Whole-Person Health and HIV Research:
Continuum 2026 Keynote Lays Out OAR Vision
By Dr. José M. Zuniga
Remarkable advances in prevention, treatment, and care have transformed HIV into a manageable chronic condition for millions of people. The challenges facing individuals aging with HIV thus demand a broader and more integrated response. At Continuum 2026, Dr. Geri R. Donenberg, Associate Director for AIDS Research and Director of the National Institutes of Health (NIH) Office of AIDS Research (OAR), delivered a compelling keynote address outlining the future of HIV research through the lens of whole-person health.
Her message was clear: HIV care and research can no longer focus solely on viral suppression. To ensure optimal health outcomes, we must address the full spectrum of factors that influence the lives of people living with HIV, including the growing burden of aging-related conditions, mental health challenges, social determinants of health, and the cumulative effects of multiple co-occurring diseases that shape long-term well-being. She urged a shift from a disease-centered model to a person-centered approach that recognizes individuals as more than their HIV diagnosis and prioritizes quality of life alongside clinical success.
HIV remains a significant public health challenge. Approximately 39,000 new diagnoses continue to be reported annually in the United States, underscoring the need to sustain and strengthen prevention efforts. And nearly 1.1 million people are living with HIV in the United States, and most are now age 50 years or older. Dr. Donenberg acknowledged these demographic shifts reflect the extraordinary success of antiretroviral therapy (ART), but noted they also signal a new phase of the epidemic characterized by aging, chronic disease management, and quality of life considerations.
Dr. Donenberg emphasized the importance of adopting a whole-person health framework that considers physical, mental, emotional, social, and environmental dimensions of well-being across the lifespan. For people living with HIV, this perspective is particularly important given the complex interplay between HIV, aging, and multiple co-occurring conditions, as well as the social and structural factors that influence access to care, treatment adherence, and overall quality of life. This perspective also underscores the need for integrated models of care that are responsive to the realities of daily life.
Her keynote address highlighted what some researchers have termed the “gray tsunami” of HIV. As people with HIV live longer, and as older adults increasingly represent the majority of those receiving HIV care, they increasingly face challenges associated with aging, including frailty, functional decline, neurocognitive changes, polypharmacy, social isolation, and the management of multiple chronic conditions. These realities require healthcare systems to evolve beyond traditional HIV care models toward more integrated and multidisciplinary approaches.
Women aging with HIV face additional complexities. Research Dr. Donenberg presented during the keynote address underscored higher burdens of co-occurring conditions, differences in immune response and antiretroviral drug metabolism, reproductive health considerations, and the earlier onset and greater severity of menopause-related symptoms. These findings reinforce the need for sex-specific and gender-responsive research and clinical care. They also highlight the importance of ensuring that women are adequately represented in HIV research to better address their unique biological, clinical, and psychosocial needs across the lifespan.
Co-occurring conditions represent one of the most significant drivers of morbidity among people living with HIV. Cardiovascular disease, diabetes, kidney and liver disease, osteoporosis, neurocognitive disorders, and certain cancers occur at elevated rates in this population and have substantial impacts on quality of life. Recognizing this reality, and the growing number of people aging with HIV who are managing multiple chronic conditions simultaneously, she indicated the NIH has dedicated approximately 20% of its HIV research portfolio to studying co-occurring conditions and their interaction with HIV.
Quality of life also emerged as a central theme throughout her presentation. Viral suppression remains a critical goal, but it is no longer sufficient as the sole measure of success. Individuals living with HIV increasingly seek not only longer lives but also healthier, more fulfilling lives. Quality of life encompasses physical health, mental well-being, social relationships, independence, housing stability, and overall life satisfaction. Dr. Donenberg emphasized that these person-centered outcomes should be considered alongside traditional clinical indicators when evaluating the effectiveness of HIV care and treatment programs.
Encouragingly, recent data show improvements in several quality-of-life indicators, including housing stability, employment, food security, and HIV-related stigma. However, unmet mental health needs have worsened, highlighting an area Dr. Donenberg says requires urgent attention. Mental health remains both a determinant and an outcome of successful HIV care and must be integrated more fully into clinical and public health responses. Addressing mental health challenges will be essential to sustaining treatment engagement, improving quality of life, and supporting healthy aging among people living with HIV.
The OAR plays a critical role in coordinating the federal HIV research agenda. In fiscal year 2025 alone, NIH invested approximately $3.29 billion in HIV research across more than 3,800 awards spanning over 20 NIH institutes and centers. This coordinated investment supports research across the continuum of prevention, treatment, cure, implementation science, aging, women’s health, and co-occurring conditions. Such a broad and coordinated portfolio reflects the complexity of today’s HIV epidemic and the need for multidisciplinary solutions that address both biomedical and broader health challenges.
Dr. Donenberg’s keynote address concluded with a call for greater coordination across agencies, disciplines, and healthcare systems. Integrating geriatric expertise into HIV care, expanding aging-related screening, strengthening multidisciplinary care teams, and promoting provider cross-training are among the strategies needed to meet the needs of an aging HIV population. She emphasized that success will require sustained collaboration among researchers, clinicians, public health practitioners, community organizations, and policymakers to deliver truly integrated, whole-person care.
Dr. José M. Zuniga is President/CEO of IAPAC and the Fast-Track Cities Institute.
Click here to access Dr. Donenberg’s keynote address. Suggested citation:
Donenberg, G. R. Implementation Science: Aligning Priorities: HIV Implementation Science in Action. Keynote Address. Continuum 2026. October 11-13, 2026. San Juan, PR.
