Acceptance In Two Forms: Lived Experiences of Body Image and Aging with HIV

Background: In the United States, an estimated 1.2 million individuals live with HIV and more than 400,000 people with diagnosed HIV are aged 55 or older. While antiretroviral therapy (ART) has significantly improved health outcomes for people living with HIV (PLWH), ART use and seropositive status are associated with notable changes in body composition, including weight gain. These changes, often conceptualized as HIV‑related lipodystrophy, can alter physical appearance and self‑perception, contributing to both physical and psychological distress. Limited scholarship has examined how PLWH make sense of these embodied changes, how they monitor and evaluate their bodies, and how attitudes toward appearance shape engagement in HIV care. To address this gap, this study seeks to understand the structure of body image as lived by PLWH, with particular attention to its intersections with aging and the ongoing work of living with HIV.

Methods: This phenomenological study explored how PLWH construct and negotiate body image in the context of HIV- and ART-related bodily changes. Recruitment was conducted in partnership with Prisma Community Care, a community-based HIV clinic, using IRB-approved printed flyers and digital announcements from August to October 2025. Eligible participants were Arizona residents aged 18 years or older, aware of their HIV-positive status, currently receiving ART for at least six months, and fluent in English. Data were collected through online semi-structured interviews; participants received a $45 gift card. Transcripts were checked against audio recordings for accuracy and analyzed inductively using a multi-coder phenomenological approach to identify recurrent meanings and essential structures across participants’ accounts.

Results: Nineteen PLWH participated in the study, including 12 men and 7 women, one of whom identified as a transgender woman. All male participants self-identified as gay, and 18 of 19 participants were middle-aged or older adults. Analysis revealed two distinct experiential structures of acceptance in relation to body image: aging-related acceptance and resigned acceptance. Aging-related acceptance was reflected in neutral or positive expressions and in participants’ comparisons of their bodies to those of other aging adults without HIV, framing bodily changes as part of the shared aging process rather than as uniquely HIV-related. In contrast, resigned acceptance was reflected in sentiments of “giving up,” indicating acceptance shaped by failed hope, defeat, and the persistence of stigma.

Conclusions and Implications: Acceptance of body image change among PLWH was not uniformly experienced as protective. While aging-related acceptance often normalized bodily change as part of growing older and resigned acceptance reflected a more painful sense of diminished hope, both pathways may signal vulnerability to disengagement from care or self-care over time. Importantly, these patterns should be understood as embedded within broader gaps in support, psychoeducation, health literacy, and access to meaningful resources. Forms of acceptance may also reflect patients’ agency, meaning-making, and strengths developed through living and aging with HIV, which practice should actively recognize and build upon. These findings underscore the importance of HIV care, case management, and chronic illness interventions that attend to how bodily change is lived and interpreted in later life.