- Psychological Issues
NIMH has been at the forefront of AIDS research since the beginning of the epidemic and has been the focal point for developing research knowledge essential for understanding and preventing the disease. The AIDS epidemic is a public health emergency that requires a coordinated and interdisciplinary Federal response. Mobilizing the best scientific minds in both neurological and behavioral research, NIMH continues to play a pivotal role in this Nation’s overall effort by developing new ways to understand, treat, and prevent the spread of HIV.
NIMH prevention research efforts target particularly vulnerable groups who are at higher risk for both HIV and co-occurring medical conditions that are mediated by health behaviors. AIDS represents a significant public health problem among the seriously mentally ill that requires an integrated behavioral and medical response. Prevention studies provide such an integrated behavioral and medical response by developing effective behavioral interventions to improve the overall health status of people with mental disorders.
An NIMH Snapshot
The National Institute of mental health (NIMH) is one of 25 components of the National Institutes of Health (NIH), the Government’s principal biomedical and behavioral research agency. NIMH is part of the U.S. Department of Health and Human Services. The actual total fiscal year 1999 NIMH budget was $859 million.
To reduce the burden of mental illness through research on mind, brain, and behavior.
How Does the Institute Carry Out Its Mission?
Furthermore, HIV/AIDS constitutes an infectious disease epidemic, and the faster the cause, prevention and treatment are established, the faster the epidemic will end.
In 1997, the NIH convened a Consensus Development Conference of distinguished scientists to evaluate NIMH research-based scientific information on behavioral interventions to reduce risk for HIV/AIDS. The conferees, representing a wide range of scientific disciplines, concluded that these interventions “are effective for reducing behavioral risk for HIV/AIDS and must be widely disseminated.”
Because the number of new infections exceeds the number of deaths due to AIDS each year both in the U.S. and worldwide, the annual number of deaths due to AIDS is expected to increase for many years before peaking.
Effective AIDS vaccines are not expected for another decade, and designing a service delivery system will take additional time. Until vaccine-based prevention becomes a reality, behaviorally based prevention strategies remain the only effective means to slow or reverse the epidemic.
As soon as science established that HIV is transmitted by specific behaviors, it became clear that behavioral expertise would play a critical role in the development of knowledge and strategies leading to effective programs against its spread.
As part of the overall NIH AIDS research effort, Congress, through the Public Health Service Act, authorized the NIMH AIDS research program in 1983. In that year, the Department of Health and Human Services (HHS) declared the epidemic as the nation’s foremost health priority. The HHS Assistant Secretary for Health directed NIMH to develop a research program to assist in preventing the further spread of the disease by identifying successful approaches to reducing risk-enhancing behavior.
Congress established the National Institutes of Health (NIH) Office of AIDS Research (OAR) in 1988, to coordinate biomedical and behavioral AIDS research at the NIH and with other governmental agencies. The four leading Institutes that support AIDS research at NIH — the National Institute of Allergy and Infectious Diseases, the National Cancer Institute, the National Institute on Drug abuse and the NIMH — are active participants in the OAR Advisory Committee.
The Center for Mental Health Research on AIDS (CMHRA) within the NIMH, supports research activities related to the primary and secondary prevention of AIDS and the neurobehavioral illnesses that develop as a result of HIV infection.
CMHRA’s research is organized into the following program areas:
HIV/STD Prevention and Translational Research Strategies to Reduce HIV Transmission
Objectives for basic and applied behavioral research include:
Initiatives supported under this program include:
Recently, the National Security Council warned that the expanding HIV/AIDS epidemic presents a security risk to the United States. AIDS kills people in the prime of their lives who are essential to the economic development and security of their countries. At present, slowing HIV transmission is the only viable approach to decelerate the widespread worsening human and economic devastation.
NIMH has initiated a two-arm randomized, community-level trial, which will be conducted in five countries — China, India, Peru, Russia, and Uganda. This will be the first international test of a community-level prevention program — Popular Opinion Leader — based on the theory of diffusion of innovations utilizing community Popular Opinion Leaders (C-POLS). This intervention engages C-POLS to serve as behavior change agents to friends and neighbors in their community. The intervention is expected to strengthen norms about safer sexual behavior and encourage risk reduction among at-risk populations.
The collaborating institutions conducting this trial are: (1) University of California at Los Angeles and Chinese Academy of Preventive Medicine in Beijing, China; (2) The Johns Hopkins University and YRG Centre for AIDS for Research and Education in Chennai, India; (3) Cayetano Heredia University and University of California at San Francisco working in Lima, Peru; (4) Medical College of Wisconsin and St. Petersburg State University and Biomedical Center in Petersburg, Russia; and (5) Columbia University and Makerere University in Rakai, Uganda.
