November 20, 1998

APA's AIDS Program Office has been awarded a three-year grant from the federal Center for Mental Health Services that will enable APA to expand its efforts to educate psychiatrists about the psychiatric and neuropsychiatric aspects of HIV and AIDS.

APA's groundbreaking education and training initiative, now in its 10th year, has developed a comprehensive array of clinical guidelines, training curricula-including one designed specifically for residents-and resource materials to help psychiatrists and mental health professionals treat patients who have HIV disease or AIDS.

The contract will allow APA to increase dramatically its efforts to address the unique issues of special populations whose HIV infection rates are soaring.

"Although news accounts that death due to AIDS has decreased over the past year with the advent of new therapy regimens, the rate of new infections with HIV continues to climb, particularly in people of color and in young Americans," said APA AIDS Commission Chair Marshall Forstein, M.D.

Particularly troubling for the future of the epidemic, Forstein told Psychiatric News, is that "among adolescents who are newly sexual, the belief that the new treatments are 'cures' has decreased their sense of seriousness about the epidemic."

He cited one recent study that found that among gay men in their late adolescent years, 4 percent are becoming infected with HIV each year. "This means that within a decade, 50 percent of that cohort will be infected with HIV," he said.

He noted as well that African-American women are becoming HIV infected "at much higher rates than other population groups and are less likely to have access to treatments."

The contract calls for the AIDS project to continue to conduct training sessions at APA's annual meeting and Institute on Psychiatric Services and to arrange training sessions at local sites around the country.

The project will now be able to incorporate the latest technology, allowing APA's cadre of HIV experts to use modalities such as teleconferencing and video initiatives and to expand the services offered on its Web site, explained Carol Svoboda, director of APA's AIDS Program Office. The project is also considering installing CME modules and training curricula on the site, she said.

The contract calls for APA to train about 1,000 psychiatrists a year. The training sessions will be conducted by psychiatrist educators who have volunteered their services to the APA AIDS Program Office.

Forstein noted that one area on which the trainers and APA AIDS staff will focus will be the increasingly critical area of treatment adherence. Adhering to treatment has become a tough challenge for many HIV-infected persons because of the complicated medication regimens they must follow to keep the virus in check. "The adherence problem requires a truly biopsychosocial model of health care," he emphasized.

APA will be responsible for ensuring that the trainers impart the latest clinical and research data, Svoboda pointed out, which is critical in light of the rapidly shifting nature of the epidemic.

Psychiatrists in rural or isolated areas are a particular target of APA's AIDS outreach efforts, as are psychiatrists working in the public sector and in substance abuse programs, said Svoboda.

A major new area addressed in the contract calls on APA to provide technical support to residency training directors and medical school educators, based on the HIV/AIDS curriculum it has developed and tested over the last two years. The AIDS Program Office already has requests from 40 training directors for an AIDS/HIV program for their residents.

Two residency programs have already taken advantage of the training opportunity-one at the University of South Carolina, the other at Wayne State University.

Chicago psychiatrist Francisco Fernandez, M.D., led the training at Wayne State. He explained that APA's curriculum is "based on the biopsychosocial model and focuses on neuroscientific, psychosocial, psychopharmacological, and behavioral issues." The training, he said, "allows residents to access the trainer's experience and combine it with their own synergistically to improve diagnostic accuracy and therapeutic effectiveness."

The Web address for the APA AIDS project is www.psych.org/aids.