mental health AIDS

2003 - 2009 Newsletter Archives

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mental health AIDS is a quarterly biopsychosocial research update on HIV and mental health organized by topic area. Each issue also includes service program profiles and the newest resources (books, articles, Web sites) for clinical practice.

Below are the archived newsletters from 2003 - 2009:

Source: CMHS/SAMHSA

Tool Box: "SAVA Latina: Addressing the Interplay of Substance Abuse, Violence, & AIDS Affecting Hispanic Women (Part 2)"

Part 1 of this series reviewed the literature linking substance abuse, violence, and AIDS (SAVA), including recent work delineating pathways that tie together violence and HIV risk. The focus then shifted to violence and its effects on immigrant Hispanic women (Latinas) living in the United States, cultural factors that contribute to the risk for both violence and HIV in this population, and screening questions (in Spanish) that have demonstrated utility in identifying women who have been abused.

This concluding segment summarizes the impact of violence on the health (including mental health) of women in general and Latinas in particular, unmet mental health needs in this population, and the evolving state of intervention research, including culturally specific interventions for clinicians working in the crosscurrents of these health and social problems.

Source: CMHS/SAMHSA

Tool Box: "SAVA Latina: Addressing the Interplay of Substance Abuse, Violence, & AIDS Affecting Hispanic Women (Part 1)"

The term "syndemic" refers to "the set of synergistic or intertwined and mutual[ly] enhancing health and social problems facing the urban poor." The first syndemic identified and analyzed was the SAVA (Substance Abuse, Violence, and AIDS) syndemic, and research on this syndemic has continued to the present day.

This is the first of a two-part series. Part 1 reviews the literature linking these interlocking threats to health and safety, including recent work delineating pathways that tie together violence and HIV risk. The focus then shifts to violence and its effects on immigrant Hispanic women (Latinas) living in the United States, cultural factors that contribute to the risk for both violence and HIV in this population, and screening questions (in Spanish) that have demonstrated utility in identifying women who have been abused.

Source: CMHS/SAMHSA

Tool Box: "HIV-Related Mental Health Interventions Delivered Through Telephone & Internet Technology"

Greater retention in care appears to be a hallmark of telephone-administered psychotherapy, which was found to produce significant reductions in depressive symptoms in a recent meta-analysis. This tool box examines a line of telephone-based intervention research that has focused on the treatment of depressive symptoms in men and women living with HIV, with particular emphasis on extending services to those who are living with HIV in rural America. The relative merits of cognitive-behavioral and interpersonal psychotherapy, and their effectiveness when administered by telephone to this population, are discussed. The tool box concludes with research on the use of Internet technology both to evaluate depressive symptoms and to automatically generate tailored self-care management strategies for those who are living with HIV, an exciting development that has "the potential . . . to reframe the traditional patient-provider relationship."

Source: CMHS/SAMHSA

Tool Box: "Cut to the 'Quick': Brief Psychodynamic Treatment for Persons Living with HIV/AIDS"

As a recent systematic literature review suggests, short-term psychodynamic psychotherapy can be an effective treatment for individuals experiencing a variety of mental health problems. In this tool box, one brief treatment model, time-limited dynamic psychotherapy (TLDP), is described at length. The promise of TLDP for alleviating distress experienced by men living with HIV/AIDS was demonstrated in a San Francisco study. Yet, with the well-trained therapist in the role of participant-observer and treatment telescoped on the client's most pervasive and problematic style of relating, the potential of this brief intervention model for addressing the concerns of the so-called "difficult" client likely will be of interest to many practicing clinicians.

Source: CMHS/SAMHSA

Tool Box: "Research on HIV-Related Cognitive-Behavioral Interventions, Stress Management Interventions, & Their Interface: A Confluence of Conclusions & Critiques"

In a relatively short period of time, several major reviews and meta-analyses have been published that will interest the many practicing clinicians who offer cognitive-behavioral interventions, stress management interventions, and cognitive-behavioral stress management interventions to people living with HIV. This tool box highlights the considerable promise of these interventions when employed with this population as well as limitations in the research conducted to demonstrate their utility and, quite possibly, in the approaches themselves.

