, L., Arechiga, V. M., Swaminathan, S., Rabinovici, G. D., Epel, E. S., Tawakol, A., & Hsue, P. Y. (2023, October). Psychological stress is associated with arterial inflammation in people living with treated HIV infection. Brain, Behavior, and Immunity, 113, 21-28. https://doi.org/10.1016/j.bbi.2023.06.019

[3] HealthHIV. (2026). Findings and implications from HealthHIV State of Aging with HIV Fifth Annual Survey. Washington, DC: HealthHIV: State of. https://healthhiv.org/stateof/agingwithhiv/

[4] Hopkins, M. J. (2026, May 14). The ADAP “Perfect Storm” Returns; Over 1,000 Patients Being Denied Care. Nags Head, NC: ADAP Advocacy: Blog. https://adapadvocacyassociation.blogspot.com/2026/05/the-adap-perfect-storm-returns-over.html

[5] Reif, S., Mugavero, M., Raper, J., Theilman, N., Leserman, J., Whetten, K., & Pence, B. W. (2011, February). Highly Stressed: Stressful and Traumatic Experiences among individuals with HIV/AIDS in the Deep South. AIDS Care, 23(2), 152-162. https://doi.org/10.1080/09540121.2010.498872

The ADAP “Perfect Storm” Returns; Over 1,000 Patients Being Denied Care

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

What’s old is new, again! The “Perfect Storm” that confronted state AIDS Drug Assistance Programs for nearly a decade and resulted in patients living with HIV/AIDS being denied access to care is now the reality…again! 

According to the National Alliance of State and Territorial AIDS Directors (NASTAD), two states—Iowa and Utah—have implemented waiting lists for their ADAPs, becoming the first to do so in thirteen years. 1,106 patients living with HIV/AIDS are impacted in Iowa, and another 10 in Utah (NASTAD, 2026b).

Photo Source: NASTAD

The reimplementation of waiting lists comes after 12 years of flat funding for ADAP at the federal level and 2 decades of declining state-level funding (NASTAD, 2026a). These conditions have been exacerbated with the passage of the One Big Beautiful Bill, which decimated the social safety net (Segal, 2025). 

ADAP waiting lists were commonplace in the 2000s and into the mid-2010s, with waiting list rosters reaching their peak in 2011, with 9,298 Persons Living with HIV/AIDS (PLWHA) impacted across eleven states (The Henry J. Kaiser Family Foundation, 2017). In 2003, eight patients died while on ADAP waiting lists, including 5 in Kentucky and three in West Virginia (Connolly, 2004).

The reality is that ADAP programs quite literally save lives.

Research published in Clinical Infectious Diseases found that, despite ADAPs serving less than 25% PLWHA in the United States, ADAP clients account for almost a third of the entire viral suppression rate, with viral suppression rates ranging from 81.2% to 91.4% for ADAP client, compared with the overall viral suppression rate of 60% to 66.3% (McManus et al., 2026).

While Iowa and Utah are the first to reintroduce waiting lists, they are unlikely to be the last, particularly given the Trump Administration’s proposed budget, which has been characterized as having an open disdain for federal healthcare and social assistance programs.

Photo Source: Rolling Stone

In April 2026, the White House’s Fiscal Year 2027 Budget proposal calls for the wholesale elimination of the Housing Opportunities for Persons With HIV/AIDS (HOPWA) program, referring to the program as “…outdated by focusing on housing low-income, homeless, and at-risk HIV-positive individuals, as the prognosis and medical care for HIV have significantly improved since the 1990s” (Office of Management and Budget, 2026).

In addition to waiting lists, NASTAD’s April 2026 ADAP Watch also reported that 19 programs are facing budget deficits, citing the following reasons:

• Increasing drug costs/expenditures per client
• Increasing health insurance premium costs
• The expiration of enhanced premium tax credits
• Increasing client enrollment
• Decreasing 340B drug pricing program rebate revenues, and
• Changes in federal allocations or supplemental funding (NASTAD, 2026b)

Two states—Indiana and Utah—have also introduced ADAP enrollment caps, with Indiana capping enrollment at 4,500 patients and Utah at 225 full-pay clients in addition to the aforementioned waiting lists. The travesty happening to Floridians living with HIV/AIDS is an entirely different situation, with one HIV advocate calling it “an open season on people living with AIDS,” and another to pen her pre-obituary as a "protest" as that state attempts to kick thousands of patients off its ADAP services.

