SAMHSA, Behavioral Health and the National HIV/AIDS Strategy (Part II)

Gretchen Stiers, SAMHSA.

As the HIV/AIDS policy lead at the Substance Abuse and Mental Health Services Administration (SAMHSA), I am pleased to return to the blog to discuss more of the activities that SAMHSA is engaged in to support the National HIV/AIDS Strategy (NHAS). In my last post, I discussed SAMHSA's commitment to addressing the behavioral health problems that can put individuals at greater risk for HIV infection, co-occur with HIV infection, and hinder access to treatment and maintenance in care for mental and substance use disorders as well as for primary medical services. I also discussed SAMHSA's efforts to examine the funding criteria that allow States to use five percent of the Substance Abuse Prevention and Treatment Block Grant funds for HIV/AIDS services, and our support of the 12 Cities Project. Today, I would like to provide an overview of how some of our current behavioral health activities are aligned with each of the three goals of the NHAS. Behavioral health refers to emotional health in general and the choices/actions that affect wellness. Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicide, and mental and substance use disorders.

Goal 1: Reducing New HIV Infections

To reduce the number of new HIV infections, the NHAS calls for us to re-orient our prevention efforts by realigning resources to serve the populations at highest risk of acquiring or transmitting HIV including those with mental and substance use disorders¹. The NHAS recommends that HIV testing and other comprehensive HIV prevention services be coupled with treatment and services for individuals with mental and substance use disorders. To help assess the need for additional services, SAMHSA is conducting a needs assessment to determine the distribution and frequency of HIV testing in SAMHSA-funded substance abuse and mental health treatment clinics. We will use the results from the assessment to determine areas for expanding HIV testing capacity in SAMHSA-funded clinics and centers. While many behavioral health service providers are not HIV specialists, their patient populations may be engaging in behaviors that put them at higher risk for HIV infection or hinder access to HIV treatment and maintenance in care. SAMHSA will develop resources, technical assistance and training to help substance abuse and mental health treatment providers offer HIV prevention services (such as access to rapid testing) and to increase their capacity to link people with HIV/AIDS to primary care in a timely manner.

Goal 2: Improving Access to Care and Improving Health Outcomes for People Living With HIV

To increase access to care and improve health outcomes for people living with HIV, SAMHSA is responding to the Strategy's call to promote collaboration at all levels of government among HIV medical care providers and agencies providing HIV counseling and testing services, treatment and services for mental and substance use disorders, housing and recovery support services for people most at risk for or living with HIV/AIDS. In support of this important priority, SAMHSA is working with its Federal partners to develop guidance for primary care providers recommending that clients who are HIV-positive or living with AIDS be given appropriate access and referrals to mental health and substance abuse treatment services, and, correspondingly, for providers of behavioral health treatment and services recommending that they directly link clients with HIV/AIDS who are not receiving medical care into primary care and that they support their maintenance in care. Since it is estimated that up to half of people with HIV have a diagnosed mental disorder, such as depression, and 13 percent have a co-occurring mental and substance use issues, SAMHSA is also developing self-directed and wellness-centered approaches to behavioral health care for people living with HIV/AIDS.

Goal 3: Reducing HIV-Related Health Disparities

The NHAS observes that the burden of HIV is often greatest in groups that have been marginalized or underserved. To address this, SAMHSA is partnering with the Centers for Disease Control, the Health Resources and Services Administration, and the Indian Health Service to increase the capacity of communities to prevent HIV and support community members living with HIV. SAMHSA also plans to release an online curriculum for substance abuse treatment providers serving minority men who have sex with men (MSM), one of the communities bearing the greatest burden of HIV.

Working to end the prejudice and discrimination experienced by people living with HIV is a critical component of curtailing the epidemic. Prejudice has been shown to be a barrier to HIV testing. People living with HIV who experience more prejudice have poorer physical and mental health and are more likely to miss doses of their medication. To help improve both the poorer physical and mental health outcomes that result, SAMHSA will work with its Federal colleagues to explore opportunities for partnering with nongovernmental and private-sector partners to develop new approaches for addressing stigma related to HIV/AIDS, including HIV prejudice, racism, sexism, and homophobia.

What needs and opportunities do you see in your community for better coordinating HIV prevention, care and treatment efforts with mental health and substance abuse prevention and treatment? Share your insights by joining the discussion in the Comments section below.

In subsequent posts, I'll discuss some of these activities in more depth and share information about how we are helping to engage States, Territories, Tribes, local organizations, and individuals—including researchers, behavioral health service providers, consumers, families, and the recovery community—in aligning efforts to work toward the important goals of the NHAS. In the meantime, you can read more about our NHAS implementation activities in the HHS NHAS Operational Plan.

Read Part I here.

Gretchen Stiers, Ph.D., is HIV/AIDS policy lead, Office of Policy, Planning and Innovation, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services.

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¹ Mental and substance use disorders includes mental disorders, substance use disorders, and co-occurring mental and substance use disorders.