AIDS has been permanently etched in our consciousness. It was not long ago
that we faced a sudden avalanche of rare conditions and diseases that signaled
the arrival of this mysterious and devastating illness. Anxious, puzzled, and
unprepared, many physicians, including psychiatrists, were reluctant to
embrace this mounting clinical challenge. Those who did faced a roller coaster
of emotions, fears, frustrations, failings, and triumphs.
While training medical students last fall, members of the APA Committee on
AIDS and the American Psychiatric Institute for Research and Education's
Steering Committee on HIV Psychiatry offered candid, often emotional, accounts
of their personal and professional HIV experiences, some spanning decades.
Their stories revealed the tenacity and optimism that continue to drive
activities of the Office of HIV Psychiatry. Students were moved and inspired
by the broad experience and dedication of these members, who also serve as
their mentors for a new APA minority fellowship program in HIV psychiatry.
Last September, the Office of HIV Psychiatry coordinated its first
fellowship program matching mentors at seven sites with 10 medical students
whose primary interests include psychiatry, HIV/AIDS, substance abuse, and
ethnic minority health.
The program was designed to foster strong mentor relationships while
offering well-supervised clinical experiences, comprehensive HIV training,
online case discussions, and ongoing mentor consultations. Ten new students
will be selected for the second group of fellowships in September 2005.
Applications are now being accepted.
Residents are also at the forefront of HIV training efforts. First,
real-time, distance learning has been incorporated into existing education and
training programs, thus offering obvious advantages to residency training. The
Office of HIV Psychiatry has piloted the program at four sites and received
positive feedback. Of course, technical constraints and problems exist,
limiting its use and possibilities. The challenges posed, however, are
countered by opportunities to reach a wider audience, expand opportunities in
underserved areas, involve expert faculty who might otherwise be unavailable,
and provide a cost-effective alternative in resident education.
Second, grand rounds and case discussions continue to link our AIDS-network
members with training programs around the country. Requests for on-site HIV
residency trainings have increased sixfold since last year at this time. In
January nearly 40 requests were received for HIV training for the 2005-06
academic year. This increase in demand is evidence of a need for not only
continuing education in HIV psychiatry, but also for the expansion of our
current training capacity.
Meeting this demand will require an increased number of experienced faculty
and preceptors to lead and facilitate this process. Building the needed
capacity will require identifying and supporting new trainers, developing and
presenting workshops for basic and advanced HIV education, and expanding
technical support. The Office of HIV Psychiatry will work to achieve these
goals by collaborating with allied programs, seeking outside funding for new
projects, and working within existing contracts and grants.
One such contract, awarded in September 2004 by the Center for Mental
Health Services (CMHS), renewed funding for five years for training
psychiatrists and residents, providing technical support to APA's HIV network,
updating curriculum, expanding distance learning, and evaluating current HIV
I want to express a special note of thanks to Dr. Melvyn Haas, who was the
leading proponent of HIV activities at CMHS and principal author of many of
the HIV-related contracts APA has received. Dr. Haas served several years as
the associate director for medical affairs and the CMHS AIDS coordinator until
his retirement last December. His commitment to HIV psychiatry, unending
support of APA, and compassion as a clinician make him an asset to the
In addition to its existing projects, the Office of HIV Psychiatry hopes to
secure funds to create innovative Internet-based education programs, train
residents to serve as HIV trainers, initiate computer-based consultations, and
adapt current clinical tools for PDAs and pocket PCs. It would like to expand
efforts in rural and underserved areas inside and outside the United States.
When the Office of HIV Psychiatry was first established, the United States was
a major site of the HIV epidemic. Today, AIDS is a global epidemic, with
worldwide mental health consequences.
Increasingly, the Office of HIV Psychiatry and members of our HIV/AIDS
committees are engaging in international collaborations. These projects
include adapting interventions for severely mentally ill people in Brazil and
China, collaborating with the World Health Organization on mental health
guidelines to treat HIV-infected patients in resource-poor countries, and
participating in international forums.
Also, the office is discussing with representatives from South Africa the
development of an e-mail hotline to foster communication and case
consultation, link physicians here and abroad, and deliver HIV information to
The global epidemic shows no signs of abating. And two decades into the
epidemic, we face a second wave of infections in the United States.
For the Office of HIV Psychiatry, there exists a host of opportunities for
crafting and implementing programs that can have an impact on HIV/AIDS care
throughout the world. These opportunities make it important for APA members to
support our HIV activities, staff, and inspiring colleagues who work in the
fight against AIDS.
An application for the medical student fellowship in HIV psychiatry
is posted online at<www.psych.org/aids>.▪