Jerry Cuffey, 74, believes he shouldn’t have been alive to speak to the Board of Supervisors.
Infected with HIV 38 years ago, the long-term survivor has a higher chance of developing diabetes and kidney disease.
“I was supposed to not be here,” he told the board on June 16, pleading with them to set aside more money to support the 11,500 people over 50 years old with HIV in San Francisco. “Help me keep going.”
As the city’s population of people with HIV ages, more investment is needed to help them remain stably housed, survivors and experts said. Failure to do so could hamper the city’s goal of getting to zero new diagnoses and HIV-related deaths in the coming years.
City officials at the Department of Disability and Aging Services, the Department of Public Health and the Mayor’s Office of Housing and Community Development acknowledged the importance of supporting the population aging with HIV.
But healthcare and other service providers point to a lack of sustained funding and coordinated support targeting the particular challenges of older adults with HIV.
“HIV providers know HIV, aging providers know aging, but they don’t know each other,” said Vince Crisostomo, the director of aging services at the San Francisco AIDS Foundation, who himself has HIV at 65. Providers also didn’t plan for people to survive long-term, he noted.
San Francisco’s population of people with HIV is living past age 50 — and even longer — for the first time. This includes people who were diagnosed decades ago, when effective treatments weren’t available, and others newly diagnosed at a later stage in life.
Now, city agencies are anticipating more residents with HIV will live into their seventies and eighties, which is expected to increase the demand for specialized services and supportive housing options, said Manuel Vasquez, housing programs manager at the Mayor’s Office of Housing and Community Development.
After survivors and advocates demanded funding dedicated to this population, the Department of Disability and Aging Services proposed a $150,000 investment, with tentative plans to increase access to existing aging services for older adults with HIV.
“It was important to us to invest funding to further address HIV and aging,” a spokesperson for the Department of Aging and Disability Services wrote in an email. As Cuffey pointed out to the Board of Supervisors, the proposed funds break down to just $13 per person living with HIV over age 50.
While advocates were successful in getting these funds earmarked, and in reversing proposed cuts to HIV prevention services by the Department of Public Health, older adults with HIV still face barriers to remaining healthy.
Housing as part of the fight against HIV
Today, almost 75% of people with HIV in San Francisco are over 50, and more than a quarter are over 65. The concentration of older adults with HIV will increase as modern treatments allow for people with HIV to live longer.
“We’re coming up against a really concerning demographic wave,” said Jonathan Frochtzwajg, director of health justice policy at the San Francisco AIDS Foundation. “If the aging services system doesn’t really start committing to serving the community now, then they’re just not going to meet the needs of the community in time.”
He called on the city to fund programs providing social support, food assistance, service navigation and more to San Franciscans aging with HIV. The Department of Disability and Aging Services’ funding proposal may be used to train aging services providers in how to address the specific needs of older adults with HIV.
But providers and survivors say housing is key to supporting older adults with HIV as they age. Housing is the single greatest need that clients come to the AIDS Legal Referral Panel with, said Jaime Rush, a managing attorney at the organization, which offers legal services to people with HIV.
Research shows that housing instability is a significant barrier to HIV care. People with HIV experiencing homelessness are less likely to adhere to medications that keep their viral load suppressed, according to a 2025 city report.
The consequences are dire from a public health perspective and at an individual level. “If somebody is unstably housed, they are unlikely to be consistent in taking their HIV medication and thus will be at risk for dying,” said Bill Hirsh, former director of the AIDS Legal Referral Panel. “In order for the city to actualize its ‘Getting to Zero’ goals, housing is really the most essential strategy that the city can embrace.”
In the 2025 report, the city estimated at least 946 additional units for people with HIV would be required to address unmet housing needs through 2030.
San Francisco’s housing plan used to prioritize people with HIV on city housing waitlists, but that changed a few years ago, said Dr. Monica Gandhi, professor of medicine and director of the UCSF Center for AIDS Research. She said the city should reinstate the policy.
An intersection of obstacles for HIV seniors
Older adults living with HIV experience unique challenges compared to their peers without HIV, requiring ongoing medical and social services to manage their conditions. Vasquez said this makes it difficult for them to maintain stable housing:
“Many face an earlier onset of mobility limitations and rely on extremely limited incomes. Social supports are often minimal or entirely absent, increasing the risk of isolation and reducing access to informal help.” He added that they often need ADA-accessible housing, which can be scarce.
These challenges can be more acute for long-term survivors, who tend to be more financially precarious. Providers noted that long-term survivors’ work histories may have been disrupted by HIV, forcing them to rely on fixed public benefits that do not keep up with today’s cost of living.
Others may have few investments and meager savings because they did not expect to live long, having been diagnosed when the life expectancy of someone with HIV was under five years.
Long-term survivors may have also lost their social networks due to the HIV epidemic, and many older LGBTQ+ adults with HIV are estranged from their families due to homophobia. As they age, they commonly lack the social support that other older adults have, Rush said. “That intense level of isolation is very real and gets worse and worse the older they get.”
These factors affecting their physical and financial health make it harder for long-term HIV survivors to age in place.
Fragmented systems need to prepare for future
Many providers and people with HIV noted that services for aging people and programs for people with HIV are often siloed, with survivors saying they don’t communicate effectively and may not be aware of the specific needs of this population. Providers also said there is not enough coordination by the city and providers on either issue to prioritize housing needs.
“It makes my blood boil,” Hirsh said.
MOHCD’s Vasquez said that the office facilitates workgroups with various city departments to discuss topics relevant to people living with HIV.
The new funding proposed by the Department of Disability and Aging Services could help with this challenge, though the department pointed out that the budget has not yet been finalized. Meanwhile, the Board of Supervisors restored cuts to HIV prevention services under Mayor Daniel Lurie’s original budget proposal, and additional major changes are not expected.
“Many of these folks acquired HIV in the early days of the epidemic and have, frankly, been through hell to get here,” Frochtzwajg said, noting that, despite the challenges they face, they contribute a tremendous amount to San Francisco culturally, artistically and politically. “We in particular owe it to this population to ensure that their needs are getting met in their golden years.”
