Q&A: New center will address mental health disparities in Miami’s HIV epidemic

Steven Safren, PhD, ABPP
Steven Safren

In 2016, Miami’s HIV rates were four times the national average, and the city was ranked number one in the nation for new HIV cases, according to the CDC’s annual HIV surveillance report.

The South is the region of the United States most affected by HIV, accounting for more than half of all new HIV diagnoses in 2017, according to the CDC. In response, the NIH is investing significant resources to address the epidemic in the Southern U.S.

As part of these efforts, the National Institute of Mental Health (NIMH) recently awarded a $3.32 million grant to create the Center for HIV and Research in Mental Health (CHARM) — meant to address the mental and minority health disparities that contribute to Miami’s local epidemic. CHARM is the NIMH’s seventh AIDS Research Center, but it is the first of its kind to be established in the South, according to the University of Miami.

Infectious Disease News spoke with the center’s director, Steven Safren, PhD, ABPP, professor of psychology at the University of Miami, about the role mental and minority health disparities play in the HIV epidemic and efforts to end it by 2030, and his advice for institutions looking to implement a similar center.

Q: What type of research will the center promote, and how?

A: The center has the goal of promoting research related to our theme, “reducing the impact of mental health and minority health disparities across the HIV prevention and care continua.” What this means is that mental health and minority health disparities affect how people access or benefit from both HIV prevention programs and HIV treatment, and we need studies and evidenced-based interventions to address this, both generally in the U.S. and globally, but particularly in Miami.

Q: How do mental and minority health disparities perpetuate the HIV/AIDs epidemic?

A: Let’s take the example of one very prevalent mental health problem: clinical depression. This includes symptoms such as sadness for most of the day on the majority of days, concentration problems, changes in appetite, loss of interest in things that you are normally interested in and other symptoms that affect functioning. Now, if you have such a problem, it can be much harder to stay motivated to adhere to daily medication, stay in HIV care or access and then use a prevention program. Other health disparities complicate treatment if patients have conditions in addition to HIV. Miami also has many structural problems affecting HIV, particularly in minority populations, that involve things like transportation, financial difficulties, housing instability, and so on. These issues also make it harder to prioritize HIV prevention or care.

Q: Should the federal plan to end the HIV/AIDs epidemic in the U .S. by 2030 address these issues?

A: Yes, most definitely. An interim goal, set by the U.N., is to have 90% of those with HIV diagnosed, 90% of those in treatment and 90% of those achieving viral suppression. To achieve this, and move on from 90-90-90 to 100-100-100, we will need to address mental health and other co-occurring problems, particularly in the 10% in each category that might be most at risk for not making it across the prevention and care continuum.

Q: Is this an unmet need in HIV care?

A: I would say that mental health screening and treatment in the context of HIV care is something that could certainly be improved upon. The existing studies show high rates of mental health comorbidity with HIV; however, adequacy of assessment and referral to evidenced-based treatments are generally needed.

Q: Do you have advice for institutions looking to develop a similar center?

A: This is a tough one. It has to be the right time, and you need to have the right set of people to work with you at your institution. If you are in that position, and have a relevant theme to address, and think that it can improve the HIV situation in the U.S. or globally, then go for it. – by Joe Gramigna

References:

CDC. 2016 HIV surveillance report. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf. Accessed June 3, 2019.

HIV.gov. U.S. Statistics. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics. Accessed June 3, 2019.

Disclosure: Safren reports no relevant financial disclosures.

Steven Safren, PhD, ABPP
Steven Safren

In 2016, Miami’s HIV rates were four times the national average, and the city was ranked number one in the nation for new HIV cases, according to the CDC’s annual HIV surveillance report.

The South is the region of the United States most affected by HIV, accounting for more than half of all new HIV diagnoses in 2017, according to the CDC. In response, the NIH is investing significant resources to address the epidemic in the Southern U.S.

As part of these efforts, the National Institute of Mental Health (NIMH) recently awarded a $3.32 million grant to create the Center for HIV and Research in Mental Health (CHARM) — meant to address the mental and minority health disparities that contribute to Miami’s local epidemic. CHARM is the NIMH’s seventh AIDS Research Center, but it is the first of its kind to be established in the South, according to the University of Miami.

Infectious Disease News spoke with the center’s director, Steven Safren, PhD, ABPP, professor of psychology at the University of Miami, about the role mental and minority health disparities play in the HIV epidemic and efforts to end it by 2030, and his advice for institutions looking to implement a similar center.

Q: What type of research will the center promote, and how?

A: The center has the goal of promoting research related to our theme, “reducing the impact of mental health and minority health disparities across the HIV prevention and care continua.” What this means is that mental health and minority health disparities affect how people access or benefit from both HIV prevention programs and HIV treatment, and we need studies and evidenced-based interventions to address this, both generally in the U.S. and globally, but particularly in Miami.

Q: How do mental and minority health disparities perpetuate the HIV/AIDs epidemic?

A: Let’s take the example of one very prevalent mental health problem: clinical depression. This includes symptoms such as sadness for most of the day on the majority of days, concentration problems, changes in appetite, loss of interest in things that you are normally interested in and other symptoms that affect functioning. Now, if you have such a problem, it can be much harder to stay motivated to adhere to daily medication, stay in HIV care or access and then use a prevention program. Other health disparities complicate treatment if patients have conditions in addition to HIV. Miami also has many structural problems affecting HIV, particularly in minority populations, that involve things like transportation, financial difficulties, housing instability, and so on. These issues also make it harder to prioritize HIV prevention or care.

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Q: Should the federal plan to end the HIV/AIDs epidemic in the U .S. by 2030 address these issues?

A: Yes, most definitely. An interim goal, set by the U.N., is to have 90% of those with HIV diagnosed, 90% of those in treatment and 90% of those achieving viral suppression. To achieve this, and move on from 90-90-90 to 100-100-100, we will need to address mental health and other co-occurring problems, particularly in the 10% in each category that might be most at risk for not making it across the prevention and care continuum.

Q: Is this an unmet need in HIV care?

A: I would say that mental health screening and treatment in the context of HIV care is something that could certainly be improved upon. The existing studies show high rates of mental health comorbidity with HIV; however, adequacy of assessment and referral to evidenced-based treatments are generally needed.

Q: Do you have advice for institutions looking to develop a similar center?

A: This is a tough one. It has to be the right time, and you need to have the right set of people to work with you at your institution. If you are in that position, and have a relevant theme to address, and think that it can improve the HIV situation in the U.S. or globally, then go for it. – by Joe Gramigna

References:

CDC. 2016 HIV surveillance report. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf. Accessed June 3, 2019.

HIV.gov. U.S. Statistics. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics. Accessed June 3, 2019.

Disclosure: Safren reports no relevant financial disclosures.