Aging with HIV involves physical, emotional, and social challenges. The perception of low social support in this population is associated with worse outcomes, such as higher risks of depression and isolation. This study aimed to describe the perception of social support and its associated factors among people living with HIV (PLHIV) aged 50 or older in Brazil.

This cross-sectional study included virally suppressed PLHIV aged ≥ 50 years from three Brazilian cities. The primary outcome was the perception of social support measured using the Social Provisions Scale (SPS), analyzed as a continuous variable (score range: 24–96), where higher scores indicate greater support. The SPS evaluates the domains of personal value, social integration, attachment, opportunity for nurturance, and reliable alliance, using Likert-scale items. Descriptive statistics and multivariable cumulative probability models were used to identify factors associated with social support, including sociodemographic, psychosocial, and clinical variables, depressive symptoms (PHQ-9), perception of aging, and HIV-related stigma.

A total of 702 PLHIV were included, with a median age of 62 years; 63% were male, 57% heterosexual, 45% white, and 20% had less than 8 years of education. The overall SPS median was 75 (IQR: 65–85). In adjusted cumulative probability models, higher social support perception was observed among participants from Salvador (aOR = 3.88; 95% CI: 2.66–5.67) and Rio de Janeiro (aOR = 1.91; 95% CI: 1.34–2.71), compared to São Paulo (p < 0.0001). Greater social support was inversely associated with education level, HIV-related stigma, and depressive symptoms (p < 0.001 for all). Lower support was also observed among homosexual individuals compared to heterosexuals (aOR = 0.587; 95% CI: 0.404–0.851), and among those with ≥ 2 comorbidities (aOR = 0.65; 95% CI: 0.42–0.99). No statistically significant differences were found by age, sex, or race.

Low education, city of residence, sexual orientation, HIV stigma, and depressive symptoms were significant predictors of lower perceived social support. These findings indicate high vulnerability within this population, particularly in social and emotional domains, underscoring the importance of regional interventions and strategies aimed at promoting healthy aging among people living with HIV throughout all stages of the care continuum.