Recent evidence suggests that transmission of human immunodeficiency virus (HIV) is increasing among late middle-aged and older adults (50 years of age or older). However, research studies explaining the unique risk factors associated with transmission in this population are limited. This integrative review examines the physiologic, psychological, social, and education risks related to HIV transmission in late middle-aged and older adults. Seventeen research studies were reviewed. Findings were categorized into individual and system-failure-related risks. Findings suggest (a) inadequate HIV transmission education, (b) poor awareness/risk perception, and (c) insufficient patient/provider communication may contribute to the increased prevalence of HIV transmission in late middle-aged and older adults. Recommendations for future research and intervention strategies based on this analysis are made.