Objective To analyse the epidemiological characteristics and spatiotemporal distribution of reported HIV/AIDS cases aged ≥50 years and infected by commercial heterosex in Sichuan province, and provide evidence for the development of AIDS prevention and control policies.

Methods Data were sourced from the China Information System for Disease Control and Prevention, the reported HIV/AIDS cases aged ≥50 years and infected by commercial heterosex from 2015 to 2023 were selected. Descriptive analysis was conducted by using software SPSS 22.0, spatial autocorrelation analysis was performed by using software ArcGIS 10.7, and spatiotemporal clustering analysis was conducted by using Poisson distribution model in software SaTScan v9.5.

Results The proportion of HIV/AIDS patients aged ≥50 years and infected by commercial heterosex increased from 51.27% in 2015 to 78.13% in 2023 in Sichuan (X_trend²=1757.99, P<0.001). In the annual reported HIV/AIDS cases aged ≥50 years and infected by commercial heterosex in Sichuan, men accounted for 95.3%, those in Han ethnic group accounted for 98.7% ,farmers accounted for 76.0%, those with education level of primary school accounted for 57.3%, those detected by medical institution accounted for68.9% and those with the first CD4 T⁺ cell count <350 cells/μL accounted for 61.6%. Spatiotemporal scanning at district and county level identified seven clustering areas, mainly distributed in the four areas of southern Sichuan, Chengdu and surrounding areas, and the areas bordering Chongqing in northeastern Sichuan.

Conclusion People aged ≥50 years is a key population for AIDS prevention and control in Sichuan, and the distribution of HIV/AIDS cases shows spatiotemporal clustering, so it is necessary to strengthen HIV testing in local people aged ≥50 years, and conduct comprehensive interventions to control the source of infection and reduce the risk for transmission.