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HIV/AIDS and Hepatitis is one of SAMHSA's matrix program priority areas. SAMHSA
plays a critical Federal role in reducing the HIV/AIDS epidemic as a result of
the link between substance abuse and the spread of HIV/AIDS. Since the epidemic
began, injection drug use (IDU) has directly and indirectly accounted for more
than one-third (36%) of AIDS cases in the United States. This trend appears to
be continuing, with 28% of new cases reported in 2000 being IDU related.
Racial-ethnic minorities populations in the U.S. have been more heavily
affected by IDU-associated AIDS. In 2000, IDU associated AIDS accounted for 26%
of all AIDS cases among African American and 31% among Hispanic adults and
adolescents compared with 19% among white adults/adolescents. 57% of all cases
among women have been attributed to IDU or sex with partners who inject drugs,
compared with 31% among men. Substance abuse prevention and treatment are key
HIV prevention strategies.
The goals of SAMHSA's HIV/AIDS programs are to:
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improve access to substance abuse prevention and treatment services through
increasing capacity and outreach to populations in communities of color
disproportionately affected by the HIV epidemic;
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strengthen community capacity and infrastructure to develop an integrated system
of care that includes HIV prevention, substance abuse prevention, substance
abuse treatment, mental health treatment, and primary care, including Hepatitis
C;
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translate science to services through the dissemination of effective models and
programs.
Providing mental health treatment services to individuals at high risk for HIV
is an effective HIV prevention approach, as well as an often essential
component of care to individuals with HIV/AIDS. Access to prevention and
treatment services, and the quality of those services, are improved when
substance abuse prevention, HIV prevention, substance abuse treatment, mental
health care, and primary care are linked and coordinated.
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SAMHSA's participation in the National Minority AIDS Initiative (NMAI) has been
instrumental in providing prevention, treatment and mental health services
programs for identified minority populations at risk for HIV or living with
HIV/AIDS. These include African American and Hispanic men (including men who
have sex with men), women, and young people. SAMHSA has also been working with
HRSA and CDC on the development of more effective services to integrate HIV
prevention and care, substance abuse prevention and treatment, and mental
health services.
SAMHSA's three surveys and Integration Meeting (1998 through 2002) examined the
extent to which States are coordinating their activities among substance abuse
services, mental health services, and HIV services. The resulting
recommendations included: 1) the importance of interfacing with the criminal
justice system, especially related to persons being discharged to the
community; 2) the need for support and incentives to local service delivery
agencies to integrate HIV/substance abuse/mental health services delivery; 3)
identification of best practices related to integration of services; 4) the
need for flexibility in use of grant funds; 4) ensuring integrated, seamless
services to the client; and, 5) further expansion of Federal, State, and
national association collaboration to improve integration of services.
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Center for Mental Health Services
The Center for Mental Health Services is requesting $10.492 million (level
funding) to use in FY 2005 for HIV/AIDS activities, and plans to continue 1)
the Mental Health HIV Service Collaborative Program and 2) best practices HIV
education activities.
In FY 2001, Congress appropriated $7 million to CMHS as part of the National
Minority AIDS Initiative for HIV/AIDS for the treatment of mental health
disorders related to HIV disease including dementia, clinical depression, and
the chronic, progressive neurological disabilities that often accompany HIV
disease. This 5-year grant program was designed to expand and strengthen the
capacity of community-based entities to provide culturally appropriate mental
health treatment services targeted to African Americans, Hispanics/Latinos,
and/or other racial, ethnic minorities living with HIV/AIDS. Direct services
grants were awarded to 21 community-based providers that operate in traditional
and non-traditional settings. Funding for these projects was continued in FY
2003 - FY 2004, and will be continued in FY 2005.
Since 1998, CMHS has had the lead responsibility for the HIV/AIDS Treatment
Adherence/ Health Outcome and Costs Study. Results will be reported in December
2003. This landmark effort reflects the collaboration of six Federal
entities-the Center for Mental Health Services; the Center for Substance Abuse
Treatment; the HIV/AIDS Bureau in the Health Resources and Services
Administration; and the National Institute of Mental Health, the National
Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug
Abuse. It is the first Federal initiative designed to study integrated mental
health, substance abuse use, and primary medical HIV treatment interventions
and to determine if an integrated approach to care improves treatment
adherence, produces better health outcomes, and reduces the overall costs
associated with HIV treatment. The findings from this joint study are expected
to have a substantial impact on practice, policy and future interventions
related to persons with HIV/AIDS and co-morbid mental health and substance
abuse disorders.
