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Behavioral and Social Science Research in HIV/AIDS: Integrating Mental Health and Prevention

This presentation discusses the importance of integrating mental health into HIV prevention and treatment efforts, focusing on behavioral and social science research. Topics include cognitive function, pathogenesis, therapeutics, prevention cascade, treatment cascade, and implementation of biomedical interventions.

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Behavioral and Social Science Research in HIV/AIDS: Integrating Mental Health and Prevention

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  1. Behavioral and Social Science ResearchNIMH Division of AIDS Research Dianne Rausch, Ph.D. Director, Division of AIDS Research, National Institute of Mental Health @NIMHgov Share your thoughts on this presentation with #IAS2019

  2. DISCLAIMER… No conflicts of interest

  3. NIMH Division of AIDS Research The Division of AIDS Research (DAR) supports research to reduce the incidence of HIV/AIDS worldwide and to decrease the burden of living with HIV. • Mental Health • Neuroscience • Behavioral • Social Science Mental health is integral to prevention and treatment efforts across the lifespan • Cognitive function • Pathogenesis • Cure • Therapeutics • Prevention cascade • Treatment cascade • Translation and implementation • Biomedical intervention

  4. NIMH Division of AIDS Research OAR Research Priorities National Institute of Allergy and Infectious Diseases (NIAID) National Institute of Child Health and Human Development (NICHD) National Institute of Drug Abuse (NIDA) Cross-Cutting Areas National Institute of Mental Health (NIMH) National Heart, Lung, and Blood Institute (NHLBI) …Many Other ICs NIMH/DAR partners with trans-HHS colleagues to reduce the incidence of HIV/AIDS worldwide and to decrease the burden of living with HIV/AIDS.

  5. Individual Behavior Key Populations Mental Illnesses Cognition Comorbidities Adherence Empowerment Testing Risk Well-being Counseling U=U Condoms Identity Quality Technology Attendance Retention Disclosure Depression PrEP Disparities Outreach Awareness Mental Health and HIV Interpersonal Factors and Structural Determinants Emotional and Mental Health Culture Stigma Sex Workers Resources Relationships Violence Ethnicity Beliefs Youth Infants Migrants Communication Race Economics Social Networks Sexual and Gender Minorities Global Adults Food Insecurity Mothers Adolescents Incarceration

  6. BSSR Functional Framework HIV/AIDS Prevention, Care, and Cure Supported by BSSR Domains Elemental Supportive Integrative BSSR BSSR BSSR Modifying vulnerable behaviors and environments Strengthening biomedical product acceptability Implementation of combination strategies Graphic adapted from: Gaist & Stirratt, 2017, JAIDS Basic BSSR: Understanding vulnerable populations and environments

  7. Violence and HIV • Among people at risk or living with HIV, trauma is associated with: • Poor retention in prevention and treatment care continua • Poor adherence to PrEP or ART • reduced viral • suppression HIV VIOLENCE

  8. Outcomes Manifestations Stigma ‘Marking’ Adapted from: Stangl, A. L., Earnshaw, V. A., Logie, C. H., van Brakel, W., Simbayi, L. C., Barré, I., & Dovidio, J. F. (2019).  BMC medicine, 17(1), 31.

  9. Community Engagement Global Stakeholders NGOs, WHO/UNAIDS, NIH, foundations National Stakeholders Ministries of Health, media, funders Broader Stakeholders NGOs, policymakers, professionals Community Stakeholders Family, friends, CBOs, CABs, Peers Trial Participant Adapted from: AVAC (2012) GPP Guidelines for Biomedical HIV Prevention Trials 2011

  10. Global Mental Health in HIV and Beyond “There is no healthwithout mental health” • Task shifting and/or sharing and use of paraprofessionals • Differentiated care/stepped care approaches • Collaborative care to support the integrated care delivery • Use of digital health/mobile technologies to support care delivery • Use of transdiagnostic approaches to address multiple mental disorders in the same interventions Research Partnerships for Scaling Up Mental Health Interventions in Low- and Middle-Income Countries 

  11. Current DAR Research Priorities Emotional and Mental Health Individual Behavior Development, Testing, Use, and Impact of Biomedical HIV Prevention, Treatment, and Cure Strategies Advancing Differentiated Care for Adolescents and Young Adults Mental Health Comorbidities in HIV Prevention and Treatment Implementation Research for Screening and Treatment for Mental Disorders Interpersonal Factors and Structural Determinants Advanced Epidemiological Modeling Addressing the Impact of Violence on HIV Prevention and Treatment Understanding and Reducing Stigma to Improve the HIV Prevention and Care Continua

  12. Thank you drausch@mail.nih.gov

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