With advances in science and antiretroviral therapy, HIV has become a manageable condition and people living with diagnosed HIV (PLWH) are living longer. In the United States (US), over 450,000 PLWH were aged ≥50 years in 2015, an increase of nearly 40% since 2011. This rapid growth of the aging population of PLWH highlights the need to identify and implement aging-appropriate HIV care and support services. The Ryan White HIV/AIDS Program (RWHAP) supports HIV care, treatment, and support services for more than 50% of PLWH in the US. This analysis examines sociodemographic characteristics, service utilization, and viral suppression (VS) among current RWHAP clients and projects the growth of the aging RWHAP population by 2030.
Client-level data from the RWHAP Services Report were used to calculate distributions among clients aged ≥50 (older) and <50 (younger), by race/ethnicity, gender, transmission risk, poverty level, health care coverage, and housing status, and trends in service utilization from 2010-2016. Among older clients, additional analyses examined differences by gender and race/ethnicity. VS was calculated among older clients receiving RWHAP outpatient health services. Five-year age distribution trends were used to project the number of RWHAP clients aged ≥50 by 2030.
In 2016, 44% of RWHAP clients were aged ≥50, an increase from 32% in 2010. A higher proportion of older than younger clients were White, lived above the poverty level, had stable housing, and accessed food-related services. Among older clients, women and transgender clients had higher housing instability and poverty compared to men. Variation was seen by race/ethnicity. In 2016, VS among older clients was 90% compared to 81% among younger clients. VS increased across all subpopulations of older clients from 2010 to 2016; however, clients with unstable or temporary housing had lower percentages compared to other key subpopulations. By 2030, a projected 66% of RWHAP clients will be aged ≥50 years.
Older PLWH receiving care and treatment through RWHAP have high percentages of VS. However, social and structural factors, such as housing stability, may impact HIV outcomes. In addition, aging PLWH may have unique needs, such as food insecurity, long-term HIV medication effects, behavioral health needs, and age-related comorbidities. As the population of older PLWH continues to grow, so too will the importance of further assessing and planning for the needs of this emerging population.