In FY 2005, CMHS also proposes to continue Mental Health Care Provider
Education, which began in the mid-1980s. The program currently consists of
contracts with three major professional mental health care provider
associations: the American Psychiatric Association, the American Psychological
Association, and the National Association of Social Workers. Each of the three
groups is required to develop and implement HIV/AIDS related mental health
treatment training/education programs and workshops for 1000 individuals/year
in their discipline (not necessarily in their membership).
Virtually every year, each of the associations has exceeded, and in some cases
significantly exceeded, these goals. As a result of CMHS coordination, the
three associations also frequently provide joint training to multi-disciplinary
trainees.
The three associations have developed numerous curricula. Of note are the
American Psychiatric Association's "Neuropsychiatry Curriculum" and a new
curriculum, "The Brain and Behavior," a neuropsychiatry curricula for
non-physicians; the American Psychological Association's multi disciplinary
"Ethical Issues and HIV/AIDS," and the National Association of Social Workers'
"Mental Health, Substance Abuse, and HIV/AIDS" curricula. In addition, the
three associations will jointly develop a basic mental health and HIV/AIDS
curriculum for use in community based organizations who serve HIV positive
individuals who also have a diagnosed mental illness.
Center for Substance Abuse Prevention
The Center for Substance Abuse Prevention (CSAP) is requesting level funding of
$39.6 million in FY 2005. $20.1 million is recycled funds from expiring grants
that will be invested in a new cohort of approximately 55 grants in FY 2005.
The remaining portion of the CSAP funds will continue an estimated 62 grants.
In FY 2003 and 2004, CSAP began to focus the HIV program on 5-year projects,
with the first year supporting a comprehensive planning process. These grants
are intended to address minority health care disparities and the
disproportionate impact of HIV infection in minority communities by expanding
the capacity of community-based organizations to provide effective, integrated
substance abuse prevention and HIV prevention services. The comprehensive
planning in the first year includes efforts such as coalescing resources,
networking, and selecting and adapting (to be culturally appropriate for the
target minority population and the community) prevention interventions that
reduce risk and enhance resiliency. The subsequent four years are for
implementation and evaluation.
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Center for Substance Abuse Treatment
CSAT is requesting $61.442 million in FY 2005 to continue grants for the
Targeted Capacity Expansion HIV/AIDS Services Program and related technical
assistance and evaluation activities. This program, initiated in FY 1999 in
response to Congressional language, seeks to address critical gaps in substance
abuse treatment capacity and to increase the availability and accessibility of
substance abuse treatment and HIV/AIDS services. The program emphasis rapid,
strategic responses for substance abuse treatment and related HIV/AIDS services
(including sexually transmitted diseases, tuberculosis, and hepatitis B and C)
specifically targeted toward racial and ethnic minority populations (e.g.,
African American, Hispanic/Latino) in Metropolitan Statistical Areas in which
the annual AIDS case rate is 20/100,000, or States in which the rate is
10/100,000. In FY 2001, CSAT added an additional eligibility standard that gave
priority to metropolitan areas with high minority AIDS rates (25/100,000 or
greater) that had not previously received funding under the National Minority
AIDS Initiative.
The program goal is ultimately to reduce the spread of substance-abuse-related
HIV/AIDS and other infectious diseases in identified high-risk communities. The
program is designed to help improve the health of substance abusers through
linkages among primary health care, HIV/AIDS, substance abuse and mental health
treatment services. The program also expands and enhances the capabilities of
substance abuse treatment programs to provide effective services for their
clients and to expand their organizational capacity through well-defined
linkages with other organizations/providers.
Significant performance has been achieved to date. The 102 Targeted Capacity
Expansion-HIV grants awarded during the period FY 1999-2001 have accounted for
approximately 13,325 clients having been served. In addition, CSAT has
supported an active HIV/AIDS Outreach program during this period, awarding 25
Outreach grants (grant funding for a separate outreach portfolio ended
September 30, 2002) through which 508,620 potential clients have been
contacted. The two groups of grants have served approximately 46,203 clients.
Six months into FY 2003, 608,460 potential clients have been contacted; 29,243
clients have received an HIV test; and 12,980 clients have been referred to
treatment.
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