APA Continues Its Commitment To Fight Consequences of AIDS

AIDS has been permanently etched in our consciousness. It was not long ago that we faced a sudden avalanche of rare conditions and diseases that signaled the arrival of this mysterious and devastating illness. Anxious, puzzled, and unprepared, many physicians, including psychiatrists, were reluctant to embrace this mounting clinical challenge. Those who did faced a roller coaster of emotions, fears, frustrations, failings, and triumphs.

While training medical students last fall, members of the APA Committee on AIDS and the American Psychiatric Institute for Research and Education's Steering Committee on HIV Psychiatry offered candid, often emotional, accounts of their personal and professional HIV experiences, some spanning decades.

Their stories revealed the tenacity and optimism that continue to drive activities of the Office of HIV Psychiatry. Students were moved and inspired by the broad experience and dedication of these members, who also serve as their mentors for a new APA minority fellowship program in HIV psychiatry.

Last September, the Office of HIV Psychiatry coordinated its first fellowship program matching mentors at seven sites with 10 medical students whose primary interests include psychiatry, HIV/AIDS, substance abuse, and ethnic minority health.

The program was designed to foster strong mentor relationships while offering well-supervised clinical experiences, comprehensive HIV training, online case discussions, and ongoing mentor consultations. Ten new students will be selected for the second group of fellowships in September 2005. Applications are now being accepted.

Residents are also at the forefront of HIV training efforts. First, real-time, distance learning has been incorporated into existing education and training programs, thus offering obvious advantages to residency training. The Office of HIV Psychiatry has piloted the program at four sites and received positive feedback. Of course, technical constraints and problems exist, limiting its use and possibilities. The challenges posed, however, are countered by opportunities to reach a wider audience, expand opportunities in underserved areas, involve expert faculty who might otherwise be unavailable, and provide a cost-effective alternative in resident education.

Second, grand rounds and case discussions continue to link our AIDS-network members with training programs around the country. Requests for on-site HIV residency trainings have increased sixfold since last year at this time. In January nearly 40 requests were received for HIV training for the 2005-06 academic year. This increase in demand is evidence of a need for not only continuing education in HIV psychiatry, but also for the expansion of our current training capacity.

Meeting this demand will require an increased number of experienced faculty and preceptors to lead and facilitate this process. Building the needed capacity will require identifying and supporting new trainers, developing and presenting workshops for basic and advanced HIV education, and expanding technical support. The Office of HIV Psychiatry will work to achieve these goals by collaborating with allied programs, seeking outside funding for new projects, and working within existing contracts and grants.

One such contract, awarded in September 2004 by the Center for Mental Health Services (CMHS), renewed funding for five years for training psychiatrists and residents, providing technical support to APA's HIV network, updating curriculum, expanding distance learning, and evaluating current HIV training programs.

I want to express a special note of thanks to Dr. Melvyn Haas, who was the leading proponent of HIV activities at CMHS and principal author of many of the HIV-related contracts APA has received. Dr. Haas served several years as the associate director for medical affairs and the CMHS AIDS coordinator until his retirement last December. His commitment to HIV psychiatry, unending support of APA, and compassion as a clinician make him an asset to the field.

In addition to its existing projects, the Office of HIV Psychiatry hopes to secure funds to create innovative Internet-based education programs, train residents to serve as HIV trainers, initiate computer-based consultations, and adapt current clinical tools for PDAs and pocket PCs. It would like to expand efforts in rural and underserved areas inside and outside the United States. When the Office of HIV Psychiatry was first established, the United States was a major site of the HIV epidemic. Today, AIDS is a global epidemic, with worldwide mental health consequences.

Increasingly, the Office of HIV Psychiatry and members of our HIV/AIDS committees are engaging in international collaborations. These projects include adapting interventions for severely mentally ill people in Brazil and China, collaborating with the World Health Organization on mental health guidelines to treat HIV-infected patients in resource-poor countries, and participating in international forums.

Also, the office is discussing with representatives from South Africa the development of an e-mail hotline to foster communication and case consultation, link physicians here and abroad, and deliver HIV information to underserved areas.

The global epidemic shows no signs of abating. And two decades into the epidemic, we face a second wave of infections in the United States.

For the Office of HIV Psychiatry, there exists a host of opportunities for crafting and implementing programs that can have an impact on HIV/AIDS care throughout the world. These opportunities make it important for APA members to support our HIV activities, staff, and inspiring colleagues who work in the fight against AIDS.

An application for the medical student fellowship in HIV psychiatry is posted online at<www.psych.org/aids>.▪