Source: CMHS/SAMHSA

Tool Box: "For Whom the Tell Tolls: Curbing the Cost of Giving & Getting Distressing, HIV-Related News (Part 2)"

It is not only when clinicians must convey distressing news (e.g., deliver an HIV-positive test result) that their own coping mechanisms come into play. In the HIV-related clinical encounter, a clinician's coping mechanisms are also called upon when the client reveals distressing, if not traumatic, life experiences that precede and/or follow from the detection of that individual's positive serostatus.

Part 1 of this series tackled the terminology used to describe how clinicians are thought to be affected by their work with trauma survivors. The earlier tool box also summarized literature on recognizing and alleviating the dangers facing clinicians practicing trauma-related psychotherapy.

This concluding segment expands on the current state of qualitative and quantitative research in this area and offers emerging evidence for the positive consequences of this work for clinicians. In the view of some investigators, incorporating concepts such as vicarious posttraumatic growth and vicarious resilience into the professional vocabulary "might help clinicians to view themselves, their clients, and the work in new and empowering ways."

Source: CMHS/SAMHSA

Tool Box: "For Whom the Tell Tolls: Curbing the Cost of Giving & Getting Distressing, HIV-Related News (Part 1)"

It is not only when clinicians must convey distressing news (e.g., deliver an HIV-positive test result) that their own coping mechanisms come into play. In the HIV-related clinical encounter, a clinician's coping mechanisms are also called upon when the client reveals distressing, if not traumatic, life experiences that precede and/or follow from the detection of that individual's positive serostatus.

Source: CMHS/SAMHSA

Tool Box: "Enlisting Service Consumers as Active Participants in HIV-Related Assessment & Care"
When equipped with the proper tools and training, as well as support and self-confidence, people living with HIV/AIDS can play an integral role in monitoring their own risk behavior as well as managing the symptoms and medication regimens associated with HIV disease.

This tool box opens with the examination of a novel, clinic-based approach to repeated risk assessment by clinic attendees, an intervention strategy for reducing sexual and substance use risk behaviors. The focus then shifts to chronic disease self-management and the enhancement of self-efficacy. The design of a foundational model in this arena, the Positive Self-Management Program, is highlighted, along with its supporting research and a recent appraisal of its utility by a team of British investigators. Variations in self-management models specific to HIV disease are also presented for the consideration of service planners, providers, and consumers.

Source: CMHS/SAMHSA

Tool Box: "Tailoring Evidence-Based HIV Behavioral Risk-Reduction Interventions to Local Capacity & Target Audience Characteristics"
To reduce HIV incidence rates in population subgroups for whom specifically defined interventions have not yet been developed and evaluated, HIV prevention planners, providers, and funding agencies have been charged with "adapt[ing] person-to-person behavioral interventions to the needs and resources of their communities and to setting, participant, and cultural characteristics of their populations."  This tool box offers preliminary guidance on how to modify an evidence-based behavioral intervention, as well as examples of modified interventions.

Source: CMHS/SAMHSA

Tool Box: "All That Is Sacred: A Primer on Spiritual Assessment"
Numerous studies attest to the importance of religion and spirituality to many people who are living with HIV/AIDS. Gathering, analyzing, and synthesizing spiritual and religious information as part of a comprehensive approach to clinical assessment can help to answer diagnostic questions and contribute to treatment planning. A two-stage spiritual assessment process, based on Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements, is outlined in this tool box.

