Increased Mental Health and Substance Abuse Services Needed for Persons Living with HIV/AIDS

The American Psychological Association (APA) strongly recommends that additional funding be provided for mental health and substance use services for persons living with HIV/AIDS.

Background

  • According to the Centers for Disease Control and Prevention (CDC), there are approximately 56,300 new HIV infections each year and there are an estimated 1.1 million people living with HIV/AIDS in the United States. Of those currently infected, one in five does not know he or she has the condition, and the majority of new infections are spread by people who are unaware of their own status. A new HIV infection occurs every 9 ½ minutes in the United States. Those at especially high risk include gay and bisexual men of all races, and African American men and women.
  • An estimated 12 percent of new HIV infections each year are directly attributable to injection drug use. Individuals with a substance abuse problem or mental disorder are more likely to become infected with HIV due to their increased likelihood to engage in sexual and drug use risk behaviors.
  • Mental disorders and substance use or dependence are common among people with HIV. According to the nationally representative HIV Cost and Services Utilization Study (HCSUS) of persons with HIV, nearly half of participants screened positive for one or more of four psychiatric disorders, including major depression, dysthymia, generalized anxiety disorder, and panic attacks. Nearly 40 percent of persons with HIV reported illicit drug use, and more than 12 percent screened positive for drug dependence. By virtue of lower socioeconomic status, the prevalence of mental disorders is even greater among racial and ethnic minorities, who represent the majority of new HIV and AIDS cases.
  • Mental health and substance abuse problems among people with HIV can lead to poor adherence to treatment regimens, including decreased likelihood of receiving and following antiretroviral treatment instructions. A 2007 Rand Corporation study found that persons with mental health or substance use problems had difficulty managing their HIV. Approximately 64 percent of individuals with a psychiatric disorder and nearly 70 percent of people with substance abuse problems were non-adherent.
  • According to an Institute of Medicine report, Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White, mental health and substance abuse treatment can help stabilize the health and well-being of individuals with HIV and can potentially improve adherence to antiretroviral drug treatment. According to data from HCSUS, over two-thirds of those either perceiving need or having 12-month non-substance use mental disorders received some kind of mental health services in the past six months. However 16 percent received care only from general medical providers rather than specialists. This is a concern due to the tendency for patients to have fewer visits with general medical providers compared to specialists. The study also found that 12 percent of patients received substance abuse treatment.
  • A 2007 RAND study found that screening for HIV and risk behaviors is not a high priority in mental health and substance abuse treatment settings and occurs haphazardly. Furthermore, many mental health professionals need more training about the relationship between HIV/AIDS and mental health.

Recommendations

  • Provide funding for mental health and substance abuse services for people with HIV/AIDS. Recognizing this need, the Center for Mental Health Services initiated a grant program in 2001 to address the mental health needs of persons living with HIV/AIDS and who have a diagnosed mental health disorder. It is critically important that such funding be continued.
  • Increase screening for HIV and risk behavior in mental health and substance abuse treatment settings. The Substance Abuse and Mental Health Services Administration (SAMHSA) should increase funding to expand HIV screening throughout mental health and substance abuse prevention and treatment delivery systems. CDC and SAMHSA should collaborate to increase HIV/AIDS training opportunities for SAMHSA funded mental health and substance abuse prevention and treatment providers.
  • Implement an “integrated” HIV/AIDS care model that includes mental health and substance abuse services for people living with HIV/AIDS. Co-occurring mental health and substance use disorders increases the likelihood of non-adherence to medication schedules and treatment regimens. HIV-positive individuals who have co-occurring mental health and substance use disorders rarely receive “integrated” care with a treatment plan for all three disorders. An integrated approach to HIV/AIDS, mental health support and substance abuse treatment can improve patient adherence and lead to more favorable health outcomes for people living with HIV/AIDS. The Health Resources Service Administration and SAMHSA should collaborate in order to expand the availability of an integrated care model.