Photo Source: ADAP Advocacy

Additional cost-containment measures, including the previously reported lowering of income eligibility thresholds across various states (Hopkins, 2026), are likely to be implemented in the coming year, with little end in sight unless federal and state legislators decide to reprioritize PLWHA.

ADAP Advocacy will continue to monitor and report on changes to ADAP waiting lists as new developments occur, as it is taking steps to launch a national advocacy campaign to confront them.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Connolly, C. (2004, May 20). States Offering Less Assistance For AIDS Drugs Federal Spending Is Up, but So Is Demand, Survey Finds. The Washington Post. https://www.washingtonpost.com/wp-dyn/articles/A41229-2004May19.html 

[2] Henry J. Kaiser Family Foundation, The (2017, August). AIDS Drug Assistance Programs (ADAPs). Menlo Park, CA: The Henry J. Kaiser Family Foundation: Fact Sheet. https://files.kff.org/attachment/Fact-Sheet-AIDS-Drug-Assistance-Programs

[3] Hopkins, M. J. (2026, March 26). Ryan White Programmatic Funding Balances on a Precarious Precipice. Nags Head, NC: ADAP Advocacy: Blog. https://adapadvocacyassociation.blogspot.com/2026/03/ryan-white-programmatic-funding.html

[4] McManus, K. A., Killelea, A., Rogers, E. Q., Liu, F., Horn, T., Steen, A., Keim-Malpass, J., Hamp, A., & Rogawski McQuade, E. T. (2026, March 25). State AIDS Drug Assistance Programs’ Contribution to the US Viral Suppression, 2015–2022. Clinical Infectious Diseases, ciag034. https://doi.org/10.1093/cid/ciag034

[5] National Alliance of State and Territorial AIDS Directors. (2026a). 2026 National Ryan White HIV/AIDS Program Part B ADAP Monitoring Project Annual Report: Stabilizing the Safety Net: Stewardship and Outcomes in a Volatile Landscape. Washington, DC: National Alliance of State and Territorial AIDS Directors. https://nastad.org/2026-rwhap-part-b-adap-monitoring-report

[6] National Alliance of State and Territorial AIDS Directors. (2026b, April). ADAP Watch: April 2026. Washington, DC: National Alliance of State and Territorial AIDS Directors: Resources: ADAP Watch. https://nastad.org/sites/default/files/2026-04/adap-watch-april-2026.pdf

[7] Office of Management and Budget. (2026). Budget of the U.S. Government. Washington, DC: Executive Office of the President: Office of Management and Budget. https://www.whitehouse.gov/wp-content/uploads/2026/04/budget_fy2027.pdf

[8] Segal, B. (2025, July 3). How the ‘One Big, Beautiful Bill’ Targets Medicare and Medicaid. GovFact.org. https://govfacts.org/money/social-safety-net/medicare-medicaid/how-the-one-big-beautiful-bill-targets-medicare-and-medicaid/

Treatment of HIV with ART Slows Advanced Biological Aging Process

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

Research presented at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global conference in Munich, Germany, has found that early initiation of antiretroviral therapy (ART) for HIV reduces accelerated aging in people living with the virus (Ryan et al., 2026).

Photo Source: ESCMID

While this research is currently in pre-print form, meaning that it has not been peer reviewed for final publication, it could help to provide additional ammunition in the argument that initiating ART as soon as possible can help People Living with HIV/AIDS (PLWHA) live longer, healthier lives.

Researchers developed a plasma proteomic aging clock (PAC)—a tool used to estimate biological age, measuring the age of the body, as opposed to chronological age which measures a body’s age in terms of birth year to present. During the period prior to initiating ART, the PAC estimated that participants’ biological age was accelerated by a median of 10 years. With effective ART, this was reduced by nearly four years. 

How Does HIV Cause Accelerated Aging?