Source: CMHS/SAMHSA

Tool Box:"From Surviving to Thriving: HIV-Associated Posttraumatic Growth"
As conceptualized by Calhoun and Tedeschi, "posttraumatic growth is set in motion by the occurrence of a major life crisis that severely challenges and perhaps shatters the individual's understanding of the world and his or her place in it" and "is manifested in a variety of ways, including an increased appreciation for life in general, more meaningful interpersonal relationships, an increased sense of personal strength, changed priorities, and a richer existential and spiritual life." In this tool box, the evolving body of research on posttraumatic growth among people living with and affected by HIV/AIDS is outlined. A set of guidelines to assist clinicians with incorporating a posttraumatic growth perspective into their work with trauma survivors is also provided

Source: CMHS/SAMHSA

Tool Box:"New Thinking on Not Thinking About HIV Risk"
In recent years, concepts such as cognitive escape, ironic processing, thought suppression, spontaneous cognition, and "heat of the moment" thinking have been incorporated into explanatory models of HIV-related risk-taking. Cognitive processes such as these are believed to exert influence upon self-awareness of HIV risk and may impede education and prevention efforts. In this tool box, notions regarding not thinking are explored, as are paradoxes for both the structure and the content of HIV prevention interventions that spotlight precisely what is being avoided.

Source: CMHS/SAMHSA

Tool Box: "Emerging Methods for Motivating Effective Medication Practice"
As one recent study made clear, clinicians' well-intentioned efforts to emphasize the importance of antiretroviral adherence can paradoxically undermine the very behavior they are intending to promote. In this tool box, the inherent power inequities that underlie the patient-provider relationship and potentially undercut collaboration are explored. One remedy may be motivational interviewing, which offers clinicians a means by which to elicit the client's own recognition of a problem as well as his or her desire, intention, and capacity to change. The fundamentals of this client-centered approach are presented, along with emerging research on its application to the critical concern of antiretroviral medication practice.

Source: CMHS/SAMHSA

Tool Box: "The Latest Last Word on HIV Prevention Interventions"
Recent meta-analytic studies have yielded general recommendations about framing strategies to increase the use of male condoms as well as tips on effectively targeting specific populations, including people who are living with HIV. These studies are summarized in this tool box. The increasingly common use of meta-analysis to provide "definitive answers" to important research questions does, however, raise a more fundamental question: Can the results of any meta-analysis represent the "last word" on intervention effectiveness?

Source: CMHS/SAMHSA

Tool Box: "Men Misunderstood: Straight Talk About HIV & Depression"
In recent reports that evaluated depressive symptoms in gay and heterosexual men living with HIV, heterosexual men were found to have higher levels of depressive symptoms than their gay counterparts. This tool box offers guidance to clinicians who wish to enhance their sensitivity and skills in assessing and treating depression in men.

Source: CMHS/SAMHSA

Tool Box: "Reducing HIV Risk Among Adults With Severe Mental Illness"
A systematic review of 52 studies on the HIV risk behavior of adults with severe mental illness (SMI) lays the groundwork for recommendations regarding the prevention of HIV in this highly vulnerable population. Included in these recommendations is a trio of Group Interventions for Adults With SMI designed for and evaluated within mental health treatment settings.

Source: CMHS/SAMHSA

Tool Box: "Casting a Mindful 'I' on HIV-Related Stigma"
Research has demonstrated that HIV-related stigma and discriminatory practices can affect the treatment of people living with HIV/AIDS by partners, family members, and the community. For practicing clinicians, the first steps in identifying and addressing HIV-related stigma in others are identifying and addressing stigmatizing attitudes and behaviors in themselves. A three-step conceptual model derived from principles of mindfulness may assist in this effort.

Source: CMHS/SAMHSA

Tool Box: "Addressing Historical Trauma Among African Americans as an HIV Intervention"
Conspiracy beliefs about HIV/AIDS, rooted in the social and historical context of racism in America , continue to be endorsed by some segments of the African American community. Given both the highly disproportionate impact of HIV on this community and recent findings that conspiracy beliefs may act as a barrier to HIV prevention, this tool box will delineate psychological theory underlying the transgenerational transmission of trauma and grief and offer thoughts on the therapeutic induction of a healing process.

