As HIV treatment and prevention have advanced, the HIV response has become increasingly biomedicalised. However, biomedical solutions are insufficient to address the social, psychological and relational impacts of HIV. Drawing on a participatory qualitative study, this chapter discusses the views and experiences of older women living with HIV in the United Kingdom to explore the barriers HIV can pose for intimacy. Women living with HIV do not live single-issue lives, and different intersecting factors influence their experiences and views of sex and intimacy. These factors include ageism, sexism, anti-trans discrimination and past experiences of sexual and gender-based violence. Partners’ attitudes, wider society and diverse life experiences all influence sex and sexual behaviours in women ageing with HIV, indicating the limitations of an increasingly biomedicalised HIV response.