Persons 50 years of age and older have consistently comprised 10% of all cases of AIDS diagnosed in the United States, accounting for 52,097 cases by the end of 1995. A review of service utilization data comparing persons over 50 with the general client population in an AIDS case management program revealed individuals 50 years of age and over were less likely to use emotional support services and mental health services than the population under 50. Caregivers with aging related problems, aging related diseases processes, difficulty with social support and disclosure of sexual orientation were consistent themes found among 15 cases of persons over 50 with AIDS. Emotional and psychological support services for older persons with AIDS may need to be configured and presented differently if the emotional needs of this population are to be adequately met.