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The HIV/AIDS Spectrum Project: Building Capacity to Improve Care for Mental Health and Substance Use

July 12, 2011

David Fawcett, Ph.D., L.C.S.W.

David Fawcett, Ph.D., L.C.S.W., is a substance abuse expert, certified sex therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Fla.

It was the peak time for the cherry blossoms in Washington, D.C. -- or so I was told. I only caught a glimpse of them from the Metro as I was riding in from Reagan National, and a few times out the window of the hotel conference room (along with rain and even a brief burst of hail during that tempestuous spring weekend). But I wasn't in town for sightseeing: I was one of about 15 individuals from around the country selected to participate in the Training of Trainers program, a component of the National Association of Social Workers' HIV/AIDS Spectrum: Mental Health Training and Education of Social Workers Project.

This project -- a broad collaboration of NASW chapters, federal and state agencies, national and state associations, universities, and community-based organizations -- aims to build the capacity of mental health workers to effectively address the complexities of the mental health and substance use disorders that are experienced by individuals living with HIV/AIDS in our communities. Having worked at bridging the gap between these disciplines for many years, I was well aware of the broader need for such training among my colleagues. I believed in this project and was excited to participate.

The first meeting of the new trainers, along with the project's advisory committee, was humbling. The participants represented years of accumulated experience, dedication and expertise with every aspect of the epidemic. Among us, we had worked abroad in Africa and India, and with Hispanic immigrants, African-American women, men who have sex with men, substance abusers and HIV/AIDS-affected children. We carried out our work in urban medical centers, prisons, inner-city clinics, the rural South, mental health centers and university classrooms.

We began our training that weekend by experiencing two of the NASW-developed courses and then teaching back portions of the content under the watchful eyes of the advisory committee. The programs, one on the effective treatment of co-occurring disorders (HIV/AIDS, substance abuse and/or mental health concerns) and one on medication adherence, are built around core concepts such as a holistic perspective and culturally competent practice. The days were intense, and any hopes of catching a glimpse of Washington by night -- the agenda seductively described time after 7:30 p.m. as "on your own," albeit with homework -- were jettisoned as we stumbled glassy-eyed to our rooms after the long days.

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As a provider, several aspects of this program struck me as particularly relevant to the state of our system of care for HIV/AIDS. The first was the acknowledgment and incorporation of the perspective that various health-related problems are interconnected. HIV/AIDS funding streams have too often been specific to only medical care, or only mental health, or only substance abuse. Agencies may be funded for one, but not for another. As a result of these "funding silos," the HIV-positive people we serve expend a great deal of energy traveling from one specialty provider to another, and the care they receive is adversely impacted.

It is well known that a mental health problem, such as depression, can increase the risk of acquiring HIV. But mental health problems can also result from testing positive or impact someone's ability to cope with the management of his or her illness. The same reciprocal relationship is true, of course, for substance abuse.

Yet, despite understanding these syndemic relationships, a truly holistic framework is rarely employed in assessing and intervening with our clients. All of the NASW HIV/AIDS Spectrum courses specifically train clinicians to think in terms of the synergy that plays out among various aspects of HIV, mental health and substance abuse.

In addition to understanding the specifics of the curricula, I came away with something else at the end of that long weekend in Washington. One of the topics I frequently hear discussed among my colleagues, both formally and informally, concerns the next generation of workers. Many of us have spent the better part of our careers working in HIV/AIDS, propelled from the early days when grassroots innovation was the only option. Some verbalize fears that the energy and passion that drove us may dissipate as the AIDS "crisis" turns 30. For me, any doubts were laid to rest at this meeting. The people I met were so bright and compassionate and articulate that I came away feeling both comforted and re-energized. Despite a stormy spring, I was reassured that the work will go on.

Follow this link to get more information on the HIV/AIDS Spectrum project, or to find out how to support a workshop in your community; you can also contact Evelyn Tomaszewski, NASW Senior Policy Advisor, at etomasze@naswdc.org.

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