A Lancet HIV Commission report published on 27 July 2026 and presented at the 26th International AIDS Conference in Rio de Janeiro warns that South Africa’s population of people living with HIV aged 50 and older will surge from 2.3 million in 2025 to 3.9 million by 2040, demanding a fundamental overhaul of how health systems deliver care.
Globally, the Commission projects the number of people aged 50 or older living with HIV will nearly double, rising from 11.5 million in 2025 to 20.2 million in 2040. The report, covered by Business Day and syndicated by AllAfrica on 25 August 2025, argues that antiretroviral therapy has extended life expectancy but has not eliminated the gap between people living with HIV and the general population.
Co-author Amy Justice told the conference in Rio de Janeiro:
There is a general belief that once you get people on antiretroviral therapy, their life expectancy is just like everyone else’s. That is absolutely not the case.
Co-author Keri Althoff said:
Older adults do get HIV.
The Commission recommends tailored prevention and screening for older adults, citing delayed diagnoses in this age group as a recurring problem across multiple studies.
The report calls for HIV services to be integrated with chronic disease and mental health care rather than run as separate clinics. The authors wrote, as cited in the AllAfrica syndicated summary:
An older person should not have to attend separate clinics and make repeated journeys.
Research linked to the AWI-Gen consortium analysed data from more than 7,000 adults aged 40 and older in Kenya and South Africa, using data collected between 2013 and 2016 and again between 2019 and 2022. The study found that widowed women had the highest HIV prevalence among the group, at 30.8%.
For South Africa, where the HIV burden is already among the highest in the world, the shift carries particular weight. Patients ageing with HIV increasingly need care for comorbidities such as diabetes, cardiovascular disease, cancer, and liver disease, conditions that Western Cape clinics may not yet be structured to manage alongside HIV treatment.
The Commission argues that health systems should make HIV testing available through chronic disease services and ensure HIV care routinely addresses noncommunicable diseases and mental health. Whether specific clinics in Cape Town or the broader Western Cape have begun implementing such integrated models remains unverified in the sources reviewed.
What is still unknown is how South Africa’s provincial health departments will respond to the Commission’s recommendations and whether integrated care pilots are already under way. This article will be updated as further information is confirmed from the Western Cape Department of Health and Wellness.