Aiona was elected Lieutenant Governor of Hawaii in the 2002 general election, on a ticket with Republican gubernatorial nominee, former Mayor of Maui, Linda Lingle. On December 2, 2010, Aiona was sworn in as Hawaii's 10th Lieutenant Governor at an inauguration ceremony at the Hawaii State Capitol rotunda. He and Lingle ran together again in 2010, winning re-election to their second terms in the general election on November 2, 2010.

Personal driver's traffic violation

In 2005, Aiona's personal driver was caught on camera breaking a new state law right after Aiona had made a public presentation about that same law. Local ABC affiliate KITV reporter Keoki Kerr reported that after a press conference about a state law that made it illegal to drive a vehicle through a crosswalk with a pedestrian in the crosswalk, news cameras caught Aiona's personal driver almost hitting a pedestrian in the crosswalk.

Temper

He was questioned about his temper at his confirmation hearing for the state circuit court bench. Judiciary committee member State Senator Matt Matsunaga asked if Aiona recalled getting kicked out of a lawyer's league basketball game in the late 1980s. Matsunaga was satisfied with the explanation that it was a misunderstanding and voted in favor of the appointment.