June 11, 2012
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.
The sun was gleaming on Miami's Biscayne Bay. Palm trees swayed in the gentle breeze and, in the distance, cruise ships were about to set sail for exotic ports. English, Spanish and a dozen other languages drifted through the air as happy people enjoyed the beautiful day. As perfect as it was, the idyllic scene was not all it seemed.
Within a few square miles, a slow-motion tragedy was unfolding. This is an epicenter of new HIV infections, which -- when compiled with high rates of existing AIDS cases -- makes Miami-Dade (as well as Broward and Palm Beach Counties) one of the most concentrated areas of HIV in the nation.
Miami is not alone in its struggle. Many communities, both rural and urban, are grappling with this 31-year-old epidemic, and there are signs of wear. State and local funding is in jeopardy, providers are undergoing a significant reorganization, and the HIV/AIDS workforce is experiencing fatigue. Beyond these infrastructure issues, a variety of concerns such as mental health and substance abuse dramatically impact virtually every aspect of the epidemic. They influence the effectiveness of prevention efforts, the willingness of an individual to be tested, and the ability to adhere to treatment regimens.
The National HIV/AIDS Strategy (NHAS), issued by the White House Office of National AIDS Policy, is focusing renewed effort and resources on the epidemic in places like Miami. It emphasizes three critical areas: reducing HIV incidence; increasing access to care and optimizing health outcomes; and reducing HIV-related health disparities. Of special significance is the distribution of extra resources to the 12 Cities Project, in which the cities with the highest incidence of HIV/AIDS receive additional funding to support the outcomes of the NHAS.
Yet, despite these efforts, many workers continue to lack the training necessary to understand the complex interaction of mental health, substance abuse and HIV. Trauma, for example, can both increase risk of acquiring the virus and affect adherence to treatment regimens. Depression is a co-occurring challenge to those living with the virus, as is substance abuse. Understanding these relationships is vital to effective care at all stages of HIV/AIDS.
That day in Miami, solutions were being formulated. The 24th Annual National Conference on Social Work and HIV/AIDS was in session, and a special meeting of the advisory committee and trainers for the National Association of Social Workers' (NASW) HIV/AIDS Spectrum Project, called the Project, was taking place. In support of the National HIV/AIDS Strategy, and with funding from SAMHSA's Center for Mental Health Services, the Project is increasing its capacity to provide such training with focused efforts in the 12 cities most affected by HIV/AIDS, as well as in selected emerging areas.
Social work's approach provides an especially powerful framework by which to integrate the bio-psycho-social-spiritual aspects of the prevention and treatment of HIV/AIDS. For example, understanding the impact on adherence of cultural beliefs, stigma or an addiction is essential. The HIV/AIDS Spectrum workshops build from this whole-person perspective and integrate interventions such as motivational interviewing, the "stages of change" model or an ethical decision-making model to improve care for persons living with HIV/AIDS.
The NASW HIV/AIDS Spectrum Project has been training mental health professionals working with HIV/AIDS for over a decade in cooperation with state and local NASW chapters and with funding from the SAMSHA. Each training curriculum is designed to improve the HIV and mental health practice skills of people working in social work, mental health and substance abuse fields, and to enhance and promote culturally competent practice with individuals, families, and communities affected by HIV/AIDS. Topics include ethics (with an HIV case study), medication adherence (with a focus on HIV but applicable to any chronic medical condition) and the complexities of co-occurring HIV, mental health and substance abuse.
The HIV/AIDS Spectrum Project is well-positioned to increase the skills of the social workers and other providers to address each objective of the National HIV/AIDS Strategy -- and, as noted earlier, it has received additional funding from SAMHSA to do just that. Local NASW chapters in each state that is home to one of the 12 cities will receive support for these trainings from the national NASW office. Recognizing that the epidemic is emerging in many areas around the country, the NASW is devoting additional resources to support building the capacity of social workers and allied providers in communities with growing HIV/AIDS incidence. Each workshop includes not only teaching but small group exercises where new skills can be applied, as well as resources such as practical clinical toolkits.
In addition to an increased focus on the 12 cities and emerging areas, the HIV/AIDS Spectrum Project continues to provide these important workshops in other locations around the country. To find out more about the project and upcoming workshops, or to inquire about bringing these trainings to your community, go to the Project's website or contact Project Director Evelyn Tomaszewski at firstname.lastname@example.org.
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