Source: CMHS/SAMHSA

Tool Box: "Sustaining Stamina at the Interface of HIV & Mental Health Practice"
Mental health professionals offering HIV-related psychotherapy must contend not only with the stresses inherent in HIV care, but also the stresses particular to the work of the psychotherapist. This tool box includes intervention ideas to reduce workplace stress and prevent burnout that may be implemented at the systems (organizational) level or at the level of the individual mental health practitioner.

Fall 2004 [PDF 199K]

Source: CMHS/SAMHSA

Tool Box: "Positive & Positive: A Winning Combination?"
With so many health advantages associated with optimism, investigators have begun to explore ways of influencing how people think about the future. And yet, in a pilot study involving women living with HIV, efforts to enhance optimism affected antiretroviral adherence among some women in an unexpected way.

Summer 2004 [PDF 169K]
Source: AIDS Education and Training Centers National Resource Center

Tool Box: "Methamphetamine on the Brain (Part 2)"
Part 1 of this series offered a medical and psychiatric overview of crystal meth use and explored the physiological and psychological factors underlying sexual risk among users. This concluding segment expands on risk assessment, treatment approaches, and special concerns at the interface of meth and HIV.

Spring 2004 [PDF 166K]
Source: AIDS Education and Training Centers National Resource Center

Tool Box: "Methamphetamine on the Brain (Part 1)"
This is the first in a two-part series focusing on the use of crystal meth by gay and bisexual men in the U.S., where the problem is most acute and growing. Part 1 offers a medical and psychiatric overview of meth use and explores the physiological and psychological factors underlying sexual risk among users.

Tool Box: "Out of Africa: Addressing HIV in Sub-Saharan Immigrant Populations"
While the few American and European studies involving sub-Saharan immigrants to the West at risk for or living with HIV are both interesting and provocative, the studies that, perhaps, have the greatest potential to inform the work of mental health professionals serving these populations come from Africa itself.

Winter 2004 [PDF 182K]
Source: AIDS Education and Training Centers National Resource Center

Tool Box: "Opening the Minds of Men Who Have Unsafe Sex with Men"
A summary of the most recent published research on psychological and interpersonal factors that influence sexual risk behavior between men, along with clinical recommendations that emerge from these findings.

Fall 2003 [PDF 182K]
Source: AIDS Education and Training Centers National Resource Center

Tool Box: "Comparing Cross-Sectional and Longitudinal Studies of HIV-Serodiscordant Mother-Child Dyads"
In some cases, longitudinal studies of young, uninfected children of HIV-infected mothers bear out findings from cross-sectional investigations; in other cases, findings contrast and may alter clinical recommendations. A selection of recent findings and their clinical implications are presented in this review.

Summer 2003 [PDF 172K]
Source: AIDS Education and Training Centers National Resource Center

Tool Box: "Remain Objective Regarding Subjective, HIV-Related Cognitive Complaints"
This short summary highlights research on the relationship between subjective cognitive complaints and objective cognitive impairment in people living with symptomatic HIV disease, as well as the importance of a thorough evaluation and appropriate clinical response to such complaints.

Spring 2003 [PDF 158K]
Source: AIDS Education and Training Centers National Resource Center

Tool Box: "Health Correlates of Cognitive Processing and Meaning-Making for People Living with HIV/AIDS"
Is emotional release beneficial to people living with HIV and AIDS? While emotional expression, in and of itself, may be beneficial within certain parameters, it the processing of emotions and, in particular, making meaning of life events that holds even greater promise of health benefits.

Winter 2003 [PDF 157K]
Source: AIDS Education and Training Centers National Resource Center

Tool Box: "The Promises and Pitfalls of STIs: A Primer for Mental Health Professionals"
During structured treatment interruptions (STIs), all antiretrovirals are discontinued under intensive medical supervision for a discrete period of time. This review highlights research findings on this controversial approach to treatment and its impact on medication adherence and quality of life.

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