Ageing, health system implications, and a changing epidemic: organizational transitions and stigma dynamics in Philippine HIV care.

Background: The global HIV epidemic is undergoing a demographic transition as expanded access to antiretroviral therapy (ART) has increased life expectancy among people living with HIV (PLWH). As a result, the population of older adults living with HIV (OPLWH) is rapidly growing, introducing new clinical, psychosocial, and public health challenges. In the Philippines, one of the fastest-growing HIV epidemics in the Asia-Pacific region, this shift is occurring alongside rising incidence, creating a dual burden of ongoing transmission and emerging survivorship needs. Methods: This study employed a structured narrative review and policy-oriented conceptual synthesis of multidisciplinary literature published between 2010 and 2025. An ecological framework guided analysis across individual, interpersonal, community, and structural levels, with emphasis on accelerated and accentuated ageing, multimorbidity, stigma, and health literacy (HL). The Optimizing Health Literacy and Access (OPHELIA) framework was applied to translate findings into equity-centered public health strategies. Results: OPLWH in the Philippines face compounded vulnerabilities driven by biological ageing, multimorbidity, and intersecting forms of stigma, including ageism and HIV-related discrimination. Structural barriers such as fragmented health systems, workforce limitations, geographic inequities, and limited HL capacity, constrain sustained engagement in care. Diagnostic invisibility and late presentation among older adults persist, while inadequate age-disaggregated surveillance limits recognition of ageing-related burden. Psychosocial factors, including loneliness, internalized stigma, and cultural norms surrounding sexuality and ageing, further influence adherence, care retention, and quality of life. Conclusion: The findings underscore the need for integrated, age-responsive HIV care models that incorporate geriatric principles, mental health services, and culturally grounded stigma reduction. Expanding the OPHELIA framework demonstrates how HL-informed, community co-designed interventions can strengthen care continuity and survivorship outcomes. Policy priorities include workforce training in HIV and gerontology, improved age-disaggregated surveillance, HL interventions, and climate-resilient service delivery. Addressing ageing with HIV in the Philippines requires coordinated, system-level reform to ensure that increased longevity is accompanied by equitable, sustained health outcomes.