HIV Among Older Adults in Sub-Saharan Africa: New Study Reveals High Prevalence, Key Risk Factors, and Urgent Policy Gaps

A recent study by Olubayo et al. (2025) titled “The prevalence, incidence, and sociodemographic risk factors of HIV among older adults in sub-Saharan Africa (AWI-Gen): a multicentre, longitudinal cohort study” published in The Lancet Healthy Longevity reveals that HIV remains highly prevalent among older adults in sub-Saharan Africa, with education, age, and rural residence significantly influencing risk.

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HIV Among Older Adults in Sub-Saharan Africa: New Study Reveals High Prevalence, Key Risk Factors, and Urgent Policy Gap– Olubayo et al. 2025

This study, conducted as part of the Africa Wits–INDEPTH Partnership for Genomic Research (AWI-Gen), explores the prevalence, incidence, and sociodemographic risk factors of HIV among adults aged 40 years and older in sub-Saharan Africa. Drawing on nearly a decade of longitudinal data from multiple sites in Kenya and South Africa—spanning both urban and rural areas—the research provides critical insights into HIV trends and public health challenges faced by this growing demographic. Sociodemographic analysis revealed that individuals with lower education levels and those residing in rural areas faced a disproportionately higher burden of HIV compared to their urban counterparts. Despite improved awareness and reporting of HIV status over time, access to HIV-related healthcare services remains uneven, especially among older adults in underserved regions. While antiretroviral therapy (ART) coverage has expanded substantially between waves, gaps persist in treatment accessibility and health system responsiveness.

How the Study was Conducted

The study focused on adults aged 40 years and older. In Wave 1 (2013–2016), participants aged 40–60 were randomly selected from community-based populations to ensure balanced representation of men and women. Wave 2 (2019–2022) included follow-up of the original cohort as well as newly recruited individuals aged 40 and above. Data were gathered through structured interviews and questionnaire surveys, covering sociodemographic and health-related information. HIV testing was performed using point-of-care rapid diagnostic tests, with confirmatory testing for positive results. Participants also self-reported their HIV status and ART (antiretroviral therapy) use. Logistic regression models were applied to evaluate HIV prevalence and incidence, alongside potential risk factors. The analysis accounted for variables such as age, gender, education level, employment status, and urban vs. rural residence. Longitudinal tracking allowed for an assessment of trends in HIV status, treatment coverage, and awareness over time.

What the Authors Found

HIV prevalence remained high but stable, with 22.2% in Wave 1 and 21.8% in Wave 2 testing positive for HIV. Women and individuals aged 40–50 exhibited the highest prevalence, with notable differences between rural and urban populations. New infections occurred at a rate of 0.35 per 100 person-years, with older age offering some protection against HIV acquisition. Education emerged as a key determinant—participants with no formal education faced significantly higher HIV risks. Rural residents were also more vulnerable than their urban counterparts. Encouragingly, ART coverage improved markedly between waves, and self-reporting accuracy regarding HIV status increased, suggesting progress in awareness and treatment access.

Why is this important

Understanding an Underserved Population: Older adults (aged 50+ years) are increasingly living with HIV due to improved antiretroviral therapy (ART) coverage. However, most HIV prevention campaigns focus on younger populations, leaving educational gaps and limited healthcare resources for older adults. This study helps bridge that gap.

Identifying Key Risk Factors: The research shows that women, individuals in rural areas, and those with no formal education face higher risks of HIV. Social and economic inequalities significantly impact access to HIV testing, treatment, and awareness, particularly for vulnerable groups.

Tracking Progress in HIV Awareness: Self-reported HIV awareness increased from 55.5% (Wave 1) to 76.7% (Wave 2), showing progress in education and awareness campaigns. ART coverage also improved, but gaps remain that could prevent older adults from achieving optimal health outcomes.

Shaping Future HIV Policies: By providing longitudinal data, this research helps policymakers understand how HIV prevalence and treatment trends evolve over time. It underscores the need for age-inclusive policies that ensure older populations are not neglected in global HIV response efforts.

What the Authors Recommended

• Tailored education programs should be developed to raise awareness about HIV risk among older populations, addressing widespread misconceptions. Integrating HIV prevention and education into routine healthcare services for ageing adults can improve outreach and early detection.
• Expanding ART (antiretroviral therapy) coverage and improving healthcare infrastructure—particularly in rural and underserved areas—are essential. Training healthcare workers to provide age-sensitive, stigma-free care will help older adults access and adhere to HIV treatment more effectively.
• Community-based support systems should be established to help older adults manage HIV. Special attention must be given to women and rural residents, who face heightened vulnerability. Providing financial, social, and psychological support can significantly enhance treatment adherence and quality of life.
• Regular HIV testing should be promoted among older adults, alongside improved self-reporting tools to increase awareness of HIV status. Strengthening data systems will enable more accurate tracking of HIV trends and inform responsive interventions.
• Governments should incorporate ageing populations into national HIV policies and strategies. Expanding research on HIV and ageing and fostering collaboration among governments, NGOs, and healthcare providers will be critical to delivering comprehensive care and reducing stigma among older adults.

In conclusion, the study by Olubayo et al. (2025) highlights the persistent and complex challenges of HIV among older adults in sub-Saharan Africa, revealing critical sociodemographic disparities and healthcare gaps. As the population ages and ART continues to extend life expectancy, there is a pressing need to shift the focus of HIV interventions to include older adults. Addressing educational, geographic, and gender-based inequalities, while strengthening healthcare systems and community support, is essential for a more inclusive and effective HIV response. This research provides a vital foundation for policymakers, healthcare providers, and global health advocates to reimagine HIV prevention and care strategies for ageing populations.