Differences in HIV Outcomes and Quality of Life Between Older and Younger Black Women With HIV in the United States, 2021–2023

<b>Objectives.</b> To characterize differences in outcomes of 733 Black women aged 50 years and older compared with younger women with HIV engaged in bundled interventions across 12 US sites from 2021 to 2023. <b>Methods.</b> We examined age differences in physical component score (PCS) and mental component score (MCS) for health-related quality of life, stigma, and viral suppression over 12 months. We examined outcome effects by age and intervention. We collected comorbidities and preventive health screenings. <b>Results.</b> Lower PCS was associated with each year with HIV for older women (b = -0.13; 95% confidence interval [CI] = -0.25, -0.02) and for younger women in the stigma reduction intervention (b = -3.36; 95% CI = -5.88, -0.84). Younger women in the intimate partner violence intervention demonstrated a decrease in MCS quality of life (b = -3.07; 95% CI = -5.16, -0.98). Stigma scores were increased for younger women in the Red Carpet Experience (b = 2.70; 95% CI = 0.07, 5.33) but lower for older women in the self-efficacy intervention (b = -1.41; 95% CI = -2.24, -0.57). Viral load suppression was associated with peer-patient navigation for older women (adjusted odds ratio [AOR] = 4.73; 95% CI = 1.51, 14.81) and the intimate partner violence intervention for younger women (AOR = 3.83; 95% CI = 2.15, 6.82). Health screenings were low. <b>Conclusions.</b> Interventions that center Black women beyond traditional HIV treatment are needed with a focus on health screenings to improve the quality of life of older women. (<i>Am J Public Health</i>. 2025;115(S1):S57-S67. https://doi.org/10.2105/AJPH.2025.308021).