The number of South Africans aged 50 and older living with HIV has more than doubled in the past decade, rising from approximately 700,000 in 2015 to 1.85 million in 2025, according to a new analysis by the Bhekisisa Centre for Health Journalism.
This demographic now represents the second-largest group of HIV-positive individuals in the country, a dramatic shift from being the smallest group two decades ago. The findings highlight both the success of antiretroviral treatment (ART) programs and emerging challenges in managing long-term health for aging HIV patients.
A Success Story with New Challenges
Mia Milan, editor-in-chief at the Bhekisisa Centre, explained that the increase is largely due to the effectiveness of ART, which was rolled out in South Africa’s public health system in 2004. “People who started treatment early and adhered to it are now living longer,” she said. “Research shows that with consistent treatment, life expectancy for HIV-positive individuals is now comparable to those without HIV.”
However, Milan noted that the aging HIV-positive population faces new health risks, including a rising prevalence of non-communicable diseases (NCDs) such as diabetes, hypertension, and heart disease. “Before, many people with HIV didn’t live long enough to develop these conditions. Now, the health system must manage both HIV and chronic NCDs simultaneously,” she said.
Ongoing New Infections and Data Gaps
While long-term survivors make up a significant portion of the over-50 HIV-positive population, new infections in this age group remain a concern. Milan pointed out that accurate data on transmission rates among older adults is limited due to under-testing in some regions.
South Africa currently has 7.8 million people living with HIV, with 5.8 million on ART. Of those receiving treatment, 1.6 million are aged 50 or older.
Funding Cuts Threaten Health Monitoring
The discussion also turned to recent cuts in U.S. funding for PEPFAR (President’s Emergency Plan for AIDS Relief) programs, which have supported critical healthcare infrastructure, including data collection. Milan warned that losing 3,200 data capturers previously funded by the U.S. government could weaken the country’s ability to track HIV and NCD trends.
“Without proper data, we can’t identify gaps or allocate resources effectively,” she said. “The priority now is to find alternative funding and integrate HIV and NCD monitoring to ensure we don’t lose progress.”
Looking Ahead
As South Africa’s HIV-positive population ages, experts stress the need for expanded healthcare training, integrated treatment programs, and sustained investment in data systems. The success of ART has transformed HIV into a manageable chronic condition, but the next challenge is ensuring that older patients receive comprehensive care for both HIV and age-related illnesses.
For now, the data underscores a critical shift in South Africa’s HIV landscape—one that demands urgent attention from policymakers and healthcare providers alike.
