HIV infection catalyzes aging, leaving older adults with HIV (OAWH) to manage multiple chronic and intersecting health conditions that likely increase their need for home and community-based services and unpaid caregiving. There is a substantial knowledge gap to understand the impact of aging with HIV at a continent-level to adapt systems and services for this population. HIV prevalence and incidence trends were examined among older adults (i.e., ≥ 50 years of age) and younger individuals (i.e., < 50 years of age). Repeated cross-sectional data of annual prevalences and incidences of HIV in California and Ontario were analyzed from 2010 to 2023; California and Ontario are the most populous jurisdictions in the U.S. and Canada, respectively, which makes them ideal for deriving continent-level estimates. Age-stratified prevalence and incidence case numerators in each year and jurisdiction were meta-analyzed with a random effects model and expressed per 100,000 individuals using jurisdiction-level denominators. The pooled prevalence among OAWH ranged from 68 to 143 per 100,000 individuals over the study period. There were 75 (95% CI [45, 108]) more OAWH per 100,000 individuals in 2023 relative to 2010, which represented a 2.09 (95% CI [1.60, 2.73]) times relative increase in the prevalence of HIV among older adults. Compared to those under 50 years of age in 2023, there were 28 (95% CI [12, 62]) more OAWH per 100,000 individuals, and this represented a 1.24 (95% CI [1.20, 1.28]) times relative increase in prevalence of HIV among older adults. Trends in the incidence of HIV among older adults and younger individuals were mostly consistent over the study period. These continent-level estimates affirm that the burden of HIV is now disproportionately borne by older adults. There is a clear need to adapt home and long-term care services and treatment strategies (i.e., long-acting antiretroviral injectables that reduce pill burden) to meet the needs of this population.