This World AIDS Day, celebrated on 1 December 2025, carries the UNAIDS theme “Overcoming disruption, transforming the AIDS response.” It is a message that resonates profoundly with a group too often overlooked in the global HIV conversation: older adults living long-term with HIV, many now well over 50, navigating the complexities of aging in a rapidly shifting health landscape. As the HIV response faces unprecedented funding cuts and disruptions to essential services, with many community-led programmes at risk, this cohort finds itself increasingly vulnerable. Yet within this instability lies a crucial opening: a chance to rethink and transform how we support those who have carried the weight of HIV for decades, by equipping them not just to survive, but to truly thrive.
Over the years, the remarkable success of antiretroviral therapy (ART) has extended life expectancy, meaning more people with HIV are now living into their older years. But longevity has brought a new burden: metabolic diseases, such as type 2 diabetes, hypertension, and central obesity, are disproportionately affecting this group. Studies show that older adults with HIV are significantly more likely to experience metabolic syndrome than their HIV-negative peers (Todowede & Mianda, 2019; Asgedom et al., 2024). Many of these conditions are not just “age-related”; they are driven by a complex interaction of long-term ART, chronic inflammation, and the aging process itself.
The disruption that UNAIDS warns about in 2025 is not only financial and political, but also clinical. As resources become constrained, routine HIV care often emphasizes viral load monitoring and medication adherence, while metabolic health, especially in older adults, remains under-prioritized. Meanwhile, the very communities that need support the most may lack access to tailored services, nutrition advice, or education on how to mitigate long-term risks.
But transformation is possible. The current crisis can be a catalyst to rethink our approach: to overcome disruption by empowering older people living with HIV through nutritional literacy. Nutrition is not a luxury add-on; it is fundamental to their resilience.
The evidence is compelling. Research consistently shows that diets lower in refined carbohydrates can improve glucose control, reduce inflammation, and mitigate components of metabolic syndrome (Snorgaard et al., 2017; Jayedi et al., 2022). For older adults with HIV, education around nutrient-dense, lower-carbohydrate eating not only supports metabolic health, but can also reduce the burden of managing multiple medications and prevent further complications.
Importantly, nutritional literacy restores agency. It shifts the narrative from “just survive” to “live to thrive.” When people understand how their food affects their blood sugar, waist circumference, blood pressure, and overall energy, they become active participants in their own health. This aligns with the spirit of transformation that UNAIDS calls for in 2025, not just sustaining the HIV response, but transforming it so that it meets the real, evolving needs of all people.
On this World AIDS Day, remembering the theme of overcoming disruption, we must include the voices of older adults ageing with HIV. Their experience, their challenges, and their potential for thriving must inform the next generation of HIV policy and programming.
To truly transform the AIDS response, we need to invest in nutrition education, community support, and practical interventions that build resilience from the ground up. In a world facing funding cuts and service disruption, supporting nutritional literacy is a cost-effective, community-centered, and scalable way to protect not just lives, but quality of life.
By committing to this transformation, we honour the legacy of those who have carried the HIV response through its toughest years, and we build a future where ageing with HIV is not simply about survival, but about health, dignity, and flourishing.
References
Asgedom, Y. S., Kebede, T. M., Gebrekidan, A. Y., et al. (2024). Prevalence of metabolic syndrome among people living with human immunodeficiency virus in sub-Saharan Africa: A systematic review and meta-analysis. Scientific Reports, 14, 11709. https://doi.org/10.1038/s41598-024-62497-y
Jayedi A, Zeraattalab-Motlagh S, Jabbarzadeh B, Hosseini Y, Jibril AT, Shahinfar H, Mirrafiei A, Hosseini F, Bidar SS (2022). Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: A systematic review and dose–response meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 116(1), 40–56. https://doi.org/10.1093/ajcn/nqac066
Snorgaard, O., Poulsen, G. M., Andersen, H. K., & Astrup, A. (2017). Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Research & Care, 5(1), e000354. https://doi.org/10.1136/bmjdrc-2016-000354
Todowede, O. O., & Mianda, S. Z., Sartorius, B. (2019). Prevalence of metabolic syndrome among HIV-positive and HIV-negative populations in sub-Saharan Africa: A systematic review and meta-analysis. Systematic Reviews, 8, 4. https://doi.org/10.1186/s13643-018-0927-y
