From Scientific Progress to Health System Action
Posted: September 14, 2026
By: Audrianna Marzette
The 26th International AIDS Conference (AIDS 2026) in Rio de Janeiro brought together scientists, clinicians, people living with HIV, community advocates, policymakers, and funders under the theme “Rethink. Rebuild. Rise.” Across the conference, a central tension emerged: HIV science continues to advance while health systems, funding structures, and community infrastructure face increasing pressure to translate those advances into equitable care.
This reflection is written from my perspective as a public health professional working directly with communities and individuals aging with HIV. It is not intended to suggest that AIDS 2026 established the prevalence of STI screening gaps specifically among U.S. adults age 50 and older. Instead, the conference raised an important question for research, public health, and healthcare systems:
As people with HIV live longer, have our health systems evolved to address their changing needs?
We need more data to answer that question and stronger systems to act on what we learn.
The Opportunity: Maximizing Impact with Integrated Services
For people aging with HIV, HIV cannot be treated as their only health concern. Sexual health intersects with primary care, cancer prevention, cardiovascular health, mental and behavioral health, medication management, insurance coverage, social isolation, and other aging-related needs.
AIDS 2026 provided compelling examples of what integration can look like.
In Zimbabwe, cervical cancer screening was integrated with ART refills and viral-load monitoring. All 1,164 eligible women living with HIV in the program were screened, 72% through outreach, and 97.1% of those with positive screening results received treatment.
In Kenya, an integrated HPV self-sampling and screen-and-treat model was implemented among fisherfolk women facing barriers to cervical cancer screening. Seventy-three percent preferred self-sampling, showing the potential of alternative delivery approaches to reach underserved populations.
In Pakistan, community-based HIV testing was integrated with hepatitis B and C testing. More than 27,000 people were tested, and investigators concluded that integrated testing effectively identified people with HIV and hepatitis and provided justification for scale-up.
These programs were not designed specifically for older adults living with HIV. That distinction matters. Instead, their outcomes raise an important question for implementation: What would an integrated health model specifically designed for adults aging with HIV look like in U.S. HIV care settings, and what evidence do we need to develop it?
Three Strategic Recommendations
1. Establish a Community Barometer on Sexual Health and Aging
Before designing solutions, we need to understand what adults aging with HIV are experiencing. NMAC can collaborate with network partners to create a 50+ Community Barometer to collect structured, community-level information about the current landscape of HIV and sexual-health care for adults age 50 and older.
The initial Barometer could examine:
- When individuals were last offered STI screening
- Whether healthcare providers routinely discuss sexual health
- Access to STI testing and treatment
- Medication and healthcare access disruptions
- HIV- and age-related stigma
- Appointment and specialist wait times
- Insurance, Medicare, and Medicaid barriers
- Transportation and geographic barriers
- Coordination between HIV, primary care, sexual-health, and aging services
- Changes in staffing or availability of services
AIDS 2026 demonstrated the potential of community-led monitoring (CLM) to move beyond listening sessions. Communities can identify problems, produce evidence, and use findings to strengthen accountability and responsiveness from health systems. Examples from Lesotho, Nigeria, South Africa, Uganda, and Brazil showed applications ranging from identifying service gaps to serving as an early-warning system for disruptions.
The Community Barometer could begin as a national community assessment and, with appropriate methodology, governance, community ownership, and partnerships, evolve into a stronger CLM model. Ultimately, findings could contribute to a recurring State of Sexual Health and Aging with HIV briefs with recommendations for researchers, healthcare providers, health departments, funders, and policymakers.
2. Fund an Integrated Sexual Health and Aging with HIV Demonstration Project
Federal agencies, research institutions, health departments, health systems, and philanthropic funders should consider supporting a multi-site demonstration project examining integrated sexual-health services for adults age 50 and older living with HIV.
Rather than assuming where the gaps exist, participating sites could first assess current clinical practices and establish baseline data. Sites could then test interventions that integrate evidence-based sexual-health assessment, appropriate STI screening, prevention, treatment, referral, and follow-up into routine HIV and primary care.
A demonstration project could include geographically diverse HIV clinics and community partners, including sites serving rural and historically underserved communities.
Potential measures could include:
- Percentage of eligible patients 50+ receiving recommended STI screening
- STI positivity and treatment completion
- Provider initiation of sexual-health conversations
- Patient-reported testing and stigma barriers
- Referral completion
- Time from positive result to treatment
- Geographic and service-access differences
- Integration of HIV, STI, primary-care, and aging services
- Feasibility, acceptability, and sustainability of the model
This would generate the evidence needed to identify gaps, determine which interventions work and for whom, and understand what it would take to scale up successful models. It also creates a clearer investment opportunity for NIH and other funders.
3. Build Cross-System Accountability and Action Forums
Data should lead to action. NMAC should convene structured forums bringing adults aging with HIV into direct conversation with federal partners, Medicare and Medicaid stakeholders, insurers, pharmaceutical companies, health departments, researchers, and hospital and clinic administrators. These forums should use 50+ or Long-term Survivor Community Barometer findings, clinical data, research, and community experience to identify where systems are fragmented and establish concrete recommendations for improvement.
Priority areas could include:
- STI screening and sexual-health assessment
- Medicare, Medicaid, and insurance coverage
- Medication access
- Specialty-care referrals
- HIV and primary-care coordination
- Cancer screening and prevention
- Mental and behavioral healthcare
- Rural access
- Workforce and staffing challenges
- Data sharing and surveillance
- Social and aging-related services
The objective is not another stakeholder meeting. Each forum should identify specific system barriers, responsible stakeholders, recommended actions, and opportunities for policy, practice, research, or funding changes.
From Testing to Surveillance to Action
STI testing and surveillance serve different but related roles. Clinical testing helps identify infections and opens the door to treatment, prevention, and follow-up care. At the same time, public health surveillance examines population patterns that can support planning, resource distribution, and response. Community-collected information provides input that traditional data might overlook, including stigma, access barriers, service interruptions, and difficulties getting care.
AIDS 2026 demonstrated the value of connecting these data. Integrated surveillance across seven mining communities in South Africa examined HIV, syphilis, hepatitis B, and hepatitis C and revealed different patterns by age. HIV prevalence peaked among adults ages 51–59, while syphilis peaked among adults ages 31–40. These findings supported one-stop HIV, STI, and viral hepatitis testing and more targeted approaches based on population need.
The strongest model connects all three:
Together, these sources provide a more complete picture of health needs and can guide earlier detection, smarter investments, targeted prevention, and coordinated care. For people aging with HIV, this means using data—not assumptions about age—to determine where health services and systems need to change.
Conclusion
One of the achievements of the HIV response is that more people are living and aging with HIV. The systems serving them must evolve accordingly. The question is not whether we should allocate more money to STI testing. It is “do we have the evidence, infrastructure, and integrated systems to make sure adults aging with HIV receive comprehensive healthcare; and can we identify and respond when those systems fail?