Research has suggested that, soon after the acquisition of HIV, the virus causes the human body to begin an accelerated aging process at the DNA level, contributing to the earlier onset of age-related diseases, such as heart and kidney diseases, medical and physical frailty, and cognitive difficulties (Rivero, 2022). Research published in 2022 found that this accelerated aging process begins within three years of the initial acquisition (Breen et al., 2022).

Earlier research also found that PLWHA may experience lipodystrophy—abnormal fat distribution—in both treated and untreated HIV, which can include the loss of subcutaneous fat in the face, extremities, and buttocks, as well as an increase in fat in the abdominal area, breasts, or at the top of the back, known as “buffalo hump.” This research also found that a combination of metabolic and immunologic changes can cause or exacerbate cardiovascular disease in PLWHA (Meir-Shafrir & Pollack, 2012).

Photo Source: MEDXY

What Does This Mean for People Living with HIV/AIDS?

Prior to 2012, people who had been diagnosed with HIV were not advised to begin ART until they had received an AIDS diagnosis after their CD4 (T-cell) count had fallen below 200 per microliter of blood (Castro et al., 1992). In March 2012, the Centers for Disease Control and Prevention (CDC) updated its treatment recommendations to recommend beginning ART as soon as possible, rather than waiting for an AIDS diagnosis (CDC, 2012).

This change has led to an overall decrease in the number of new diagnoses, in no small part due to the fact that PLWHA who are receiving ART and are virally suppressed have been shown to be unable to transmit the virus through sexual contact (CDC, 2024).

For PLWHA, early initiation of ART can help to slow down the accelerated aging process. This is true, also, for those currently receiving ART, which makes remaining on treatment and being virally suppressed even more important.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Breen, E. C., Sehl, M. E., Shih, R., Langfelder, P., Wang, R., Horvath, S., Bream, J. H., Duggal, P., Martinson, J., Wolinsky, S. M., Martinez-Maza, O., Ramirez, C. M., & Jamieson, B. D. (2022, July 15). Accelerated aging with HIV occurs at the time of initial HIV infection. iScience, 25(7), 104488. https://doi.org/10.5041/RMMJ.10089

[2] Castro, K. G., Ward, J. W., Slutsker, L., Buehler, J. W., Jaffe, H. W., Berkelman, R. L., & Curran, J. W. (1992, December 18). 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. MMWR, 41(RR-17). https://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm

[3] Centers for Disease Control and Prevention. (2012). Changes in US HIV Treatment Guidelines [Transcript]. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: Audio Rounds. https://tools.cdc.gov/podcasts/media/pdf/AudioRounds_HIV_Tx_Guidleines.pdf

[4] Centers for Disease Control and Prevention. (2024, October 24). HIV Treatment as Prevention. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: HIV Public Health Partners: HIV Treatment. https://www.cdc.gov/hivpartners/php/hiv-treatment/index.html

[5] Meir-Shafrir, K. & Pollack, S. (2012, October). Accelerated Aging in HIV Patients. Rambam Maimonides Medical Journal, 3(4), e0025. https://doi.org/10.5041/RMMJ.1008

[6] Rivero, E. (2022, June 30). Study shows HIV speeds up body’s aging processes soon after infection. Los Angeles, CA: University of California Los Angeles: UCLA Health: News: Release. https://www.uclahealth.org/news/release/study-shows-hiv-speeds-up-bodys-aging-processes-soon-after

[7] Ryan, B., Oumelloul, M. A., Rouached, S., Juillerat, A. D., Giacccheto, L., Thorball, C. W., Schoepf, I. C., Arribas, J. R., Soldevila, B. R., Kootstra, N., Reiss, P., Jackson-Perry, D., Haerry, D. H-U., Günthard, H. F., Bartl, L., Dollé, C., Russenberger, D., Nanni, P., Kockmann, T., … Tarr, P. E. (2026, March 26). A Plasma Proteomic Ageing Clock Reflects Advanced Ageing in People with Untreated HIV and its Reduction Under Antiretroviral Therapy. medRxiv. https://doi.org/10.64898/2026.03.24.26348875