Promoting Healthy Aging Through Mindfulness and Yoga: A Systematic Review of Interventions for People Living with HIV Who Use Drugs or Who Have a History of Substance Use

Advances in HIV care and broader access to antiretroviral therapy (ART) have extended life expectancy for people living with HIV, yet aging-related health concerns, especially among those who use substances, remain under-researched. This systematic review examined the effects of mindfulness and yoga-based interventions on healthy aging outcomes in adults living with HIV who use drugs or who have a history of substance use. We searched Medline, Embase, PsycINFO, and Scopus for randomized controlled trials, cohort studies, quasi-experimental designs, and pre–post intervention studies that assessed healthy aging indicators—broadly defined to include physical, cognitive, and mental health outcomes—along with substance use and HIV-related quality of life measures such as ART adherence. All five studies that met inclusion criteria found mindfulness and yoga interventions to be feasible and acceptable for people living with HIV who use substances, with some evidence suggesting reductions in stress and substance use, as well as improvements in ART adherence. However, most studies were small, short-term pilot trials, none focused specifically on older adults, and few used HIV-specific measures of quality of life or healthy aging. Notably, older adults living with HIV were underrepresented in the studies examined, pointing to the need for increased engagement with older adults living with HIV. These findings suggest promise for mindfulness and yoga for promoting healthy aging among people living with HIV who use substances. Future research should prioritize larger sample sizes and longitudinal designs to better understand clinical efficacy. Existing interventions may be enhanced by incorporating multilevel, community-driven approaches that reflect lived experiences and expand definitions of aging well among people living with HIV who use drugs or who have a history of substance use.