NIMH is also funding grants, research centers, conferences and meetings in other countries, including Brazil, Indonesia, Mexico, Zimbabwe and South Africa, that actively promote international collaborations in AIDS research.
HIV-1 Infection of the Central Nervous System
The NIMH CMHRA neuro-AIDS research program supports research to enhance understanding of the effects of HIV on the central nervous system (CNS). Neurobehavioral and neurological abnormalities are frequent consequences of HIV infection. This unique program supports research to identify the cellular and molecular changes underlying HIV-associated CNS dysfunction and the consequences of impaired mental health. The major goal of this research is to provide the foundation for the rapid development of therapeutic interventions to prevent and treat the effects of HIV-1 on the CNS.
HIV-associated cognitive and motor impairments may be significant sources of disability for HIV-infected persons in the early or asymptomatic stages of the disease. They can also be markers for progressive HIV disease and the need for aggressive therapy. NIMH supports investigations to understand mental health, psychiatric, behavioral, social, and psychological aspects of HIV infection in infants, children, adults, and the elderly.
Research interests include:
NIMH has supported studies in private psychiatric hospitals in New York City that found the HIV infection rate among patients with mental illness to be more than seven times the national average. Psychiatric patients treated in the public sector are infected at a rate 10 times the national average, and 1 in 5 homeless mentally ill persons also suffer from HIV infection.
NIMH-sponsored research has shown that behavioral interventions can effectively reduce risk among homeless persons with serious mental illness, who appear to be especially vulnerable to HIV infection.
NIMH also participates in the first Federally funded initiative targeting persons triply afflicted with mental illness, substance use disorder and HIV infection, to find out whether an integrated and comprehensive treatment approach will lead to better adherence, better health outcomes, and reduced cost.
The NIMH CMHRA supports research on the risk of HIV infection and the medical problems due to HIV infection among severely mentally ill persons. Research is encouraged within and across the priority research areas listed below.
AIDS Mental Health Services Research
NIMH provides research support to investigate mental health service needs and the provision of mental health services to persons with HIV infection who develop psychological and psychiatric disorders.
Research interests include:
Small Business Initiatives
The NIMH CMHRA supports research on the development of effective HIV prevention and risk reduction interventions and on the effects of HIV-1 on the central nervous system. In addition to traditional research support mechanisms, the Center supports HIV-related research and development (R&D) initiatives proposed by small businesses under the Small Business Innovative Research (SBIR) and Small Business Transfer Technology Research (STTR) programs. The fiscal year 1999 budget for these programs was approximately $2.6 million.
The SBIR and STTR programs support the R&D of innovative technologies proposed by small businesses that have the potential to succeed commercially. These are statutorily-mandated, set-aside programs for U.S. small business concerns.
The STTR program is specifically designed to encourage cooperative R&D efforts between small businesses and U.S. research institutions (e.g., colleges and universities). The research institutions have substantial responsibilities as subcontractors on STTR grants.
The NIMH CMHRA seeks to support SBIR and STTR initiatives in the following areas:
In addition to AIDS research, NIMH supports and conducts a broad based, multi-disciplinary program of scientific inquiry aimed at improving the diagnosis, prevention, and treatment of mental disorders. These conditions include bipolar disorder, clinical depression, and schizophrenia.
Increasingly, the public as well as health care professionals are recognizing these disorders as real and treatable medical illnesses of the brain and behavior. Still, more research is needed to examine in greater depth the relationships among genetic, behavioral, developmental, social and other factors to find the causes of these illnesses. NIMH is meeting this need through a series of research initiatives.
While the definition of prevention will broaden, the aims of research will become more precise and targeted.
In total, NIMH supports more than 2,000 research grants and contracts at universities and other institutions across the nation and overseas. It also conducts basic research and clinical studies involving 9,000 patient visits per year at its own facilities on the National Institutes of Health campus in Bethesda, MD, and elsewhere. NIMH research projects focus on:
At the beginning of the 21st century, NIMH stands poised to surmount the burden, loss, and tragedy of mental illnesses that afflict millions of Americans.
FOR MORE INFORMATION ABOUT NIMH
For more information on NIMH’s activities and programs in HIV and AIDS research contact:
Office on AIDS (OA)
National Institute of Mental Health
6001 Executive Boulevard, Room 6105, MSC 9615
Bethesda, MD 20892-9619
Fax: (301) 443-9719
For information about NIMH and its programs, please contact
Office of Communications and Public Liaison
Information Resources and Inquiries Branch
6001 Executive Blvd, Room 8184, MSC 9663
Bethesda, MD 20892-9663
Fax: 301- 443-4279
Mental Health FAX 4U: 301-443-5158
All material in this fact sheet is in the public domain and may be copied or reproduced without permission from the Institute. Citation of the source is appreciated.
Updated: June 27, 2002