APA Public Interest Policy Office: January 19, 2006

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What do we know?

• Approximately 40,000 people are newly infected with HIV each year. Those at especially high risk include gay and bisexual men, women, racial/ethnic minorities, and injecting drug users and their sexual partners. An estimated 25 percent of new HIV infections each year is directly attributable to injection drug use. Individuals with a substance abuse problem or mental disorder are more likely to become infected with HIV than in the past, with the latter being almost one and a half times more likely to become infected than those without a mental disorder.

• Mental disorder and substance use or dependence are common among people with HIV. According to the nationally representative HIV Cost and Services Utilization Study (HCSUS), 50% of persons with HIV screened positive for illicit drug use, 36% for major depression, and 26% for a generalized anxiety disorder. By virtue of lower socioeconomic status, the prevalence of mental disorder is even greater among racial and ethnic minorities, who represent the majority of new HIV and AIDS cases.

• Persons with mental health or substance use problems frequently have difficultly managing their HIV. They tend to be less compliant with medication regimens and are less likely to utilize health services. This can lead to the emergence and potential transmission of drug-resistant HIV. Depression among persons with HIV has also been linked to a more compromised immune system and earlier mortality.

• According to a 2004 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 potentially improve adherence to antiretroviral drug treatment. According to HCSUS, 40% of persons with HIV received mental health services and 20% received substance abuse treatment. However, the rates are lower for persons of color, who have less access and lower utilization of mental health and substance abuse services than whites.

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What do we need?

• Funding for mental health and substance abuse services for people with HIV/AIDS. Although funding for the Ryan White CARE Act can be used directly for substance abuse and mental health services, a recent study funded by the Health Resources and Services Administration found that in New York City, for example, only 22% to 31% of substance abuse treatment programs and 11% to 20% of mental health services for HIV-infected individuals received funding from this program.

• Increased screening for HIV and risk behavior in mental health and substance abuse treatment settings. A RAND study found that screening for HIV and risk behaviors is not a high priority in mental health treatment settings and occurs haphazardly. Furthermore, many mental health clinicians have inadequate knowledge of the relationship between HIV/AIDS and mental health. In 2000, the Center for Substance Abuse Treatment recommended that substance abuse treatment centers screen for HIV.

• An “integrated” care model that includes mental health and substance abuse services. HIV-positive individuals who have co-occurring mental health and substance use disorders rarely receive an “integrated” care with a treatment plan for all three disorders. Physical health, mental health, and substance abuse services are usually provided by different agencies. However, the HIV/AIDS Mental Health Services Demonstration Program found that HIV-positive individuals who received mental health services or substance abuse treatment were more likely to receive and retain HIV primary medical care.

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