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Agencies told to streamline care for HIV
NORWOOD - Public health officials Monday called on agencies that serve people with HIV/AIDS, mental illness and substance abuse problems to work together to streamline services and treatment.
Many agencies are serving the same people, said Gary Crum, director of the Northern Kentucky Health Department, and Cincinnati Health Commissioner Noble Maseru.
Now, it's time for all the parties involved to come up with a strategy to ensure clients get quality care for all of their health issues, they said.
Monday's meeting included executives from more than 20 agencies serving substance abusers, the mentally ill and HIV-positive individuals. Future meetings are planned so health officials can hear from case managers and others who work one-on-one with clients and from consumers.
All of the agencies lack money and personnel, Crum said, but the issue of HIV prevalence among mentally ill and substance abusers is "screaming for" a unified approach.
About half of the HIV-positive clients served by the Northern Kentucky Health Department are homeless, mentally ill or substance abusers, Crum said. The HIV diagnosis, coupled with their other issues, creates a long-term crisis for those clients who have to navigate multiple agencies to get help, he said.
The overlap in HIV, mental illness and substance abuse is constant, said Bernard Young, who oversees HIV/AIDS services for the Cincinnati Health Department.
The issue of HIV among the mentally ill and substance abusers is important enough that the state of Ohio and federal health agencies are funding prevention and treatment services for those populations, said Charles Wallner, a consultant for the Greater Cincinnati AIDS Coalition.
HIV is transmitted mainly through unprotected sex or sharing needles during drug use.
Substance abusers and the mentally ill are at much greater risk for contracting HIV. Drug users might share needles, and both drug use and mental illness can impair judgment about sex.
Victoria Brooks, executive director of AIDS Volunteers of Cincinnati, said 30 to 40 percent of her agency's clients have mental health issues serious enough to require treatment. She estimated that 60 to 65 percent of her program's clients have substance abuse or addiction issues.
The program provides services for people with HIV and their loved ones. Coordinating treatment for mental health and substance abuse "has become a major focus of what we do," Brooks said. "We can't do one without the other."
People with mental health or addiction issues tend to be diagnosed with HIV later in the disease's development , which makes treatment more difficult, experts say.
It's also often more difficult for substance abusers and the mentally ill to stick to the complex treatment regimen for HIV infection. Drug interactions can be a problem, and some illicit drugs further suppress patients' immune systems.
Some HIV medications are so particular that missing even one dose a month will keep the drug from working properly, said Peter Grubbs, director of the Infectious Disease Clinic at University Hospital.
CDC right: Need to simplify process of offering an HIV test
The Birmingham News
When my family and I moved to Birmingham in 1994, I was pleased to see a "pro-testing" attitude in the Alabama Department of Public Health, encouraging everyone to be tested for HIV.
The year 2006 is more than 20 years after the HIV test was licensed in 1985. At that time, we had no effective anti-retroviral drugs to restore the integrity of the devastated immune system of an AIDS patient. Today, we can use modern treatments to save lives in the United States and even, as the University of Alabama at Birmingham team is doing, in Zambia, as documented by News staff writer Dave Parks.
The Centers for Disease Control is correct in advising simplification of the process of offering an HIV test (front-page article, Sept. 22). Let's take away barriers to learning one's infection status. The therapy available and the prevention possible after knowing that status make this an important public health tool.
Sten H. Vermund, M.D., Ph.D.
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