HIV-AIDS Research At the National Institute of Mental Health

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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.

NIMH Mission

To reduce the burden of mental illness through research on mind, brain, and behavior.

How Does the Institute Carry Out Its Mission?

  • NIMH conducts research on mental disorders and the underlying basic science of brain and behavior.
  • NIMH supports research on these topics at universities and hospitals around the United States.
  • NIMH collects, analyzes, and disseminates information on the causes, occurrence, and treatment of mental illnesses.
  • NIMH supports the training of more than 1,000 scientists to carry out basic and clinical research.
  • NIMH communicates information to scientists, the public, the news media, and primary care and mental health professionals about mental illnesses, the brain, mental health, and research in these areas.

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.

History of NIMH AIDS Research

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.

Overview of NIMH AIDS Research

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:

  • To understand, prevent, and/or change high-risk behaviors for HIV
  • To sustain lower risk HIV-related behaviors over time

Initiatives supported under this program include:

  • Theory-driven behavioral interventions to prevent and reduce high-risk behaviors in children, adolescents, adults, and older persons.
  • Methodologies to assess behavioral determinants and distribution of risk behaviors in specific populations and to improve methods for measuring behavior change.
  • Evaluation of the efficacy of AIDS prevention programs in urban and rural settings.
  • Research to understand the effectiveness of HIV serotesting and counseling as prevention interventions.
  • Brief interventions that can be adapted for use in STD clinics, primary healthcare facilities, or other health-related settings.
  • Economic evaluations of existing or proposed preventive intervention programs.
  • International HIV/STD Prevention Program

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.

  • The NIMH AIDS Strategic Intervention Simulation Tool (NIMH/ASIST)NIMH has developed a computerized behavioral prevention tool that mathematically models the epidemic under different conditions of uncertainty. The NIMH/ASIST can be used by Ministers of Health, directors of non-governmental organizations (NGOs), or directors of public health clinics to choose and focus interventions and to make predictions about their public health impact. It can be used to provide estimates of the impact of behavior change that is targeted by different behavioral prevention programs on HIV/ STDs. Data from this modeling program can be used to prioritize prevention programming, distribute resources, and dramatize the cost of not initiating behavioral prevention programs.The NIMH computer modeling tool can be used to design a cost-effective, resource appropriate, national AIDS behavioral prevention program, based on individualized prevention strategies.
  • NIMH Collaborative HIV/STD Prevention TrialThe AIDS epidemic remains largely out of control in many areas of the world, and developing countries with few economic resources are being particularly hard-hit with large increases in HIV incidence. Rapidly increasing STD rates are also a widespread concern leading to infertility and increased risk of HIV. Effective behavioral prevention programs must convince individuals to change high-risk behaviors and replace them with lower risk behaviors. This can be achieved by intervening at multiple mutually reinforcing levels: (1) individual/family; (2) institution/community; and (3) societal/government.Effective individual prevention approaches, however, are not rapid enough to avert the epidemic and they are too resource intensive. Community-level behavior change interventions have the potential to reach large numbers of people, be cost-effective, and be feasible for implementation even in areas with limited resources.

    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:

  • Cellular and molecular mechanisms underlying HIV-associated CNS dysfunction
  • Development of new instruments or adaptation of existing measures to assess HIV-related changes in mental and psychological status
  • Development and testing of therapeutics on neuropsychological and psychological conditions, as well as the effects of psychoactive medications on psychopathological conditions
  • Adherence issues with respect to HIV treatment regimens

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.

  • Epidemiology of HIV infection (e.g., prevalence and incidence studies) among severely mentally ill persons.
  • Epidemiology of sexual and drug-use behaviors and other relevant risk behavior patterns among severely mentally ill persons.
  • Risk reduction and transmission prevention interventions of HIV infection among severely mentally ill persons.
  • Mental health service needs and assessment of the most effective services for its delivery and financing to HIV-infected persons with severe mental illness.

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:

  • Assessment of the most effective methods for providing services.
  • Innovative models of service delivery.
  • Financing of mental health services, including adequacy of current methods of financing and the impact of funding strategies.

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:

  • Behavior Change and Prevention Strategies to Reduce HIV Transmission
  • Interventions to Prevent Negative Consequences of HIV/AIDS
  • Neuro-AIDS: HIV-1 Infection and the Central Nervous System (CNS)
  • AIDS Mental Health Services Delivery
  • Neurobehavioral and Psychosocial Issues in HIV

The Broad NIMH Research Program

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.

  • NIMH Human genetics InitiativeThis project has compiled the world’s largest registry of families affected by schizophrenia, bipolar disorder, and Alzheimer’s disease. Scientists are able to examine the genetic material of these family members with the aim of pinpointing genes involved in the diseases.
  • Human Brain ProjectThis multi-agency effort is using state-of-the-art computer science technologies to organize the immense amount of data being generated through neuroscience and related disciplines, and to make this information readily accessible for simultaneous study by interested researchers.
  • Prevention Research InitiativePrevention efforts seek to understand the development and expression of mental illness throughout life so that appropriate interventions can be found and applied at multiple points during the course of illness. Recent advances in biomedical, behavioral, and cognitive sciences have led NIMH to formulate a new plan that marries these sciences to prevention efforts.

While the definition of prevention will broaden, the aims of research will become more precise and targeted.

More Than 2,000 Grants and Contracts

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:

  • basic research on behavior, emotion, and cognition to provide a knowledge base for a better understanding of mental illnesses
  • basic sciences, including cellular and molecular biology, developmental neurobiology, neurochemistry, neurogenetics, and neuropharmacology, to provide essential information about the anatomical and chemical basis of brain function and brain disorders
  • neuroscience and behavioral aspects of acquired immune deficiency syndrome (AIDS) and behavioral strategies to reduce the spread of HIV (human immunodeficiency virus)
  • interventions to treat, prevent, and reduce the frequency of mental disorders and their disabling consequences
  • mental health services research, including mental health economics and improved methods of services delivery
  • co-morbidity among mental disorders and with substance abuse and other medical conditions, such as depression and heart disease
  • the prevalence of mental disorders
  • risk factors for mental disorders
  • differences in mental health and mental illness among special populations
  • children and adolescents who suffer from or who are at risk for serious mental disorders and learning disabilities
  • psychotherapies and pharmacotherapies for specific disorders

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
Telephone: 301-443-7281
Fax: (301) 443-9719
e-mail: drausch@mail.nih.gov
Website: http://www.nimh.nih.gov/about/organization/od/office-on-aids-oa.shtml

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
Tel: 301-443-4513
TTY: 301-443-8431
Fax: 301- 443-4279
Mental Health FAX 4U: 301-443-5158
e-mail: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov

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.

NIH 00-4509

Updated: June 27, 2002

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