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The federal government’s major mental health agencies announced a new program last month to reduce the incidence of HIV infection by identifying risk-reduction strategies and the best methods of ensuring they are implemented.
In the 12 years since scientists identified HIV as the virus that causes AIDS, a tremendous amount has been learned about behavior changes that will successfully reduce a person’s risk of contracting that infectious agent. A considerable gap has persisted, however, between that knowledge and the extent to which it has been translated into community-based prevention programs.
The new $2 million program is called the HIV/AIDS High-Risk Behavior Prevention/Intervention Model for Young Adults/Adolescents and Women. These populations make up the fastest growing proportion of Americans infected with HIV. In the United States, for example, 22 percent of AIDS cases now occur among women. Moreover, while the number of AIDS-related deaths fell 15 percent among men in the last year, a 3 percent increase occurred among women.
A major factor contributing to the selection of these groups as the project’s focus is that "they have not been sufficiently studied when looking at ways to decrease behaviors that put people at risk for HIV," said psychiatrist Melvyn Haas, M.D., associate director for medical affairs of the federal government’s Center for Mental Health Services (CMHS). The CMHS, a division of the Substance Abuse and Mental Health Services Administration (SAMHSA), will coordinate the program.
"Fortunately, the knowledge and principles necessary to develop large-scale, behavior-oriented training tailored to specific at-risk populations are now available," said SAMHSA Administrator Nelba Chavez, Ph.D., in announcing the new project. "Previous research confirms that small-group interactive programs can be successful in reducing high-risk behaviors" that contribute to HIV infection.
Psychiatrist Bernard Arons, M.D., director of the CMHS, added that "because of the importance of understanding the issues from a consumer perspective," women and adolescents, the primary targets of the project, will be involved in its planning at each of the seven sites chosen to participate.
Pilot Project Sites
Those sites, each of which was selected based on its proposal for short-term prevention and intervention efforts, are Virginia Commonwealth University in Richmond; the University of Texas Health Sciences Center, Houston; the Education Development Center in Newton, Mass.; Rhode Island University’s psychiatry department; the University of Alabama, Birmingham, School of Public Health; the University of Miami; and Miriam Hospital in Providence, R.I. Each site has access through existing programs to the populations targeted by the initiative, although to be selected they did not have to have specific HIV-prevention programs up and running, Haas said in an interview with Psychiatric News.
None of the proposed interventions is aimed specifically at gay youth, who remain at particularly high risk of contracting HIV, but the programs are free to target those individuals as a "subtarget" within their youth-oriented initiatives, Haas noted. Recent surveys point to a growing unwillingness of gay adolescents and young adults to adhere strictly to safe-sex practices, in part because with the advent of more effective drugs, many have stopped viewing AIDS as a death sentence. Others have come to see the disease as an inevitable outcome of being a gay man in this era and are unconvinced that safe-sex measures will actually protect them from HIV.
Identifying Best Ideas
In the next phase of the project, the CMHS, the seven program sites, and representatives of groups at whom the initiative is aimed will, based on pilot testing of the proposed programs, collaborate on selecting what they judge to be the best ideas for fostering behaviors that will reduce HIV-infection risks. The CMHS will coordinate separate selection processes for strategies targeted at women and those designed to reach adolescents and young adults.
Among the topics participants will examine are obvious ones such as high-risk sexual activities and substance abuse, as well as ones whose link to HIV transmission is less quantifiable, including peer pressure, mental illness, and cultural variations.
At the end of two years the participants are expected to arrive at some consensus about what activities seem to be the most effective in reaching these populations.
Haas said he hopes that the knowledge and experience gleaned from this project will have broad applicability for changing behaviors beyond those that put people at risk of HIV infection. He gave smoking as an example of an area in which the lessons learned during the HIV project could be valuable.