Integrating Mental and Behavioral Health into HIV and Aging

Leo Rennie, MPASenior Legislative & Federal Affairs Officer

Federal AIDS Policy Partnership MeetingSeptember 10, 2014

Washington, DC

Key Points

• Psychosocial, mental and behavioral health issues need greater attention in the HIV and aging discussions.

• Opportunities exist for the HIV community to work more closely with the Substance Abuse and Mental Health Services Administration (SAMHSA), including HIV and aging.

• Mental health system reform bills pending in Congress offer opportunities and challenges for integrating HIV and mental health issues .

• Leadership at federal, state and local levels is critical.

Why Focus on HIV and Aging

• Antiretroviral therapy (ART) has greatly increased the life expectancy of people living with HIV.

• People currently infected in their 20s, 30s and 40s are expected to live into their 60s.

• CDC estimates that as early as 2015, people over 50 years of age will account for over half the people living with HIV in the United States.

• HIV incidence rates are steadily increasing among people 50 years and older.

Psychology’s Role in HIV and Aging

• HIV-infected older adults face many psychological challenges over their lifespan.– Rates of depression are as

high as 50% and rates of anxiety are as high as 20% in HIV-infected persons over 50 years of age.

– Each week, as many as 25% of HIV-infected older adults think about taking their own life.

• Progress at each step across the HIV Care Continuum requires attention to these challenges.

• APA Policy Statements on HIV and AIDS .

Mental and Behavioral Health Issue Confronting OPLWH

• Older people with HIV face unique psychosocial challenges in dealing with multifactorial comorbidities that affect their mental health, neurocognitive functioning, access to social support, and use of coping strategies to aging successfully with HIV. (Rueda,2014)

• Challenges include demands of ongoing and near perfect adherence; expectations of sex with condoms; psychosocial, social and economic burdens; struggles delineating HIV versus age-related morbidities; and navigating the complex health care system. (Heckman, 2014)

• A comprehensive response to HIV includes behavioral and mental health assessment and intervention, including treatments and wellness interventions to encourage positive health behavior and optimize clinical management of HIV disease. (Farber, 2013)

SAMHSA

• Budget and Appropriations

• (FY) 2014 Minority AIDS Initiative funding for Minority Serving Institutions Partnerships with CBOs

• Continuum of Care Pilot-Integration of HIV Medical Care into Behavioral Health Program

• Addiction Technology Transfer Center (ATTC): Center of Excellence (CoE) on Behavioral Health for Racial/Ethnic Minority (YMSM) and LGBT Populations

113th Congress Mental Health Bills

• H.R. 3717 - Helping Families in Mental Health Crisis Act of 2013, by Rep. Tim Murphy (R-PA)

• H.R. 4574, Strengthening Mental Health in Our Communities Act of 2014, by Rep. Ron Barber (D-AZ)

• House Action Uncertain Before End of 2014

• No Senate Companion Bills

References• American Psychological Association (2012). Combination biomedical and behavioral

approaches to optimize HIV prevention. http://www.apa.org/about/policy/biomedical.aspx

• American Psychological Association (2013). Testimony submitted before the U.S. Senate Special Committee on Aging, “Older Americans: The Changing Face of AIDS in America. 9/18/13.

• Farber, Eugene W (20113). Psychological aspects of HIV: the role of behavioral health in optimizing HIV care and prevention. 5:4, 11-13.

• Heckman, T.G., Halkitis, P.N. (2014) Biopsychosocial aspects of HIV and aging, Behavioral Medicine, 40:3, 81-84, DOI: 10.1080/08964289.2014.93763.0.

• Rueda, S., Lawd, S., and Rourkea, S.B. (2014). Psychosocial, mental health and behavioral issues of aging with HIV. Current Opinion HIV AIDS, 9:325–331. DOI:10.1097/COH.0000000000000071.

Contact

Leo RennieSenior Legislative & Federal Affairs OfficerPublic Interest Government Relations OfficeAmerican Psychological Association750 First Street Washington, DC 20002lrennie@apa.org